Last update: September, 2014
What is Seborrheic Dermatitis?
In simple terms, SD is a fairly common inflammatory skin
condition that affects between 3% to 5% of the overall population
. It's usually seen in areas of the skin that are rich in
sebaceous glands and sebum, including the scalp, face,
eyebrows, beard, nose, ears, neck, chest, navel, armpits, groin,
and perianal area. The usual signs of SD are areas of pink to
red inflamed skin with either dry or greasy flakes. In some
cases, the affected areas may also itch or burn. Try
this Yahoo image search to see
photos of SD. Here are Google image searches as well:
Researchers and physicians don't know the exact causes of SD.
One popular theory is that SD is associated with
yeast (malassezia genus) organisms that are common residents of
human skin ,,,. Since they need lipids to
survive , they tend to colonize areas of the skin that are
relatively rich with sebum. These fungi, according to some
studies, are believed to trigger an immuno-allergic type response in susceptible
individuals ,,,, while other studies report that the yeast metabolize
sebum and generate byproducts that are irritating to the skin ,,,.
Other factors suspected of possibly contributing to SD
* genetic predisposition 
* seborrhea (oily skin) fosters the growth of malassezia ,,,,
* environment, i.e., temperature, humidity 
* exposure to soaps, detergents and irritants that degrade the skin's
barrier function 
* androgens may play a role by increasing sebum output ,
* Parkinson's disease 
* other neurological conditions such as stroke, multiple sclerosis,
and paralysis 
* HIV infection ,,
* mood disorders such as depression ,
* alcoholism ,,
* stress 
* malnutrition ,,,,
* poor hygiene 
* seasons, i.e., winter, summer 
* work environment 
To sum it all up, it seems that there are a variety of possible factors
that might contribute to the development of seborrheic dermatitis.
Unfortunately, researchers don't have a full understanding
of these factors and their relationship to SD. In light of all the research
that has been conducted, however, it does appear that there are three
main factors that are believed to play a major role in SD: malassezia yeast, sebum, and
individual sensitivity to the yeast. ,
Seborrheic Dermatitis Treated?
There are many treatments available to manage seborrheic
dermatitis. The aim of most of them is to reduce the yeast
colonization of the skin and control inflammation and scaling.
While it's possible to control SD with a good treatment regimen,
it's generally considered a chronic condition that waxes and
wanes over time . Currently, no permanent cure exists. For some
people, one treatment alone may be enough to manage SD, while others
may require a combination of treatments to maintain
adequate control of the condition. This FAQS by no means covers
all the possible treatment options. If you have a treatment or regimen that
has worked for you and isn't listed, please forward the
information to me and I'll include it in the list.
That being said, let's look at the treatments. (Note: to denote whether an item is used topically or
orally, T indicates topically, O indicates orally, OTC (over the
counter) indicates that the item can be purchased without a
prescription in the U.S.).
Topical and Oral Corticosteroids
Topical and oral corticosteroids are
used to reduce the inflammation associated with SD. For facial
areas, low potency topical steroids creams, lotions, or ointments
may be used. On the scalp and other areas, low to mid potency
creams, ointments or lotions may be used as well.
Generally, physicians prefer to limit the use of topical steroids
to relatively short periods of time, especially on delicate areas
such as the face. This is done to avoid the possibility of side
effects such as thinning skin, steroid rosacea, and perioral
dermatitis. In some cases, the prolonged use of topical steroids
can also lead to a rebound effect. Upon withdrawal of the
steroid, the underlying condition can come back with a
Oral corticosteroids are also occasionally used for SD. However,
since they can have serious side effects, physicians usually
reserve their use for cases that are severe or resistant to other
treatments. Like topical steroids, oral corticosteroids can also
lead to a rebound worsening of SD in some cases. Because of these
potential side effects, topical and oral corticosteroids should
be administered under the care of an experienced physician or
Some of the more common items prescribed for SD in this category
are listed here by their generic names:
0.5% to 2.5% hydrocortisone (T, OTC)
betamethasone valerate (T)
dexamethasone (T, O,)
fluocinolone acetonide (T)
fluticasone propionate (T)
hydrocortisone valerate (T)
Topical and Oral Antifungals
Topical and oral anti-fungals are
used to reduce the skin colonization by the malassezia yeast. In
doing so, SD often improves since fewer yeast are available to
trigger an inflammatory response. While the number of yeast on
skin can be reduced, completely and permanently eradicating them
is considered to be difficult, if not impossible . As such, upon
stopping anti-fungal treatment, the yeast often start to
re-colonize the skin and SD symptoms may resurface. Physicians
and pharmacists often try to address this by advising patients to
continue using anti-fungal treatments for maintenance purposes
even after symptoms clear.
