Seborrheic dermatitis

Seborrheic dermatitis is a common, chronic inflammatory skin disorder that primarily affects areas rich in sebaceous (oil) glands—most often the scalp, face (especially the eyebrows and sides of the nose), ears, eyelids, chest, and body folds. It presents with flaky white or yellowish scales, greasy patches, and variable redness or discoloration depending on skin tone. The condition is not contagious; in infants it is called “cradle cap,” and in older children and adults mild scalp involvement often manifests as dandruff. While symptoms may wax and wane over time, they can be effectively controlled with consistent care.

Key features, causes, and risk factors

Although the exact cause is multifactorial and not fully defined, seborrheic dermatitis is strongly associated with an inflammatory response to Malassezia yeast that normally resides on the skin, along with individual differences in sebum production and skin barrier function. Triggers that can provoke flares include stress, fatigue, cold or dry weather, and use of alcohol‑containing skin or hair products. The condition can be more severe or prevalent in certain situations, including neurologic disorders (such as Parkinson’s disease) and immunosuppression (including HIV infection). Importantly, it is not caused by poor hygiene and does not inherently lead to permanent hair loss, though scratching can shed hairs temporarily.

Clinical presentation and diagnosis

Adults typically notice persistent or recurring flakes on the scalp and beard/mustache areas, scaling and erythema (or dyschromia in darker skin tones) around the eyebrows, nasolabial folds, and ears, and sometimes involvement of the chest or body folds. Eyelid margins can be affected (blepharitis). In infants, cradle cap appears as thick, greasy scaling on the scalp and may extend to axillary and groin folds; it usually resolves by 6–12 months. Diagnosis is clinical, based on appearance and distribution; testing is rarely needed unless features suggest other conditions such as psoriasis, tinea, rosacea, or lupus.

Management and self‑care

Treatment aims to reduce scale, itch, and inflammation and to prevent relapses. For scalp disease, rotating medicated shampoos with active ingredients such as ketoconazole, selenium sulfide, zinc pyrithione, salicylic acid, coal tar, or ciclopirox is standard; letting the product sit on the scalp several minutes before rinsing improves efficacy. For facial and body involvement, topical antifungals (e.g., ketoconazole or ciclopirox) are commonly used. Short courses of low‑potency topical corticosteroids can quickly calm flares but should be limited to avoid side effects; steroid‑sparing options include topical calcineurin inhibitors in sensitive areas. In December 2023, the FDA approved roflumilast 0.3% foam (a PDE4 inhibitor) for patients 9 years and older, offering a once‑daily, steroid‑free option suitable for hair‑bearing areas. For widespread or refractory cases, dermatologists may consider oral antifungals or UVB phototherapy. Gentle cleansing, avoiding alcohol‑based products, regular beard/scalp hygiene, and stress management support long‑term control.

Importance and impact

Seborrheic dermatitis is highly prevalent across the lifespan, with a biphasic peak in infancy and again in adolescence/adulthood. While medically benign, its visibility on the face and scalp can carry meaningful quality‑of‑life burdens, including embarrassment, sleep disturbance from itch, and psychosocial stress—factors that can, in turn, exacerbate disease activity. Early recognition, patient education, and an individualized maintenance plan are therefore essential. With appropriate selection of antifungal agents, anti‑inflammatory therapies (including newer nonsteroidal options), and practical skincare, most people can keep symptoms well controlled and minimize relapses over time.

When to seek care

Seek medical attention if over‑the‑counter shampoos or creams fail to control symptoms, if the rash becomes painful, weepy, or extensively inflamed (suggesting secondary infection), or if there is significant eyelid involvement affecting vision. Individuals with risk factors such as neurologic disease or immunosuppression who develop unusually severe or recalcitrant disease should also consult a clinician for tailored therapy.

Sources

• Mayo Clinic. Seborrheic dermatitis: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/seborrheic-dermatitis/symptoms-causes/syc-20352710

• Mayo Clinic. Seborrheic dermatitis: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/seborrheic-dermatitis/diagnosis-treatment/drc-20352714

• American Academy of Dermatology (AAD). Seborrheic dermatitis: Overview. https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-overview/

• AAD. Seborrheic dermatitis: Diagnosis and treatment. https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-treatment

• MedlinePlus Medical Encyclopedia. Seborrheic dermatitis. https://medlineplus.gov/ency/article/000963.htm

• DermNet. Seborrhoeic dermatitis: Causes and treatment. https://dermnetnz.org/topics/seborrhoeic-dermatitis

• Cleveland Clinic. Seborrheic Dermatitis. https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis

• U.S. FDA approval news (press release): Zoryve (roflumilast) topical foam 0.3% for seborrheic dermatitis (Dec 15, 2023). https://www.globenewswire.com/news-release/2023/12/15/2797309/0/en/FDA-Approves-Arcutis-ZORYVE-roflumilast-Topical-Foam-0-3-for-the-Treatment-of-Seborrheic-Dermatitis-in-Individuals-Aged-9-Years-and-Older.html

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