Seborrheic dermatitis (SD) is inflammation of skin regions with a high density of sebaceous glands (eg, face, scalp, upper trunk). The cause is unknown, but Malassezia (formerly Pityrosporum) ovale, a normal skin organism, plays some role. SD occurs with increased frequency in patients with HIV and in those with certain neurologic disorders. SD causes occasional pruritus, dandruff, and yellow, greasy scaling along the hairline and on the face. Diagnosis is made by examination. Treatment is tar or other medicated shampoo and topical corticosteroids and antifungals.

Despite the name, the composition and flow of sebum are usually normal. The pathogenesis of SD is unclear, but its activity has been linked to the number of Malassezia yeasts present on the skin. The incidence and severity of disease seem to be affected by genetic factors, emotional or physical stress, and climate (usually worse in cold weather). SD may precede or be associated with psoriasis (called seborrhiasis). SD may be more common and more severe among patients with neurologic disorders (especially Parkinson disease) or HIV/AIDS. Very rarely, the dermatitis becomes generalized.

Symptoms and Signs

Symptoms develop gradually, and the dermatitis is usually apparent only as dry or greasy diffuse scaling of the scalp (dandruff) with variable pruritus. In severe disease, yellow-red scaling papules appear along the hairline, behind the ears, in the external auditory canals, on the eyebrows, in the axillae, on the bridge of the nose, in the nasolabial folds, and over the sternum. Marginal blepharitis with dry yellow crusts and conjunctival irritation may develop. SD does not cause hair loss.

Seborrheic Dermatitis

Newborns may develop SD with a thick, yellow, crusted scalp lesion (cradle cap); fissuring and yellow scaling behind the ears; red facial papules; and stubborn diaper rash. Older children and adults may develop thick, tenacious, scaly plaques on the scalp that may measure 1 to 2 cm in diameter.

Diagnosis

• Clinical evaluation

Diagnosis is made by physical examination. SD may occasionally be difficult to distinguish from other disorders, including psoriasis, atopic dermatitis or contact dermatitis, tinea, and rosacea.

Treatment

• Topical therapy

Adults: In adults, zinc pyrithione, seleniumSome Trade Names
SELSUN
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sulfide, sulfur and salicylic acidSome Trade Names
MEDIPLAST
PROPA PH
STRI-DEX
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, or tar shampoo should be used daily or every other day until dandruff is controlled and twice/wk thereafter. A corticosteroid lotion (eg, 0.01% fluocinolone acetonide solution, 0.025% triamcinoloneSome Trade Names
ARISTOCORT
KENACORT
KENALOG
NASACORT
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acetonide lotion) can be rubbed into the scalp or other hairy areas twice daily until scaling and redness are controlled. For SD of the postauricular areas, nasolabial folds, eyelid margins, and bridge of the nose, 1% hydrocortisoneSome Trade Names
CORTEF
SOLU-CORTEF
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cream is rubbed in 2 or 3 times daily, decreasing to once/day when SD is controlled; hydrocortisoneSome Trade Names
CORTEF
SOLU-CORTEF
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cream is the safest corticosteroid for the face because fluorinated corticosteroids may cause adverse effects (eg, telangiectasia, atrophy, perioral dermatitis). In some patients, 2% ketoconazoleSome Trade Names
NIZORAL
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cream or other topical imidazoles applied twice daily for 1 to 2 wk induce a remission that lasts for months. An imidazole or hydrocortisoneSome Trade Names
CORTEF
SOLU-CORTEF
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can be used as first-line therapy; if necessary, they can be used simultaneously. For eyelid margin seborrhea, a dilution of 1 part baby shampoo to 9 parts water is applied with a cotton swab.

Infants and children: In infants, a baby shampoo is used daily, and 1% hydrocortisoneSome Trade Names
CORTEF
SOLU-CORTEF
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cream is rubbed in twice daily. For thick lesions on the scalp of a young child, 2% salicylic acidSome Trade Names
MEDIPLAST
PROPA PH
STRI-DEX
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in olive oil or a corticosteroid gel is applied at bedtime to affected areas and rubbed in with a toothbrush. The scalp is shampooed daily until the thick scale is gone.

Key Points

• In adults, seborrheic dermatitis causes dandruff and sometimes scaling around the eyebrows, nose, and external ear, behind the ears, in the axilla, and on the sternum.
• Childhood SD can cause a thick, yellow, crusted scalp lesion (in newborns) or thick, scaly scalp plaques (older children).
• Treatments can include medicated shampoos and topical corticosteroids.

Last full review/revision October 2012 by Karen McKoy, MD, MPH

Content last modified November 2012