What Triggers Seborrheic Dermatitis Symptoms?

Characteristics of the skin lesions include:

• Recurring episodes of active skin scaling, burning, and itching, alternating with inactive periods
  • Active episodes occur more frequently when weather is cold and dry such as in winter and early spring, and remissions tend to happen during the summer
  • In active phases, secondary infection can occur in areas where skin rubs together (such as the armpits)
  • Stress can worsen the condition
• Candida overgrowth (a type of yeast)
• Generalized intense, widespread skin redness (seborrheic erythroderma) (rare)

Symptoms of seborrheic dermatitis include:

• Skin lesions that usually occur on the scalp, face, back, chest, in skin folds under the arms and on the legs, below the breasts, and in the groin area
• Redness, inflammation, scaling, oozing, or crusting of skin patches
• Scaly patches may look greasy or oily
• Mild, patchy scaling or thick, widespread crusts on the scalp
• Itching 
• Loss of pigmentation (in dark-skinned patients)
• Eye redness
• Inflammation of the eyelids
• Crusty yellow material on the eyelashes
• White flakes or scales on the head or in the hair (dandruff)
• In infants: redness and greasy scales, usually on the scalp (“cradle cap”)

A patient history and physical examination of the skin may be sufficient to diagnose seborrheic dermatitis. There is no specific test used to diagnose seborrheic dermatitis. 

In some cases, a skin biopsy may be performed to help confirm the diagnoses or to help rule out other causes.

Treatment for seborrheic dermatitis usually involves long-term management and may include:

• Topical corticosteroids (for short-term use only) for itching and redness
  • Betamethasone (Valisone) 
  • Desonide (Tridesilon, Verdeso, Desonate) 
• Topical antifungal creams and gels for itching and redness
  • Ketoconazole (Xolegel, Nizoral)
  • Naftifine (Naftin)
  • Ciclopirox (Ciclodan, Loprox Kit, Loprox) 
• Calcineurin inhibitors 
  • Pimecrolimus (Elidel)
  • Tacrolimus (Protopic)]
  • Sulfur or sulfonamide combinations
  • Propylene glycol 
• For acute flares, corticosteroid creams, lotions, or solutions
• For severe or unresponsive lesions, systemic fluconazole (Diflucan)

Treatment of dandruff includes:

• 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 
• Frequent shampooing or longer lathering
• Avoiding use of hair spray or hair pomades

Treatment for “cradle cap” in babies includes: 

• Cleansing the scalp or affected areas with baby shampoo 
• Using a fine-toothed comb or soft toothbrush to remove scaly skin
• Applying a small amount of oil (such as vegetable oil, mineral oil, baby oil, or petroleum jelly) on the baby's head and leaving it on overnight to loosen scaly skin. 
  • Once the oil loosens the scales, brush the baby's scalp gently with a soft brush to remove the scales
  • Finally, wash the area with regular baby shampoo 

It may be possible to prevent seborrheic dermatitis flares with lifestyle changes. TA number of over-the-counter (OTC) shampoos and creams can also help manage the condition and prevent symptoms from recurring.