Bruce P.Robinson, MD

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin disorder that can be easily treated. This condition is a red, scaly, itchy rash most commonly seen on the scalp, sides of the nose, eyebrows, eyelids, skin behind the ears, and middle of the chest. Other areas, such as the navel (belly button), buttocks, skin folds under the arms, auxillary regions, breasts, and groin, may also be involved.

Diagnosis

Your doctor will likely be able to determine whether you have seborrheic dermatitis by examining your skin. He or she may scrape off skin cells for examination (biopsy) to rule out conditions with symptoms similar to seborrheic dermatitis, including:

  • Psoriasis. This disorder also causes dandruff and red skin covered with flakes and scales. With psoriasis, usually you'll have more scales, and they'll be silvery white.
  • Atopic dermatitis (eczema). This skin reaction causes itchy, inflamed skin in the folds of the elbows, on the backs of the knees or on the front of the neck. It often recurs.
  • Tinea versicolor. This rash appears on the trunk but usually isn't red like seborrheic dermatitis patches.
  • Rosacea. This condition usually occurs on the face and has very little scaliness.

Are Dandruff, Seborrhea and Seborrheic Dermatitis the same?

Dandruff appears as scaling on the scalp without redness. Seborrhea is excessive oiliness of the skin, especially of the scalp and face, without redness or scaling. Patients with Seborrhea may later develop Seborrheic Dermatitis. Seborrheic Dermatitis has both redness and scaling.

Who gets Seborrheic Dermatitis?

This condition is most common in three age groups - infancy, when it's called cradle cap, middle age, and the elderly. Cradle cap usually clears without treatment by age 8 to 12 months. In some infants, Seborrheic Dermatitis may develop only in the diaper area where it could be confused with other forms of diaper rash. When Seborrheic Dermatitis develops at other ages it can come and go. Seborrheic Dermatitis may be seasonally aggravated particularly in northern climates; it is common in people with oily skin or hair, and may be seen with acne or psoriasis. A yeast-like organism may be involved in causing Seborrheic Dermatitis.

How long does this disease last?

Seborrheic Dermatitis may get better on its own, but with regular treatments, the condition improves quickly.

Can it be prevented or cured?

There is no way to prevent or cure Seborrheic Dermatitis. However, it can be controlled with treatment.

Treatment

Medicated shampoos, creams and lotions are the main treatments for seborrheic dermatitis. Your doctor will likely recommend you try home remedies, such as over-the-counter dandruff shampoos, before considering prescription remedies. If home remedies don't help, talk with your doctor about trying these treatments.

  • Creams, shampoos or ointments that control inflammation. Prescription-strength hydrocortisone, fluocinolone (Capex, Synalar), clobetasol (Clobex, Cormax) and desonide (Desowen, Desonate) are corticosteroids you apply to the scalp or other affected area. They are effective and easy to use, but should be used sparingly. If used for many weeks or months without a break, they can cause side effects, such as thinning skin or skin showing streaks or lines.Creams or lotions containing the calcineurin inhibitors tacrolimus (Protopic) and pimecrolimus (Elidel) may be effective and have fewer side effects than corticosteroids do. But they are not first-choice treatments because the Food and Drug Administration has concerns about a possible association with cancer. In addition, tacrolimus and pimecrolimus cost more than mild corticosteroid medications.
  • Antifungal gels, creams or shampoos alternated with another medication.Depending on the affected area and the severity of your symptoms, your doctor might prescribe a product with 2 percent ketoconazole (Nizoral) or 1 percent ciclopirox. Or you doctor may prescribe both products to be used alternately.
  • Antifungal medication you take as a pill. If your condition isn't improving with other treatments, your doctor may recommend an antifungal medication in pill form. These aren't a first choice for treatment because of possible side effects and drug interactions.
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