Introduction

Seborrheic dermatitis is a non-contagious skin condition. It leads to scaly patches of skin with oily, dandruff-like flakes, especially on your face and scalp. It is only rarely itchy. Experts believe that seborrheic dermatitis is made more likely by certain things. These include an increased production of sebum (an oily substance) in the skin, too much of a yeast (fungus) that lives on the skin, and a weakened immune system.

If someone first has the scaly rash as a teenager or adult, it almost always tends to come back again and again. Then it helps to apply antifungal medicines or steroid creams to the inflamed areas of skin.

The situation is very different in babies, though: If seborrheic dermatitis occurs during the first few months of a child’s life, it usually goes away on its own within one year and also doesn’t come back. This is commonly known as cradle cap.

At a glance

• The typical symptoms of seborrheic dermatitis are scaly flakes of skin on your face and scalp.
• This rash isn't contagious, but it does keep on coming back in adults.
• Creams and shampoos can relieve the symptoms.
• No treatment is needed in babies (where it is commonly known as cradle cap).

Symptoms

The typical symptoms of seborrheic dermatitis are patches of skin covered with yellowish, shiny, oily scales. On light-colored skin, these patches look reddish. On dark skin, the scaly areas look like lighter patches. They don’t usually itch.

The patches occur most commonly on areas of skin that have a lot of sebaceous (oil-producing) glands. These typically include areas

• along the hairline and on the part of the scalp covered with hair,
• along and between the eyebrows,
• on the cheeks and particularly in the folds of skin there that run from the nostrils down to the corners of the mouth.

The rash can also spread to other parts of the body, most commonly above the breastbone and on the back near the thoracic spine. Folds of skin may be affected too – for example, under the breasts, or in the armpits or groin area. In men, the patches sometimes also occur in the genital area.

Seborrheic dermatitis: Typical areas and appearance on light and dark skin

In babies, seborrheic dermatitis mostly affects the scalp.

Causes and risk factors

The scaly patches of skin are probably caused by various factors. These include an increased production of sebum (skin oil) and the usually harmless growth of a certain type of yeast (Malassezia furfur) on the skin.

Other factors that can play a role here include bacteria, stress, genes, hormones, nervous system disorders like Parkinson’s disease, and a weakened immune system. People with a weakened immune system also have a higher risk of developing a more severe type of seborrheic dermatitis that spreads to the rest of the skin and is harder to treat.

Prevalence and outlook

Seborrheic dermatitis is common: About 3 to 10 out of 100 people are affected. It is more common in men than in women. People usually get the scaly rash for the first time either when they are young adults or over the age of 50.

Seborrheic dermatitis is a chronic condition in adults and teenagers, with symptoms that vary in their severity over time. These skin symptoms might also go away for a while – often in the summer. But they may return in the winter or during periods of stress.

Diagnosis

Seborrheic dermatitis is easy to diagnose if scaly, non-itchy, red or lighter patches of skin appear on typical parts of the body. Usually, it’s enough to have a detailed talk with the doctor and then a physical examination. The doctor will first try to rule out other skin conditions that are similar to seborrheic dermatitis, such as psoriasis or atopic dermatitis (also called atopic eczema or simply "eczema"). Like seborrheic dermatitis, these conditions cause changes in the skin, but usually on other parts of the body. In eczema, the inflamed skin is itchy. On light-colored skin, it’s made up of reddish patches without clearly defined edges, and sometimes small blisters too. On dark skin, the areas affected by eczema appear darker than the surrounding skin. And instead of blisters, small, firm bumps (papules) are more likely to develop.

Further examinations are only rarely needed. For instance, a swab test can be done and sent to a laboratory to find out whether it’s a bacterial skin infection such as impetigo. It is usually not necessary to take a sample of the tissue (biopsy).

Treatment

In teenagers and adults, the symptoms can be relieved by applying certain medications to the inflamed patches of skin. Medicines that can be used include:

• Shampoos containing tar
• Creams that have salicylic acid in them
• Creams or shampoos with antifungal agents (antimycotics)
• Anti-inflammatory creams or gels containing steroids

It usually isn’t necessary to take any pills or tablets. Because sunlight can make seborrheic dermatitis improve, some people also try phototherapy with UVB light.

There is no treatment that can clear up seborrheic dermatitis for good.

Babies don't usually need treatment for seborrheic dermatitis because it goes away on its own in babies.

Everyday life

Although seborrheic dermatitis is harmless, it can still be distressing for teenagers and adults: The scaly patches of skin often occur on the face, making them visible to others. And they may never go away again. If you feel very bad about your skin, you can talk with a doctor about finding a way to better cope with the condition, for instance with the help of behavioral therapy.

It is not a good idea to cover up the inflamed patches of skin with a heavy foundation or concealer because that clogs the pores in the skin. But it’s okay to use a light foundation every now and then. Mild, non-oily skin care products are well suited for skin care.

You don’t need to use special sun protection for seborrheic dermatitis. Exposing the skin to sunlight and fresh air, for example by going to the beach, may even reduce the symptoms. It is enough to use an appropriate sunscreen strength for your skin type. Less oily sun lotions are more suitable than very oily lotions.

Further information

When people are ill or need medical advice for themselves or a child, they usually go to see their family doctor or pediatrician first. Information about health care in Germany can help you to navigate the German health care system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Sources

• Elgash M, Dlova N, Ogunleye T et al. Seborrheic Dermatitis in Skin of Color: Clinical Considerations. J Drugs Dermatol 2019; 18(1): 24-27. [PubMed: 30681789]
• Kastarinen H, Oksanen T, Okokon EO et al. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Cochrane Database Syst Rev 2014; (5): CD009446. [PMC free article: PMC6483543] [PubMed: 24838779]
• Moll I. Duale Reihe Dermatologie. Stuttgart: Thieme; 2016.
• Naldi L, Diphoorn J. Seborrhoeic dermatitis of the scalp. BMJ Clin Evid 2015: 1713. [PMC free article: PMC4445675] [PubMed: 26016669]
• Okokon EO, Verbeek JH, Ruotsalainen JH et al. Topical antifungals for seborrhoeic dermatitis. Cochrane Database Syst Rev 2015; (5): CD008138. [PMC free article: PMC4448221] [PubMed: 25933684]
• Pschyrembel online. 2023.
• Victoire A, Magin P, Coughlan J et al. Interventions for infantile seborrhoeic dermatitis (including cradle cap). Cochrane Database Syst Rev 2019; (3): CD011380. [PMC free article: PMC6397947] [PubMed: 30828791]

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