Seborrhoeic dermatitis in adults
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Seborrhoeic dermatitis is a common scaly rash that typically affects the scalp, face and chest, but can affect other areas, too. ‘Seborrhoeic’ simply means that the condition appears in those areas of skin with large numbers of grease (sebaceous) glands, such as the scalp and sides of the nose.
There are two types of seborrhoeic dermatitis: adult and infantile. This information is for adults with seborrhoeic dermatitis. Seborrhoeic dermatitis in infants (known as ‘cradle cap’) differs from the adult form and is discussed here.
Symptoms
Seborrhoeic dermatitis may or may not be itchy and can vary from day to day
The most common sites for seborrhoeic dermatitis are the scalp, eyebrows, forehead, creases around the nose and cheeks, ears, front of the chest, between the shoulder blades and in skin flexures (folds)
On the scalp, it can range from a mild flaking of the skin (dandruff) to inflamed, scaly areas, which can sometimes weep.
On the face, skin around the sides of the nose, creases, and sometimes cheeks, can become red or lighter or darker than the surrounding skin (depending on skin tone), and scaly. The inner half of the eyebrows can develop ‘dandruff’. Sometimes the eyelids and eyelashes become involved, a condition known as ‘blepharitis’.
Eczema can occur in the ear canal (otitis externa), on the earlobe or behind the ears. For more information, please see our ear eczema page.
Very rarely, the dermatitis can become severe and extensive, covering large areas of the body and needing more aggressive management.
In people with lighter skin tones, the skin appears scaly and faintly red
In people of colour, affected areas are scaly and lighter or darker in colour than the surrounding skin, and may have no redness
In people with darker skin, scaling can have a flower-like shape
There is often dandruff, which can vary in severity
In flexural areas such as the armpits or groin, the scale may be absent and the skin can look a bit more glazed
On more exposed areas, the scale can become quite marked and yellowish.
Triggers
Detergents, soaps and shampoos - Once the skin has become inflamed with any form of eczema, exposure to detergents, soaps, shampoos etc. will aggravate it further. This can be a major factor in causing the seborrhoeic dermatitis to become more severe and persistent.
Solvents - Many skin irritants can make the condition worse. Care should therefore be taken to limit exposure to DIY materials such as solvents and chemicals.
Treatments
Seborrhoeic dermatitis cannot be cured, because once an individual has become allergic to Malassezia on the skin, exposure to it will always cause a problem.
Long-term treatment is needed to keep this condition at bay. If it recurs, it is not because the treatment has failed – it is because of the persistent nature of the condition, due to sensitivity to Malassezia yeasts. Therefore, ongoing treatment with anti-yeast measures is vital.
The only way to keep seborrhoeic dermatitis under control is to use anti-yeast treatments, such as anti-yeast shampoos, creams and ointments.
Mild topical steroids can be used for short-term treatments. The steroid treats the skin inflammation, and once any irritation has settled, it's wise to just use the anti-yeast agent.
Medical emollients can be applied to the scalp by parting the hair and massaging them into the skin.
