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Seborrheic dermatitis on the face

Seborrheic (seb-o-REE-ik ) dermatitis is a common skin disorder that mainly affects the scalp, causing scaly, itchy, red skin and stubborn dandruff. For infants, seborrheic dermatitis of the scalp is known as cradle cap. Seborrheic dermatitis can also affect the face, upper chest, back and other oily areas of the body.

Seborrheic dermatitis isn't harmful, but it can be uncomfortable and unsightly. You may be able to treat seborrheic dermatitis yourself by recognizing its signs and symptoms and by using a combination of self-care steps and over-the-counter (nonprescription) medications.

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Seborrheic dermatitis on the scalp

Common signs and symptoms of seborrheic dermatitis include:

• Patchy scaling or thick crusts on the scalp
• Yellow or white scales that may attach to the hair shaft
• Red, greasy skin covered with flaky white or yellow scales
• Itching or soreness
• Skin flakes or dandruff

Seborrheic dermatitis predominately affects the scalp, but it can occur between folds of skin and on skin rich in oil glands. It can occur in and between your eyebrows, on the sides of your nose and behind your ears, over your breastbone, in your groin area, and sometimes in your armpits. You may experience periods when your signs and symptoms improve alternating with times when they worsen.

In infants, seborrheic dermatitis of the scalp is known as cradle cap. The patches may be thick, yellow, crusty or greasy. In most cases, the condition isn't itchy for infants like it is for older children or adults.

When to see a doctor
See your doctor if:

• You're so uncomfortable that you're losing sleep or are distracted from your daily routines
• Your skin is painful
• You suspect your skin is infected
• You've tried self-care steps without success

Though the exact cause of seborrheic dermatitis isn't known, several contributing factors seem to play a role, including:

• A yeast (fungus) called malassezia that grows in the oily secretion found on the skin (sebum) along with bacteria — antifungal treatments, such as ketoconazole (Nizoral), are often effective, supporting the idea that yeast is a contributing factor
• Stress and fatigue
• Change of season — outbreaks are usually worse in the winter
• Neurological conditions — seborrheic dermatitis may also occur more frequently in people who have certain neurological conditions, such as Parkinson's disease
• HIV/AIDS — people with HIV/AIDS have an increased risk of seborrheic dermatitis

You'll probably first visit your family doctor or a general practitioner. However, in some cases, you may be referred to a doctor who specializes in skin disorders (dermatologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time may help you make the most of your time together. For seborrheic dermatitis, some basic questions you might want to ask include:

• What's the most likely cause of my symptoms?
• What treatments are available, and which do you recommend?
• Are there any side effects from treatment?
• How long does treatment take to clear up this condition?
• Will the treatment need to be repeated and if so, how often?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment if you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• How often do you use treatments?
• What, if anything, appears to worsen your symptoms?

What you can do in the meantime
An over-the-counter antifungal medication or anti-itch cream can be helpful. If your scalp is affected, an over-the-counter antifungal shampoo may ease your symptoms. Try not to scratch the affected area, because if you open the skin through scratching, you increase your risk of infection.

Your doctor may diagnose seborrheic dermatitis by:

• Physical examination — talking to you about your symptoms and examining your skin and scalp
• Skin biopsy or other tests — which are sometimes necessary to confirm the diagnosis and to rule out other types of dermatitis

Conditions that are similar to seborrheic dermatitis include:

• Atopic dermatitis. This form of dermatitis is a chronic condition that causes itchy, inflamed skin. Most often, it occurs in the folds of the elbows, on the backs of the knees or on the front of the neck. It tends to flare periodically and then subside for a time, even up to several years.
• Psoriasis. A skin disorder characterized by dry, red skin covered with silvery scales. Like seborrheic dermatitis, psoriasis can affect the scalp and cause flaky dandruff. Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas of the body.
• Ringworm of the scalp (tinea capitis). Ringworm of the scalp is a type of fungal infection that is most common in toddlers and school-age children. It causes red, itchy, bald-looking patches on the scalp.

There's no treatment that's guaranteed to stop seborrheic dermatitis forever, but treatments can control its signs and symptoms. Treatment depends on your skin type, the severity of your condition and where it appears on your body.

Seborrheic dermatitis of the scalp
Medicated shampoos are the first step in treating seborrheic dermatitis of the scalp. Choose an over-the-counter shampoo that contains one of the following ingredients:

• Ketoconazole
• Ciclopirox
• Tar
• Pyrithione zinc
• Selenium sulfide
• Salicylic acid

Try using the shampoo daily until your symptoms are controlled; then cut back to two or three times a week. If one type of shampoo works for a time and then seems to lose its effectiveness, try alternating between two types of dandruff shampoos. Leave the shampoo on for three to five minutes — this allows the ingredients time to work.

If you've shampooed faithfully for several weeks and you're still experiencing an itchy, flaky scalp, talk to your doctor or dermatologist. You may need a prescription-strength shampoo or more aggressive treatment with a steroid lotion.

Seborrheic dermatitis on the face and body
Treatments for nonscalp seborrheic dermatitis aim to reduce inflammation and the buildup of scaling on the skin. Over-the-counter (nonprescription) antifungal or anti-itch creams, along with other self-care measures, may help control your symptoms.

If these measures don't help, your doctor may prescribe topical corticosteroids, antifungal medications or a combination of the two to treat stubborn patches. A common course of treatment includes a daily regimen of ketoconazole (Nizoral) and desonide (Desowen) applied to your skin. Prescription oral medication, such as terbinafine (Lamisil), may be an option if the condition affects a large portion of your body.

A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affects the immune system. These medications have anti-inflammatory and mild antifungal properties and are effective in treating seborrheic dermatitis. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods of time, the Food and Drug Administration (FDA) recommends that Elidel and Protopic be used only after other treatments have failed, or if someone can't tolerate other treatments. Additionally, the FDA advises against long-term use of these medications.

The following over-the-counter treatments and self-care tips can help you control and manage seborrheic dermatitis.

• Shampoo daily. Use an anti-dandruff shampoo that contains selenium sulfide, tar, pyrithione zinc, salicylic acid, ciclopirox or ketoconazole as the active ingredient. If you don't see results, try a shampoo with a different active ingredient.
• Use an over-the-counter antifungal cream. Daily application of nonprescription clotrimazole (Lotrimin) may be helpful.
• Apply an anti-itch cream or lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch.
• Avoid harsh soaps and detergents. Be sure to rinse the soap completely off your body.
• Wear smooth-textured cotton clothing. This will help you avoid irritation.
• Shave off your beard or mustache. Seborrheic dermatitis can be worse under mustaches and beards. If this is the case for you, shaving might ease your symptoms.
• Avoid scratching whenever possible. Cover the itchy area with a dressing, if you can't keep from scratching it. Trim nails and wear gloves at night.

Cradle cap
Cradle cap usually clears up on its own within a few months. In the meantime, wash your baby's hair once a day with mild baby shampoo. Loosen the scales with a small, soft-bristled brush before rinsing off the shampoo.

If the scales don't loosen easily, rub a few drops of mineral oil or olive oil onto your baby's scalp. Let the oil soak into the scales for a few minutes, and then brush and shampoo your baby's hair as usual. If you leave the oil in your baby's hair, it may allow more scales to accumulate on your baby's scalp.

If cradle cap persists or seems severe, your doctor may suggest a medicated (antifungal) shampoo, lotion or other treatment.

Tea tree oil was found to be more effective against seborrheic dermatitis of the scalp than a placebo in one study. But, no one's symptoms went away completely, so tea tree oil may not be as effective as other therapies.