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Seborreic Dermatitis

Dermatology, Randy Jacobs, M.D.

Seborrheic Dermatitis - Q & A

Your itchy face and scalp may be due to seborrheic dermatitis. The name may make you wonder if it is a rare disease. Far from it, Seborrheic dermatitis AKA "seborrhea" is one of the five most common skin conditions, and can affect all ages. In this education sheet, we will try to answer some of the more common questions you may have about seborrhea. Routine therapy requires consistency, patience, time, and daily washing of the hair and face.

What is seborrheic dermatitis?

Seborrheic dermatitis is due to chronic, scaling, itching, and inflammation of the oil glands of the skin. It is most commonly found in people with excessive oiliness of the skin. Seborrhea is not contagious to others and is not a sign of cancer, but seborrheic dermatitis may be associated with or aggravated by emotional or physical stress. Literally, "seborrhea" means "freely flowing oil" and refers to "sebum," the oily secretory product of the sebaceous glands. The main function of the sebaceous glands is to manufacture and release sebum. This fatty, oily substance makes a thin film over the skin’s surface and prevents excess water loss from your skin. An early form of seborrheic dermatitis may be nothing more than simple dandruff. As the condition worsens, the sebaceous glands become more and more inflamed and more more oil (sebum) is produced. When dandruff becomes oily, it is then referred to as seborrhea. Seborrheic dermatitis is usually itchy. Tiny white scales form on your scalp, face, and ears and fall freely onto your shoulders. It is embarrassing to see these white scales on your dark-colored clothing. However, other forms of seborrheic dermatitis can be more severe. Instead of a simple localized scalp condition, scaly crust-like patches may form around your hairline, behind your ears, in the external ear canals, around your neck, or on your chest and back. These areas become inflamed, irritated, and uncomfortable.

What does seb dermatitis look like?

The most common symptom of seborrheic dermatitis is a pinkish-yellow patch of skin with a thin, greasy scale on top. These patches tend to form in groups in oily skin areas. Warm and moist skin areas (such as the creases of the neck, groin, armpits, and under women's breasts) may have larger moist, red, itchy, and shiny patches.

Which body parts are affected most?

Because seborrheic dermatitis is related to the activity of sebaceous glands, the areas affected most are those parts of the body which have the highest concentration of sebaceous glands: the scalp, face, neck, armpits, central chest, back, navel region, and groin.




What Are the more common ages ?

Yes. Sebaceous gland activity varies greatly with age. It is relatively high in the newborn until one year of age. As a result, many infants develop "cradle cap," a condition where the scalp is covered with greasy, yellow crusts, and the hair becomes matted. This type of seborrheic dermatitis is treated very much like adult seborrheic dermatitis, with special topical medications and shampoos. The skin of the diaper area of infants is also frequently affected by seborrheic dermatitis. However, sebaceous gland activity diminishes shortly after infancy and is inactive until puberty. Therefore, during childhood, seborrheic dermatitis is rarely seen. During puberty, however, the developing sex glands stimulate the sebaceous glands, which increase in size and become more active. Because seborrheic dermatitis is most likely to appear during periods of highest sebaceous gland activity, adolescents are prone to develop the condition. In most cases, adult levels of sebaceous gland activity are reached by age 25. Although the sebaceous gland remains active until old age in men, the gland activity decreases after menopause.

What causes seborrheic dermatitis?

The exact cause of seborrheic dermatitis is not known. Although seborrheic dermatitis is not contagious, it may be related to a yeast like organism which can be found on normal non-diseased skin in low numbers. With the increased scaling and retention of oil in seborrheic dermatitis, this yeast can also increase and can aggravate the inflammation. Foam, an anti-fungal foam, can decrease the numbers of yeast. Foam can also help. In addition to yeast, there are several other factors that seem to contribute:

  1. Heredity
    a. Familial tendencies
  2. Mental and physical stress
  3. Glandular activity
    a. Birth
    b. Puberty
  4. Certain nervous system disorders 
    a. Parkinsonism
    b. Strokes
    5. Obesity

Is It associated with skin disorders?

Yes. For example, patients who have psoriasis may have a tendency to have seborrheic dermatitis as well. Psoriasis, too, is a skin disorder characterized by scaly patches. However, unlike the moist oily scales you get with seborrheic dermatitis, psoriatic patches are fine, dry, and white. Another association: Patients with severe acne often have associated seborrheic dermatitis, because acne, too, is directly related to the over-secretion of sebum. With overactivity of the sebaceous glands, there is a good chance of acne pustules developing. Finally, many patients with seborrhea also suffer with rosacea, a form of adult acne. For the above reasons, patients with seborrhea may also need therapy for psoriasis, acne, or rosacea.



What is the treatment?

Seborrheic dermatitis is a condition that comes and goes. At times you may be surprised to find that you are practically symptom-free, while at other periods the condition may be very active and unsightly. The most important thing you can do to get rid of and prevent seborrhea is to wash your hair every day. This may be a problem for many people, but daily hair washing is important if seborrhea is to be controlled. There are some people who shampoo once per week or once per month and never get seborrhea. Unfortunately, if you’re the one who suffers with seborrhea, you will need to wash your hair every day. Do not expect your seborrhea to go away unless your hair is washed daily. In addition to frequent hair washing, perhaps the most annoying thing about seborrheic dermatitis is that it's a recurring condition. The bottom line: Though there is no known cure for seborrheic dermatitis at this time, but, a great deal can be done to control its symptoms. Most patients will need some form of long-term treatment. Generally, there are several measures you can take to obtain relief.

  1. If your doctor has prescribed a topical medication, carefully follow the instructions for its proper use. Topical cortisones or anti-fungals should be liberally applied to all oily areas. Avoid use of over-the-counter remedies that are not recommended.
  2. Bathe or shower daily. Wash your hair daily. Use a dandruff type shampoo when recommended by your doctor. Tar shampoos are best for dark haired patients. Zinc or selenium based shampoos are best for lighter haired patients. These may be purchased over the counter. Foam kills yeast organisms. Daily cleanliness is extremely important to remove the excess oil.
  3. Stay away from greasy, fatty foods. They may taste good but they also add unnecessary body pounds and can aggravate existing seborrhea.
  4. Alcoholic beverages should be restricted to a minimum.
  5. Try to maintain your ideal weight.
  6. Avoid oily cosmetics. You may use water based cosmetics.
  7. Keep your hands away from the affected areas. Scratching and rubbing the skin may cause infection. Report any signs of infection to your doctor so he or she can recommend treatment right away.
  8. Get plenty of rest, fresh air, and sunshine. Eat a balanced diet. Gentle, consistent care is needed to attain control.
  9. When applying medication to the scalp, part the hair a few strands at a time and rub the foam into your scalp.
  10. If there is oozing, with your seborrhea make a solution by dissolving 1 tablet of OTC Domeboro in 1 pint of warm water. Make wet compresses by dipping a clean cloth folded into several layers in the solution. Consistently apply the compresses to the involved areas of skin for 20 minutes four times daily.
  11. Loosen scales with fingernails while shampooing and scrub for at least ten minutes. Let the shampoo settle in your hair, and give the ingredients a chance to work. The shampoo you use is not as important as the way you scrub your scalp and your dedication to continue daily hair washing.

When can I expect results?

Most people find relief within one month of therapy with Foam. Please be patient and consistent with your medications and daily care. Most people who do not find relief are those who use their medications sporadically. Some who don’t find relief may have other associated skin problems complicating their condition. Finally, please note: Seborrhea almost always returns if you do not follow daily hair and face washing techniques.