An added benefit of some anti-fungal agents is that they may also
have some anti-inflammatory properties . And, unlike topical
steroids, topical anti-fungals can be used for prolonged
periods without causing skin thinning . They can be applied in creams,
lotions, foams, ointments, powders, gels, or shampoos for body,
facial, and scalp use.
In some cases, oral anti-fungals may also be used. However, many
of the oral anti-fungal agents can have serious side effects. As
such, physicians may limit their use to SD that is either severe
or resistant to other treatments.
Here's some of the more common anti-fungal agents available listed
by their generic names:
benzoyl peroxide (T, OTC)
chloroxine (T, OTC)
clotrimazole (T, OTC)
coal tar (T, OTC)
fluconazole (T, O)
itraconazol (T, O)
ketoconazole (T, O)
LCD (liquor carbonis detergens -- coal tar solution)(T, OTC)
lithium succinate (T)
miconazole (T, OTC)
piroctona olamina (T, OTC)
povidone iodine (T, OTC)
propylene glycol (T, OTC)
terbinafine (T - OTC, O)
selenium sulfide (T, OTC)
sulfur (T, OTC)
tea tree oil (T, OTC)
triclosan (T, OTC)
undecylenic acid (T, OTC)
vinegar + boric acid (T, OTC)
zinc pyrithione (T, OTC)
De-scaling Agents (keratolytics)
De-scaling agents (keratolytics) are
used to address the flaky aspect of SD. This serves both a
cosmetic and a practical purpose. Removing scale helps to return
skin affected by SD to a more normal appearance. At the same time,
scale removal may give topical treatments a better chance of
reaching the underlying skin areas. Some of these agents work by
decreasing the bond between the dead skin cells and the skin's
outermost layer. Other agents may actually reduce the rate at
which skin cells turnover, which in turn reduces flakiness.
These are the most common agents in this class used for SD. Again,
they are listed by their generic names:
carbamide (T, OTC)
coal tar (T, OTC)
salicylic acid (T, OTC)
urea (T, OTC)
zinc pyrithione (T, OTC)
Topical immunomodulators are a
relatively new class of treatment agents that are proving to be
useful for controlling SD. As their name suggests, these
medicines modulate the local immune factors that are involved in
the SD inflammation process. Available in creams and ointments,
their primary benefit is that they can reduce and control
inflammation without the side effects of topical steroids. And,
they're also safe to use on delicate skin areas like the face and
can be used for prolonged periods. The commonly prescribed agents
in this class include:
pimecrolimus (Elidel) (T)
tacrolimus (Protopic) (T)
Miscellaneous treatments include
items that don't fall neatly into any of the above categories.
Due to the variety in this category, each item will be discussed
Back to top
alpha lipoic acid (T, O, OTC)--
anecdotal claims suggest that alpha lipoic acid 5% applied
topically reduces skin inflammation. Some claims have been made
that it has provided some benefit in reducing inflammation in
rosacea, and thus might also work for SD. 
aloe vera (T, OTC)-- there are anecdotal
reports that it may be used to relieve the itching and
inflammation associated with SD. Two studies have also concluded that
it has anti-fungal activity ,. It's available in many forms
including creams, gels, lotions, oils, and shampoos. It's
probably best to look for products like pure aloe vera juice or
gels that contain fewer ingredients that might bother sensitive
anti-androgens (O)-- anti-androgens such
as spironolactone, cyproterone acetate (androcur), and various
oral birth control medicines may be useful for women when oily
skin is believed to contribute to SD , since they can
reduce sebum output. These agents should not be used in men due to
potential feminizing side effects such as loss of libido and
gyneocomastia (breast growth). They should only be used under the
care of a physician.
