Seborrhoeic dermatitis

Published by Bupa's Health Information Team, September 2010.

This factsheet is for people who have seborrhoeic dermatitis, or who would like information about it.

Seborrhoeic dermatitis (also called seborrhoeic eczema) is a common condition that causes patches of inflamed skin on areas of the face, scalp and body.

About seborrhoeic dermatitis

Seborrhoeic dermatitis causes inflammation of areas of your skin that tend to have hair growing from them and are more greasy or oily - such as your eyebrows, nose and scalp. It's a chronic condition (one that lasts for a long time). You may get flare-ups of inflammation and then periods of time when the inflammation calms down.

Seborrhoeic dermatitis is very common, affecting up to three in 100 adults at any one time. It most often affects adults aged 30 to 60 and is more common in men than in women.

Babies under three months can also develop seborrhoeic dermatitis, although it may have a slightly different appearance. The condition isn't usually serious or harmful to your baby, and normally goes away on its own in time. Seborrhoeic dermatitis is less common in older children.

Symptoms of seborrhoeic dermatitis

If you have seborrhoeic dermatitis, your skin will be very red with greasy looking white or yellowish-coloured scales. The outbreaks most commonly appear on your:

• scalp - this may just appear as scaling (dandruff) or as a very red and sore scalp
• face - especially around your eyebrows and the sides of your nose
• ears - this may cause otitis externa - inflammation of the skin in your external ear canal (the tube that leads into your ear)
• central chest and between your shoulder blades
• flexures - these are areas where your skin is folded and may retain moisture, such as your armpits, under your breasts and in your groin

Your skin may be slightly itchy but not usually sore.

If you have any of these symptoms, see your GP. You may notice that your symptoms get better in summer and worse in winter.

The condition may make you may feel self-conscious about the way your skin looks.

Causes of seborrhoeic dermatitis

The exact reasons why you may develop seborrhoeic dermatitis aren't fully understood at present. However, it's thought that a type of yeast called Malassezia may play a role in its development. Malassezia is present on the surface of everyone's skin, but people with seborrhoeic dermatitis seem to have more of it.

Usually, there is no underlying cause of seborrhoeic dermatitis but you're more likely to get the condition if you have Parkinson's disease or HIV/AIDS. The condition tends to be more severe if you have HIV/AIDS.

Your symptoms can sometimes be triggered by tiredness or stress.

Diagnosis of seborrhoeic dermatitis

Your GP will usually be able to diagnose seborrhoeic dermatitis just by looking at your skin. There are no specific tests for the condition. Seborrhoeic dermatitis on your scalp can look very similar to scalp psoriasis, and sometimes the two conditions can overlap.

Occasionally, if your diagnosis isn't clear, your condition is very widespread, or if it doesn't respond to the normal treatments outlined below, you may be referred to a dermatologist (a doctor who specialises in conditions affecting the skin).

Treatment of seborrhoeic dermatitis

Treatment for seborrhoeic dermatitis is aimed at reducing inflammation and reducing the yeast that is associated with the condition. Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.

Scalp seborrhoeic dermatitis

If you have scalp seborrhoeic dermatitis, your GP will probably recommend that you try one of the following treatments.

• Antidandruff shampoo containing coal tar or pyrithione zinc. These are suitable for mild seborrhoeic dermatitis and you can buy them without a prescription.
• Medicated, anti-yeast shampoo (containing ketoconazole or selenium sulphide). This is suitable for moderate or severe seborrhoeic dermatitis. You can buy these shampoos from a shop, or they can be prescribed by your GP. These products can irritate your skin so should generally only be used once or twice a week.
• Corticosteroid gels or lotions. Apply these to your scalp, especially if you have severe inflammation, itching and flaking; they can only be used for short periods, or under medical supervision.

Seborrhoeic dermatitis on your face and body

Your GP may prescribe the following treatments for seborrhoeic dermatitis on your face or body:

• a cream containing an anti-yeast agent called ketoconazole
• a corticosteroid cream - your GP may prescribe a preparation combining a corticosteroid with or without an anti-yeast agent

If these treatments don't work, you may be referred to a dermatologist to check the diagnosis. Your dermatologist may prescribe tablets of an antifungal medicine called itraconazole if your rash is very widespread and isn't helped by other treatments.

Special considerations

Seborrhoeic dermatitis in babies

Seborrhoeic dermatitis most commonly causes greasy, yellow, scaly patches on your baby's scalp (known as 'cradle cap'). The patches don't usually itch and won't usually seem to bother your baby. Seborrhoeic dermatitis may also affect other parts of your baby, including his or her face, behind his or her ears and in his or her flexures (skin folds). It can also develop in your baby's nappy area.

Your GP will probably advise you to wash your baby's scalp daily with baby shampoo and loosen the scales with soft brushing. You can also use baby oil to soften the scales before brushing them off and washing. The condition usually improves on its own, and as it doesn't usually bother babies, strong treatment isn't essential. If your baby's condition is more severe, your GP may prescribe a medicated shampoo or cream.

Prevention of seborrhoeic dermatitis

Anti-yeast treatments can't cure seborrhoeic dermatitis, but they can help you to control it. The condition may come back if you stop your treatment. If your seborrhoeic dermatitis keeps coming back, your GP may advise you to continue using a medicated cream or shampoo once or twice a week.

Washing daily with soap and water will also help to reduce your chance of the condition coming back. If soap irritates your skin, use an emollient soap substitute instead.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.