Seborrheic dermatitis

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.

In babies, seborrheic dermatitis mostly affects the scalp.

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.

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.

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).

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.

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.

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.