Dandruff

‘Dermatitis’ is a red (inflamed), itchy, flaky skin complaint; ‘seborrheic’ means that the rash affects greasy (sebaceous) skin zones such as the scalp, sides of nose, eyebrows, ears, and eyelids. Essentially, it presents as pink/red itchy skin with greasy flakes involving the eyebrows, creases of nose, behind the ears, beard area and sometimes the forehead. People sometimes use the terms dandruff and seborrhea interchangeably.

Seborrheic dermatitis is very common affecting people of all ages and many people don’t even know they have it. Overall it has been reported to affect about 4% of the population, and dandruff (which is mild seborrheic dermatitis of the scalp) can affect almost half of all adults. It can start at any time after puberty and is slightly commoner in men. Babies can also get a short-lived type of seborrheic dermatitis in the scalp (cradle cap) and diaper area, which usually clears after a few months.

It is thought that seborrheic dermatitis is triggered by an overgrowth of a harmless yeast called Pytrosporum ovale that lives on the skin and an overreaction by the skin’s immune system to this yeast. The excess oil from the skin makes a food source for the yeast to grow. The yeast overgrowth causes inflammation, irritation, scaling, and flaking. Of note, these are not the same as the yeasts that cause thrush or those that are present in foods.

The symptoms of seborrheic dermatitis seem to vary from person to person. Affected areas can be itchy, sore and sensitive and flaking skin can be bothersome and embarrassing, especially with dark clothing. Some people have the rash without being troubled

For most patients, there’s no need to do blood, urine, or allergy tests. Most often a dermatologist can diagnose seborrheic dermatitis by the way it looks and where it is on the body. Rarely, people with chronic seborrheic dermatitis that does not respond to treatment may need additional testing test to rule out another skin disease such as a fungal infection. This may include a skin scraping or rarely a biopsy.

There’s no way to prevent or cure seborrheic dermatitis. It is managed with treatment that reduces the level of skin yeast and inflammation in the skin.
Gentle shampooing with a mild soap helps infants with cradle cap. Apparently also apply cream or lotion containing a low-dose corticosteroid or antifungal medicine to the child’s affected skin.

Adults often need to use a medicated shampoo and or a stronger corticosteroid cream the dermatologist can prescribe. Common antifungal creams/shampoos include ketoconazole, clotrimazole, and econazole. Pyrethrin zinc and sodium sulfacetamide/sulfur shampoos are also very effective as treatments and maintenance therapies.

Some of the most effective over the counter products for treating the scalp include: DHS Zinc Shampoo ( since this is 2% zinc it’s stronger and more effective than Head and Shoulders), Head and Shoulders (for mild cases), Dove Scalp Care (very moisturizing especially for curly hair), Selsun Blue ( best if mixed with a zinc based shampoo also)
For treating seborrheic dermatitis of the face I recommend using Vanicream Z-Bar cleanser daily and for an itchy flare-up applying Vanicream HC 1% Hydrocortisone twice daily for 2 weeks only.

Yes, there are a few things that can actually worsen seborrheic dermatitis. These include coconut oil and olive oil. It is not uncommon for when somone first notices the flaking it is assumed that it is a result of dry skin or dry scalp. As it relates to seborrheic dermatitis, the flakes will be greasy which signifies an over accumulation of the natural yeast on the skin. Because dryness is the assumed culprit, coconut oil and olive oil are often applied reflexively. However, these will feed the yeast and while the flakes will look less severe when they’re damp with the oil, the condition will actually flare in response to the excess oil.