Seborrheic dermatitis in AdultSee also in: Anogenital,Hair and Scalp
Alerts and Notices
SynopsisSeborrheic dermatitis is a common inflammatory papulosquamous condition that affects the sebum-rich areas of the body, including the face, scalp, neck, upper chest, and back. The pathogenesis is not known with certainty, but it may be related to an abnormal immune response to Pityrosporum (Malassezia) yeast, a common skin commensal.
Seborrheic dermatitis presents in infants as a self-limited eruption caused by persistent maternal androgens, or in adults, after adrenarche. Up to 5% of adults are affected by seborrheic dermatitis, and the condition is particularly common after the fifth or sixth decades.
Clinical presentations of seborrheic dermatitis are widely varied, ranging from simple "dandruff" to fulminant rash. There is often dryness, pruritus, erythema, and fine, greasy scaling in characteristic sites, such as the scalp, eyebrows, glabella, nasolabial folds, the beard area, upper chest, external ear canal, posterior ears, eyelid margins (blepharitis), and intertriginous areas. Anogenital involvement has also been reported. One or multiple sites may be involved. In persons with darker skin phototypes, the involved areas may be hypopigmented or hyperpigmented. These pigmentary changes may persist after treatment.
Stress may exacerbate the condition. In immunocompromised persons and those with neurologic conditions, such as Parkinson disease or stroke, seborrheic dermatitis may be severe and recalcitrant.
Since seborrheic dermatitis is such a common disorder, it has been difficult to associate it with specific medications. However, there are some published associations of medications causing, triggering, or exacerbating the condition (see Drug Reaction Data table).
Even with treatment, seborrheic dermatitis tends to be a chronic condition, and remissions and exacerbations are expected. Seborrheic dermatitis is often better in summer months and worse in the winter.
Immunocompromised patient considerations:
- Seborrheic dermatitis is more common and more severe in persons infected with the human immunodeficiency virus (HIV). It may regress with highly active antiretroviral therapy, but remissions and exacerbations can be expected.
- Seborrheic dermatitis is also often seen in patients with Parkinson disease. The course is chronic and relapsing and may be difficult to treat.
- Associated Pityrosporum folliculitis may be seen in immunocompromised patients.
L21.9 – Seborrheic dermatitis, unspecified
50563003 – Seborrheic dermatitis
Differential Diagnosis & Pitfalls
- Perioral dermatitis
- Tinea versicolor
- Allergic contact dermatitis
- Irritant contact dermatitis
- Nummular dermatitis (nummular eczema)
- Atopic dermatitis
- Tinea corporis
- Psoriasis – The distinction between psoriasis and seborrheic dermatitis may be difficult at times, and there may be an overlap condition, sometimes referred to as "sebo-psoriasis," particularly when "greasy" scale is present in the scalp.
- Candidiasis (intertriginous areas)
- Pityriasis rosea
- Lichen simplex chronicus
- Darier disease
- Dermatomyositis – The eyelid erythema seen in this condition has a more violaceous hue. The scalp is pink and scaly and extremely pruritic.
- Subacute cutaneous lupus erythematosus
- Acrodermatitis enteropathica
Drug Reaction DataBelow is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
Patient Information for Seborrheic dermatitis in Adult
OverviewSeborrheic dermatitis, also known as seborrhea, is a common noncontagious condition of skin areas rich in oil glands (the face, scalp, and upper trunk). Seborrheic dermatitis causes overproduction and flaking of skin cells and sometimes itchy skin. It can vary in severity from mild dandruff of the scalp to scaly patches on the skin. Normal skin yeast called Pityrosporum ovale lives in oil-rich skin regions and plays a role in this disorder; the changes seen in the skin are due to the body's inflammatory response to the yeast on the skin. Seborrheic dermatitis seems to worsen with stress, dry weather, and infrequent shampooing. Although there is no cure for seborrheic dermatitis, control is usually possible with medicated shampoos and topical steroids (when inflammation is prominent).
Who’s At RiskDandruff occurs in 15%-20% of the population, and more severe seborrheic dermatitis (with flaking and inflamed skin) occurs in 3%-5% of all people. Seborrheic dermatitis affects all races / ethnicities and may be a bit worse in men. It typically starts after puberty (although babies may have a variant called cradle cap). The severity of seborrheic dermatitis peaks around age 40 and then may improve. Severe seborrheic dermatitis is frequently seen in people with Parkinson disease, central nervous system problems, and HIV infection.
Signs & Symptoms
- The scalp is itchy and sheds white, oily skin flakes.
- One or more of the following areas has patches of scaly skin: the scalp, hairline, forehead, eyebrows, in between the eyebrows, the area of the eyelid between the eye and the eye lashes (the free lid margin), creases of the nose and ears, ear canals, beard area, breastbone, midback, groin, and underarms. In lighter skin colors, affected areas may appear pink or red; in darker skin colors, the redness may be subtle, or affected areas may appear purplish or darker brown, but the affected areas may also look lighter in color (hypopigmented).
- Mild – only some flaking and skin color change (as outlined above) in a few small areas.
- Moderate – several areas affected with bothersome skin color change and itch.
- Severe – large areas of skin color change and severe itch that do not improve with self-care measures.
Self-Care GuidelinesMost cases of seborrheic dermatitis are easy to control with nonprescription home treatments. These include:
- Frequent shampooing or a longer lather time with shampoo. If a regular daily shampoo fails, consider an over-the-counter dandruff shampoo. There are several types on the market, and one may work better for one individual than another.
- Shampoos containing ketoconazole (Nizoral), selenium sulfide (Selsun Blue), 2% pyrithione zinc (Head & Shoulders), salicylic acid (Neutrogena T/Sal), or tar-based (Neutrogena T/Gel) compounds may be helpful. Consider occasionally rotating shampoos because the ability of how well a product works (its efficacy) can change with time.
- If the scalp is covered with widespread, dense scale, the scale may first be removed by applying warm mineral oil or olive oil to the scalp and washing several hours later with a detergent, such as a dishwashing liquid or a tar shampoo.
- Some over-the-counter creams will help if the medicated shampoo is not working well enough. These can be added to the shampoo until there is improvement and then can be discontinued; these creams can be used again temporarily as needed and include:
- Creams that reduce the Pityrosporum yeast (clotrimazole [Lotrimin], miconazole [Monistat]).
- Hydrocortisone cream (eg, Cortaid), which may work well at first but may be less helpful if used for a long time.
- Managing eyelid inflammation (called blepharitis) by gentle cleaning of the skin around the eyelashes (eyelid margins) with a cotton swab and baby shampoo (eg, Johnson's Baby Shampoo).
When to Seek Medical CareSeek medical help from a dermatologist or other medical professional if there is no response to self-care measures.
- Corticosteroid creams, lotions, or solutions
- Sulfur or sulfacetamide products, such as a wash, cream, or lotion, applied on the skin (topically)
- Prescription-strength ketoconazole shampoo or cream
- Tacrolimus (Protopic) ointment or pimecrolimus (Elidel) cream
Seborrheic dermatitis in AdultSee also in: Anogenital,Hair and Scalp