antihistamines (O, T, OTC)-- these are
used primarily to reduce itching, if present. However, research
studies suggest that some antihistamines have anti-inflammatory
properties ,, and thus, might be beneficial in inflammatory
skin disorders such as SD. They're also used to good effect in other
inflammatory and allergic skin disorders such as atopic
dermatitis and urticaria (hives). There are many different
antihistamines available both over the counter and via a
physician's prescription. Newer antihistamines such as Claritin
(loratadine), Zrytec (cetirizine), and Allegra (fexofenadine) are
supposed to cause less drowsiness than older antihistamines such
as Benadryl (diphenhydramine), Chlor-trimeton (chlorpheniramine),
aspirin (O, T, OTC)-- oral low dose
aspirin (80mg daily) is sometimes used to reduce inflammation
associated with rosacea ,. As such, it might also be useful for
reducing the inflammation that accompanies SD. Discuss this with
your doctor if you have any other medical conditions that might
be aggravated by aspirin, such as asthma, hives, ulcer, etc.
b-complex vitamins (O, OTC)-- some
sources indicate a deficiency of B vitamins might be associated with
SD ,,,. In cases of SD associated with true B vitamin deficiency,
replenishing the body's depleted stores via supplements or vitamin rich foods
should clear the condition rather quickly .
blue light (T, OTC)-- some research and
suggests that blue light (420nm) therapy seems to improve SD by
killing off the malassezia yeast on the skin ,. These
treatments can be administered at home or at a health-care facility.
Several vendors of blue light systems and bulbs can be found via
the internet. It appears that blue light night also be used in conjunction with
red light (660nm) which reportedly has anti-inflammatory properties.
borage oil (T, O, OTC)-- one study reports
that topical and oral use of this oil rich in GLA (gamma lineolic acid)
may improve skin conditions like eczema and SD . It's believed that
these fatty acids down-regulate the production of inflammatory substances within
boswellia extract (O, OTC)-- this herbal
extract has been shown to have anti-inflammatory properties when
taken orally ,. As such, some individuals affected by SD have proposed that
it might be useful for reducing the inflammatory aspect of SD.
cod liver oil (O, T, OTC)-- oral use of
this oil rich in DHA (docosahexaenoic acid), EPA
(eicosapentaenoic acid), and vitamins A & D, may have
anti-inflammatory effects within the body. Consequently, it might
prove useful in skin conditions like SD at a dose of one to two
tablespoons daily. Economical generic versions are usually
available in pharmacies or via the internet. Orange or other
flavored versions are also available to cover the fishy taste.
crude honey (T, OTC)--some researchers
have suggested that crude honey (not filtered or processed) in a
ratio of 9 parts honey to one part warm water has a beneficial
effect on SD ,. The honey was applied for three hours (then rinsed
off) daily for one month. Supposedly, this resulted in a marked
improvement. PS -- if you try this, steer clear of bees and
hungry bears :)
cyclosporine (O)-- this immunomodulating
drug is occasionally used orally for severe or generalized cases
of SD . However, it can have serious side effects and requires
close supervision by an experienced physician.
evening primrose oil (T, O, OTC)-- some
studies and anecdotal reports suggest that topical and oral use
of this oil rich in GLA (gamma lineolic acid) may improve skin
conditions like eczema and SD . It's believed that these fatty
acids down-regulate the production of inflammatory substances
within the body.
flax seed oil (T, O, OTC)-- some studies
and anecdotal reports suggest that oral use of this oil rich in
omega-3 fatty acids may improve skin conditions like eczema and
SD ,. It's believed that these fatty acids down-regulate the
production of inflammatory substances within the body.
fish oil (T, O, OTC)-- some studies
report that oral use of this oil rich in DHA (docosahexaenoic
acid) and EPA (eicosapentaenoic acid) may have anti-inflammatory
effects within the body. Some anecdotal reports have mentioned
that it might prove useful in skin conditions like SD.
