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Seborrhoeic dermatitis

Published by Bupa's health information team, August 2008.

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 causing patches of inflamed skin on areas of the face, scalp and body.

• About seborrhoeic dermatitis
• Symptoms of seborrhoeic dermatitis
• Complications of seborrhoeic dermatitis
• Causes of seborrhoeic dermatitis
• Diagnosis of seborrhoeic dermatitis
• Treatment of seborrhoeic dermatitis
• Prevention of seborrhoeic dermatitis
• Questions and answers
• Related topics
• Sources

About seborrhoeic dermatitis

Seborrhoeic dermatitis causes inflammation in areas of the skin that tend to be the most greasy or oily - such as the nose, forehead and scalp. When it affects the scalp, it can cause severe dandruff. It is a chronic condition (one that lasts for a long time), and tends to re-occur - you may get flare-ups of inflammation and periods when your symptoms subside.

The condition is harmless, but it may make you may feel self-conscious about the way your skin looks.

Seborrhoeic dermatitis is very common, affecting up to five in 100 adults at any one time. It most often affects adults aged 18 to 40 and is more common in men than women.

Babies under the age of eight months can also develop seborrhoeic dermatitis. It isn't usually serious or harmful to the baby, and normally goes away on its own within a few weeks. The condition is extremely rare in older children.

Symptoms of seborrhoeic dermatitis

Skin affected by seborrhoeic dermatitis is 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 the eyebrows and the nose
• ears - this may cause otitis externa (see related topics)
• chest and between your shoulder blades
• flexures - these are areas where the skin is folded and that may retain moisture, such as the armpits, under the breasts and in the groin

The rash may be itchy or sore. You may notice that your symptoms get better in summer and worse in winter.

In babies, the condition most commonly causes greasy, yellow, scaly patches on the scalp (known as 'cradle cap'). The patches do not usually itch and don't usually seem to bother the baby. Other areas may also be affected in babies, including the face, behind the ears and the flexures (skin folds). It can also develop in the nappy area and be mistaken for nappy rash.

Complications of seborrhoeic dermatitis

Skin affected by seborrhoeic dermatitis can sometimes become infected with bacteria, causing redness, oozing and crusting.

Causes of seborrhoeic dermatitis

It is not fully understood at present exactly what causes seborrhoeic dermatitis. However, it is 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.

Tiredness and stress can sometimes trigger a flare-up of the condition. You are also more likely to get it if you have Parkinson's disease or HIV/AIDS. The condition tends to be more severe if you have HIV/AIDS.

Diagnosis of seborrhoeic dermatitis

Your GP will usually be able to identify that you have seborrhoeic dermatitis, just from the look of 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 specialising in conditions affecting the skin).

Treatment of seborrhoeic dermatitis

Treatment for seborrhoeic dermatitis is aimed at removing the yeast that is associated with the condition.

Scalp seborrhoeic dermatitis

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

• antidandruff shampoo containing coal tar or pyrithione zinc - these are suitable for mild seborrhoeic dermatitis and you can buy them from a shop without a prescription
• medicated, antifungal shampoo (containing ketoconazole or selenium sulphide) - these are used for moderate or severe seborrhoeic dermatitis; you can buy them from a shop, or they can be prescribed by your GP
• corticosteroid gel or lotion - these can be applied to your scalp and can be used for more severe inflammation, itching and flaking; they can only be used for short periods, or under medical supervision

Seborrhoeic dermatitis on the face and body

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

• a cream containing an antifungal agent called ketoconazole
• a corticosteroid cream - your GP may recommend a preparation combining a corticosteroid with an anti-fungal agent
• antibiotics, if you have developed a bacterial infection
• tablets of an antifungal medicine called itraconazole - your GP may occasionally prescribe this if your rash is very widespread and isn't helped by other treatments

Seborrhoeic dermatitis in babies

Your GP will probably advise you to wash your baby's scalp daily with baby shampoo and loosen the scales with soft brushing. Baby oil can also be used to soften the scales before brushing off and washing. If your baby's condition is harder to get rid of, your GP may prescribe a medicated shampoo or cream, containing ketoconazole.

Prevention of seborrhoeic dermatitis

If your seborrhoeic dermatitis keeps coming back, your GP may advise you to continue using an antifungal cream/shampoo once or twice a week to stop the condition from coming back.

Washing daily with soap and water will also help to reduce the chance of the condition coming back.

Related topics

• Eczema
• Psoriasis

Sources

• Seborrhoeic dermatitis. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 3 July 2008
• Seborrhoeic dermatitis. British Association of Dermatologists. www.bad.org.uk, accessed 3 July 2008
• Joint Formulary Committee, British National Formulary. 54th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007:611, 626
• Fitzpatrick TB, Johnson RA, Wolff K, et al. Color Atlas and Synopsis of Clinical Dermatology - common and serious diseases. 3rd ed. New York: McGraw-Hill, 1997:414

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Mike Ardern-Jones, BSc, MBBS, MRCP, DPhil, Consultant Dermatologist, Southampton University NHS Trust and Spire Southampton Hospital, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008.