"Dry" Scalp and Face - Do you have Seborrheic Dermatitis?

Many people who have irritating, "dry" scalp and face may actually have seborrheic dermatitis.  Seborrheic dermatitis (or seb derm) is a common skin condition that can affect up to 70% of infants in the first three months of life and about 11% of the general population.  Unlike dry skin, the flaking from seb derm has a greasier look and usually has a pink or red base.  Seb derm of the scalp can be all over the scalp or in patches.  On the face, seb derm usually affects the eyebrow areas and between the eyebrows, around the creases of the nose, around the mouth, chin and beard area in men.  Other areas that can also be affected are inside or around the ears, mid chest and mid back.  In infants, seb derm can also occur in the diaper area looking very similar to diaper rash.

The cause is unknown for seb derm.  It is a chronic condition in which there are medications which can control the condition but no medications which can permanently cure people with this problem.  Over-the-counter shampoos such as Head and Shoulders, Selsun Blue, T-Gel or T-Sal shampoo may help milder cases of scalp seb derm.  Otherwise, prescription shampoos such as ketoconazole shampoo or clobetasol shampoo may be needed.  I generally do not recommend using these shampoos to treat other areas affected with seb derm such as the face or body as the shampoo base may dry out the skin too much and cause other problems.  With very itchy forms of scalp seb derm, topical steroids can also be used to relieve the itch.

Since seb derm is an inflammatory condition rather than a dry skin problem, simply putting on moisturizers to these dry-looking areas will not usually improve the condition.  I usually prescribe a combination treatment of an anti-fungal cream and topical steroid cream.  Although seb derm is not considered a fungal skin infection, there are certain yeasts that are present in this condition.  

Generally, these treatments are used for about 1-2 weeks until the condition subsides and then when it flares again, the medications are restarted.  As far as we know, there are no simple external factors which can change the course of the condition such as foods that we eat, hygiene or general lifestyle.  

Dana Kang, MD Dr. Kang is a board-certified dermatologist.

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