glycerin (T, OTC)-- a recent study
suggests that glycerin may be beneficial for skin conditions
such as SD . It was reported that topical application
may help normalize the rate at which skin cells turnover. Besides
that, glycerin has long been used as a skin humectant. Some
anecdotal reports state that one part glycerin to two parts water
seems to control flaking and dryness without resorting to oil
based moisturizers. Gylcerin can be found on the shelves in many
green tea (T, O, OTC) -- Green tea is
reported to have anti-oxidant and anti-androgenic properties . As
such, anecdotal reports have implied that green tea may have some benefit for SD
when used either topically, orally, or both.
isotretinoin (accutane) (O)-- this
powerful drug, with anti-inflammatory and anti-seborrheic
properties, is primarily used to treat cystic or severe acne.
However, on occasion it's used for severe or stubborn cases of
SD, or when SD is accompanied by rosacea . When used for SD,
a low dose regimen (2.5 mg to 5 mg per day) might be the way to go
since one study has found that this dosage scheme greatly reduces side
effects, yet sebum output is still reduced by up to 65% .
Interestingly, one physician reported two cases of SD that were
actually worsened by accutane . However, no information was provided
regarding the dosages used in those cases. Please note: any use of
accutane requires close supervision by an experienced physician, especially
for women of child bearing age since it can cause severe birth defects.
low carb diet -- some anecdotal reports claim that maintaining a
low carb diet may improve SD by stabilizing blood sugar levels,
hormones, and enzymes, etc. The end result is claimed to be
better overall health , better immune function,
down-regulation of inflammatory processes, etc.. There is much
debate over these theories and experts offer no clear cut answers
one way or the other.
low yeast diet -- some sources suggest that adhering to a low
yeast diet may be helpful for SD. It's proposed that folks with SD
may also be sensitive to yeasts such as baker's and brewer's yeast,
which are commonly found in many foods. Low yeast diets commonly
recommend avoiding baked foods that use yeast, over-ripe fruit,
fermented foods, alcoholic beverages, fungi (mushrooms),
B vitamins prepared from yeast sources, etc. By avoiding these foods,
it's proposed that the overall allergen load on the body is
reduced for individuals sensitive to yeasts. This in turn, so the
theory goes, may lead to an improvement in SD. There's plenty of
information about low yeast diets on the web. Try a Google search
for "low yeast diet" or "foods that contain yeast". Here's one such diet suggestion
Dr. Andrew Lockie -- Yeast and mould free diet.
metronidazole (T)-- this antibiotic is
used topically primarily for its reported ability to reduce skin
inflammations. It's widely prescribed for rosacea and sometimes
SD as well.
narrow-band ultraviolet B light(T)-- some
researchers have found that this treatment improves SD . This form
of ultraviolet light therapy is usually administered in a health
care professional's office or hospital for several short
sessions. This treatment may be reserved for more severe or
olive leaf extract (O, T, OTC)-- One study reports
that this herbal extract has anti-fungal and anti-bacterial properties .
Perhaps, that might explain the anecdotal reports of some SD sufferers who
have claimed that using this natural extract topically or orally may improve SD.
probiotics (O, T, OTC)-- probiotics are
live microorganisms that are believed to provide health benefits
when they are part of the gastrointestinal flora environment.
One study suggested that some individuals with SD seem to have
unbalanced gastrointestinal tract flora . Consequently, some
anecdotal reports suggest that consumption of probiotics may improve
SD by re-balancing the intestinal flora to include more beneficial
organisms, which in turn might help to balance the immune system.
