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Seborrheic Dermatitis

by Karen McKoy, MD, MPH

Seborrheic dermatitis is chronic inflammation that causes yellow, greasy scales to form on the scalp and face and occasionally on other areas.

The cause is unknown. Seborrheic dermatitis occurs most often in infants, usually within the first 3 months of life, and in those aged 30 to 70 years. The disorder is more common among men, often runs in families, and is worse in cold weather. A form of seborrheic dermatitis also occurs in as many as 85% of people with AIDS. Seborrheic dermatitis is also common in people with Parkinson disease.

Symptoms

Seborrheic dermatitis usually begins gradually, causing dry or greasy scaling of the scalp (dandruff), sometimes with itching but without hair loss. In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back. In infants younger than 1 month of age, seborrheic dermatitis may produce a thick, yellow, crusted scalp rash (cradle cap) and sometimes yellow scaling behind the ears and red pimples on the face. Frequently, a stubborn diaper rash accompanies the scalp rash. Older children and adults may develop a thick, tenacious, scaly scalp rash with large flakes of skin.

Treatment

In adults and older children, the scalp can be treated with a shampoo containing pyrithione zinc, selenium sulfide, salicylic acid and sulfur, or tar. The person usually uses the medicated shampoo daily or every other day until the dermatitis is controlled and then twice weekly. Ketoconazole cream (an antifungal drug) is often effective as well. Thick crusts and scales, if present, can be loosened with overnight application of corticosteroids or salicylic acid under a shower cap.

Often, treatment must be continued for many weeks. If the dermatitis returns after the treatment is discontinued, treatment can be restarted. Topical corticosteroids are also used on the head and other affected areas. On the face, only mild corticosteroids, such as 1% hydrocortisone, should be used. Even mild corticosteroids must be used cautiously, because long-term use can thin the skin and cause other problems.

In infants and young children who have a thick scaly rash on the scalp, 2% salicylic acid in olive oil or a corticosteroid gel can be rubbed gently into the rash with a soft toothbrush at bedtime. The scalp can also be shampooed daily with mild baby shampoo, and 1% hydrocortisone cream can be rubbed into the scalp.

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Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • NIZORAL
  • CORTEF, SOLU-CORTEF