Can You Scratch Off Seborrheic Dermatitis?

Seborrheic dermatitis causes red inflamed patches of skin.

Seborrheic dermatitis is a skin condition that affects the skin in areas with many oil glands, such as the scalp, face (often around the nose, on the eyelids, or behind the ears), chest, and back. Considered a chronic form of eczema, seborrheic dermatitis may also occur in skin folds under the arms and on the legs, below the breasts, and in the groin area and cause red, scaly, flaky skin and sometimes itching. Dandruff is a mild type of seborrheic dermatitis.

Seborrheic dermatitis also occurs frequently in babies and is called "cradle cap," which causes redness and greasy, crusty yellow or brown scales on the head, face, diaper area, or other parts of the body.

Symptoms and signs of seborrheic dermatitis include the following:

• Skin lesions, typically on the scalp, face, chest, back, in skin folds under the arms and on the legs, below the breasts, and in the groin area
• Patches may be red, inflamed, scaly, oozing, crusting
• Scaly patches may appear greasy or oily
• Loss of pigmentation (in dark-skinned patients)
• Scalp may have mild, patchy scaling or thick, widespread crusts
• Itching
• Eye redness
• Crusty yellow material on the eyelashes
• Inflammation of the eyelids
• White flakes or scales on the head or in the hair (dandruff)
• In infants, redness and greasy scales, usually on the scalp (cradle cap)

These are characteristics of the skin lesions:

• Recurrent active episodes of skin burning, scaling, and itching that alternate with inactive periods
• Active episodes occur more frequently in winter and early spring when weather is cold and dry, and remissions usually occur during the summer.
• In the active phases, there is the potential for secondary infection in areas where the skin rubs together (such as the armpits).
• Stress may worsen the condition.
• Candidal overgrowth
• Generalized intense, widespread skin redness (seborrheic erythroderma) is rare.

Seborrheic dermatitis is not contagious.

Doctors don't know the exact cause of seborrheic dermatitis, though they believe that it may be due to an inflammatory reaction to a type of yeast (Malassezia) that naturally lives on the skin. Allergies do not cause seborrheic dermatitis. Genetics and hormones may also be a factor.

Risk factors for seborrheic dermatitis include the following:

• Stress
• Certain medications
• Hormonal changes
• Illness
• Certain neurologic conditions, such as Parkinson's disease
• Certain diseases that affect the immune system, such as HIV or AIDS

There is no specific test for seborrheic dermatitis. A history and physical exam of the skin may be enough to diagnose the condition.

Your doctor may perform a skin biopsy to help confirm the diagnosis of seborrheic dermatitis (or to help rule out other causes).

Treatment for seborrheic dermatitis often involves long-term management and may include the following:

• Topical corticosteroids (for short-term use only) such as betamethasone (Valisone) or desonide (Tridesilon, Verdeso, Desonate) for itching and redness
• Topical antifungals: ketoconazole (Xolegel, Nizoral), naftifine (Naftin), or ciclopirox (Ciclodan, Loprox Kit, Loprox) creams and gels, also for itching and redness
• Calcineurin inhibitors (for example, pimecrolimus [Elidel], tacrolimus [Protopic], sulfur or sulfonamide combinations, or propylene glycol)
• For acute flares, corticosteroid creams, lotions, or solutions
• For severe or unresponsive lesions, systemic fluconazole (Diflucan)

Treatment of dandruff may include the following measures:

• Frequent shampooing or longer lathering
• Avoiding use of hair spray or hair pomades
• Use of shampoos with antifungal or antiseptic properties containing salicylic acid, tar, sulfur, or zinc; selenium sulfide (2.5%), ketoconazole, and ciclopirox
• Use of conditioner with zinc, 0.01% fluocinolone, and acetonide topical oil
• Applying tar, bath oil, Baker's P&S solution, or Derma-Smoothe F/S oil overnight to loosen scales may be helpful.

The following are treatments for cradle cap in babies:

• Cleanse the scalp or affected areas with baby shampoo and use a soft toothbrush or fine-toothed comb to remove scaly skin.
• Apply a small amount of oil (such as baby oil, vegetable oil, mineral oil, or petroleum jelly) on the baby's head and leave it on overnight to loosen scaly skin. Once the oil has loosened the scales, gently brush the baby's scalp with a soft brush to remove the scales. Finish by washing the area with regular baby shampoo.

In severe cases, if seborrheic dermatitis is not treated, a secondary bacterial infection may occur. This may require antibiotics to treat.

Side effects from treatment may also cause some complications. For example, long-term use of topical corticosteroids may cause thinning skin.

The skin condition may also cause embarrassment, which can result in anxiety or depression in some patients.

It may be possible to prevent seborrheic dermatitis flares with lifestyle changes. There are many over-the-counter (OTC) shampoos and creams that can help manage the condition and prevent symptoms and signs from occurring.