PUVA (psoralen plus ultraviolet A) (T,
O)-- this treatment involves taking oral psoralen, a drug
that increases the skin's photo-sensitivity, and then exposing
the skin to ultraviolet A light therapy. This treatment is often
used in psoriasis, but it is also used in SD on occasion .
sun exposure -- some individuals find that their SD improves with
light to moderate sun exposure. Yet, others claim that the sun
only worsens their SD. And, it's very interesting to note that one
group of scientists studied Swiss mountain guides and found that they
had higher rates of SD than the general population. They concluded that
the SD in these guides might have been related to a weakening of their
skin's immune system brought on by UV damage from the sun . Considering
that, avoiding excessive sun exposure seems like a good idea.
turmeric (O, OTC)-- this spice is
widely used in many parts of the world such as India. It contains
curcumin which has been found to have anti-inflammatory and
antioxidant properties ,. As a result, it may help reduce
inflammation in SD. It's usually very economical and available in
supermarkets or in Indian/Asian grocery stores. A few teaspoons
daily added to water should suffice. Some may find it has a
rather strong taste. Mixing it with fruit juices or other
flavoring agents may make it more pleasing to the palate.
vinegar (T, O, OTC)-- some anecdotal
reports suggest that vinegar applied topically, and in some
cases, orally consumed, can improve SD. It is believed to act as
an anti-fungal agent via its acidic ph properties. Supposedly,
the malassezia yeast don't thrive very well in acidic
environments. Applying vinegar topically is supposed to create a
more acidic skin environment which hinders the yeast's ability to
colonize the skin. It is also combined with 2% boric acid for
vitamin E (O, OTC)-- one team studied the
vitamin E status in individuals with SD and concluded that they had
lower levels of the vitamin in comparison with people without SD .
As such, it might be wise to ensure that you eat enough vitamin E
rich foods or take a supplement
zinc (dietary) (O, OTC)-- two groups of researchers
have suggested that low levels of zinc in the body might be associated
with SD ,. With that in mind, it might be beneficial to analyze your diet
to ensure that your body is getting enough zinc.
zinc oxide (T, OTC)-- this item has long
been used in cream or ointment bases for skin inflammations. One
of its most common applications is for diaper rash where it
probably has a beneficial effect by providing a protective film
on the skin. With SD, it may provide relief from flaking, itching
and irritation in a similar manner.
Seborrheic Dermatitis and Skin Care
Generally, the overall goal of skincare for SD is to gently
clean the skin while attempting to avoid further damage and
irritation. As a first step in that direction, one should try to
determine their skin type. Skin is commonly categorized as dry,
combination, or oily. Skin care routines for each category differ
in some respects.
For most skin, a mild soap or soap-less cleanser would
probably be a good start. For very sensitive skin, choosing
fragrance free and hypo-allergenic cleansers may offer the least
irritating solution. However, when the skin is very dry or during a
more severe flare of SD, it may be best to avoid cleansers and wash
with only water or two parts water mixed with one part glycerin. In all cases,
cool to lukewarm water should be used--not hot, as that has a tendency to
further aggravate and dry out already inflamed skin.
Dry skin should probably be washed once a day at most. After
washing, skin should be allowed to air dry or gently patted dry
with a clean towel. Some individuals with dry skin may find they
need or want to use a moisturizer following bathing. If you are
using a medicated cream or ointment such as Nizoral, Elidel,
etc., you may find that these items can replace the need for a
If you do decide to use a moisturizer, choose with it care for two
reasons. First, given the sensitive nature of skin affected with
SD, anything applied to the skin has the potential to create
further irritation. Second, products that contain oils should
probably be avoided since the malassezia yeast associated with SD
tend to thrive in oily skin environments. So, you'll probably
need to carefully look at the ingredients in moisturizers for
possible irritants and oily additives.
Combination skin is a bit different in that frequent washing
may keep the oily areas of the skin relatively clean, but the dry
areas of the skin will dry out even further. To avoid this, you
might find it helpful to only apply a cleanser to the oilier
areas of the skin and cleanse dry areas with only water. Then
rinse all areas with water and dry. If needed, a moisturizer may
be applied to the dry areas while avoiding the oiler skin zones
such as the nose and forehead.
Oily skin may need to be cleansed twice a day. However, the
advice with regard to mild cleansers and cool to lukewarm water
should still be followed. Often, there is a common misconception
that oily skin needs to be cleansed with strong cleansers and hot
water to remove excess oils. Yet, such a routine will likely lead
to a weakened skin mantle and increased susceptibility to
irritation. With oily skin, one should also avoid applying
moisturizers or oily topical products.
For males, SD can complicate shaving routines. Some men have
found that shaving with an electric razor is less irritating than
shaving with a razor blade. A helpful hint for using electric
razors is to apply corn starch to dry skin before shaving. This
tends to give a smoother, less irritating shave. If you prefer a
wet shave with a razor, choose your shaving products carefully
since skin affected by SD can be very sensitive to grooming
products. Check labels for potentially irritating ingredients
like dyes, perfumes, alcohol, menthol, euclyptus, etc. In the
USA, Edge Fragrance Free or Aveeno Sensitive Skin shave gels
are free of dyes and perfumes and may be a good choice for skin
affected by SD. In general, shaving gels or oils seem to reduce
irritation better than shaving cream.
If possible, use razors for no more than three or four shaves on
heavier beards, and, perhaps, four to seven times for lighter
beard growth. Try not to press down heavily on the razor while
shaving and avoid shaving against the grain of hair
growth. Always rinse skin well with cool water after shaving and
don't apply aftershave lotions or tonics which often contain
alcohol and perfumes that can further irritate SD. Pat skin dry
with a clean towel or let it air dry.
Since SD often affects the scalp, special routines may need to
be followed to keep the affected areas as healthy as possible.
One of the most common methods of treating SD on the scalp is via
medicated shampoos. Depending upon the situation, a physician or
pharmacist may recommend a particular medicated shampoo and
guidelines for usage. At times, this may include allowing the
shampoo to soak on the scalp for a short period before rinsing.
Initially, you may be instructed to use the medicated shampoo every
day or every other day until your condition stabilizes. Then, a less
frequent application schedule may be recommend for maintenance.
In addition to shampoos you may be required to use medicated lotions
that are applied for a period (sometimes overnight) before
or after washing. Your physician may also suggest that you wear a
disposable shower cap before retiring to bed to increase the effectiveness
of topical agents, and to help keep bed linens and clothing clean.
As a result of these treatment regimens, you might find it necessary to adjust
your hair care routines. Drying your hair
with a hair dryer and hot air, for example, may increase scalp
dryness and further irritate the areas affected by SD. Or, other
styling products or chemicals might be irritating as well. If you
suspect that your hair care products or usual routine might
interfere with your treatment program or vice versa, consult your
physician and pharmacist to be sure that your concerns are
Important note: When considering soaps,
cleansers, or topical treatments in general, remember that any
agent applied to the skin can lead to adverse events such as
irritation, itching, dryness, redness, etc. In such cases, it may
be difficult to determine whether the side effect is due to the
active ingredients or the topical vehicle used to deliver the
active ingredients. If you're concerned about a possible negative
reaction to a topical treatment, it might be wise to test the
treatment for a few days on a small spot of your inner arm. If no
reaction is noted within a few days, it's probably safe to apply
to other areas as directed by a physician or pharmacist. However,
in some instances, adverse events might only surface after using
an item topically for awhile. In any case, if you ever note that
your condition is worsening rather than improving, contact your
physician or pharmacist to discuss your
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A good Yahoo discussion and support group for SD. Contains useful
archives that group members can search.
Seb Derm and Rosacea are often companions. The Rosacea Blog is an excellent resource for timely information regarding rosacea primarily, with occasional seb derm related items as well.
A time honored medical reference that provides solid information
on a wide variety of illnesses and treatments.
The latest health-care breakthroughs are often reported here.
Skin and Connective Tissue Diseases
An interesting resource for skin diseases.
The indispensable Physician's Desk Reference to Herbs and
Nutrition. It provides detailed information about nutritional
issues supported by solid references.
Martindale's Health Science Guide
An excellent and very comprehensive source for medical
The very valuable Pubmed system. Here, you can search hundreds of
thousands of medical abstracts for free !
Dr. Mirkin provides a wide range of medical information. His
valuable archives can be searched for gems. All free !
Atlas of dermatology
A fairly good source of information about skin diseases. Some
photos as well.
This dermatology trade journal is a good place to find easy to
understand dermatology related news.
Another good source of information about skin diseases. Many
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