About Seborrheic Dermatitis
Karen is a young mother with a one month-old baby. She’s concerned about a yellowish crust on her baby’s head. Will shampooing remove the scales? Will it affect his "soft spot" in any way? Is his skin condition contagious?

Phil, 89 years old, is recuperating from a heart attack. After a lengthy hospital stay, his family noticed some white crusts in his ears and scales on his scalp that won’t go away. They wonder if he caught a skin disease while he was in the hospital.

Shortly after Sue was diagnosed with Parkinson’s disease, she found that her hair needed to be washed more often. If she didn’t wash it daily with medicated shampoo, she would develop scales on her scalp that seemed worse than typical dandruff. What does she have? Will it ever go away?

Who Can Get Seborrheic Dermatitis? As with other types of eczema, anyone at any age can develop SD. It is most common in infants and among adults age 30 and older.

Despite the differences in age and circumstances, what all these people have in common is a skin condition called seborrheic (seb-oh-REE-ick) dermatitis (SD). SD is one of the most common skin disorders. It can be stubborn, persistent and lingering, causing embarrassment and discomfort. The cause of SD is unknown but while there is no cure, it can be treated and controlled.

What is Seborrheic Dermatitis
SD is a non-contagious condition that causes flaking and redness of the skin. It occurs when there is inflammation in areas of the skin where sebaceous (skin oil) glands are concentrated. It usually affects the scalp, but can also affect other parts of the body, such as the central face and chest, eyebrows, eyelids, the folds of the nose, behind or inside the ears, the forehead and the chin. Sometimes patches can appear around the navel, in the skin folds under the arms, in the groin, or under the breasts. In babies it’s known as "cradle cap."

SD can be unpleasant and uncomfortable, and is usually unattractive. It can disappear spontaneously and suddenly reappear, for no known reason. Or it can stubbornly linger, resisting treatment. But as frustrating as SD can be, it is readily diagnosed and is treatable.

SD is a genetically determined condition, meaning it can be inherited from one’s parents and can sometimes affect several members of the same family

What Does Seborrheic Dermatitis Look Like?
SD begins gradually, with dry or greasy scaling of the scalp. The affected areas are oily and red, and may or may not be itchy.

SD has also been linked to neurological disorders such as Parkinson’s disease, stroke, and epilepsy, but the reason for this link is not known.

What is the Difference Between Seborrheic Dermatitis and Dandruff?
Every month, our skin replaces its cells. As these skin cells rise to the surface, they shed. They generally go unnoticed, but if they stick together in clumps, the dry scalp flakes are easily seen. Dandruff is the result of these clumps of dead skin cells flaking off the scalp. It is so common that it is considered normal. Clinically, there is no inflammation (pain or redness) but at a microscopic level there is inflammation associated with dandruff, which is why people with this condition sometimes complain of an itchy scalp.

What Causes Seborrheic Dermatitis? The exact cause of SD is unknown. A yeast called Pityrosporum ovale, may be a factor in the development of SD. This member of the fungus group is quite common and is found on healthy skin. For people with SD, when the skin retains oil and scales, this organism grows rapidly and can aggravate the skin condition. That’s why some people with SD respond well to treatment with soaps or shampoos containing antifungal agents.

Seborrheic dermatitis is sometimes thought of as a more severe form of dandruff. If your scalp becomes itchy and the scales build up, it’s an indication that you may have SD. In severe cases, there may even be an offensive odor. The odor is partially caused by the buildup of bacteria due to excessive oil on the scalp. Fatty acids in the skin that get trapped by the SD scales also contribute to the odor.

What is the Difference Between Seborrheic Dermatitis and Other Skin Conditions, Such as Psoriasis and Eczema?
Psoriasis is a chronic skin disorder affecting 2.6 percent of the population in the United States. It can begin at any age, but is relatively rare in infants. Men and women have an equal chance of developing psoriasis. At first, little red patches appear. In time, they grow larger and develop silvery scales. The scales of psoriasis can be very itchy; SD itching is more mild. Psoriasis can be limited to one or a few small patches, but usually covers larger portions of the body, especially the elbows, knees, and nails, in addition to the scalp.

"Eczema" refers to a variety of itchy, red inflammations of the skin. Most doctors include SD in the broad definition of eczema. More common, "itchier" types of eczema include allergic contact dermatitis (e.g. "poison ivy") and atopic dermatitis (AD). Atopic dermatitis is a common familial form of eczema, seen often in people who have hay fever and/or asthma. Atopic dermatitis affects more than 15 million Americans.

Seborrheic Dermatitis in Infants
When infants get SD, it’s called "cradle cap." The name comes from the yellow scales or flakes that build up and form a "cap" on the baby’s head. Some pediatricians describe the flakes as looking like small potato chips. Cradle cap is very common and can begin in the first month of a baby’s life. This may be due to hormones passed from the mother to the child before birth. It is not caused by poor care or poor hygiene. As the child gets older, the hormones gradually disappear. Most cases are mild and respond well to simple treatment or will clear up with no treatment at all within a few months after birth and almost always

by the child’s first birthday. If the cradle cap spreads to the forehead or persists beyond the first birthday, it’s best to consult the baby’s pediatrician. Sometimes cradle cap can be seen in babies who have atopic dermatitis as well.

Cradle Cap: Simple Treatment for Uncomplicated Cases Gently rub mineral oil on the scalp to help loosen the scales. Wash the baby’s head gently with a non-medicated baby shampoo. This can be done as often as every day. Some mothers may be afraid of washing the baby’s head because they do not want to harm the "soft spot." Careful and gentle washing will not hurt the baby. Brush the baby’s hair gently with a soft brush to help get rid of the scales.

Seborrheic Dermatitis in Adults
In adults, SD seems to be more prevalent in men than women, and is more common among the elderly. Adults who are immunocompromised (such as those with AIDS, cancer, hepatitis, etc.) or people who have chronic neurological conditions like Parkinson’s disease or epilepsy are all more likely to develop SD than others. The reasons are unknown. In HIV-infected patients, the SD may be more severe and may require more aggressive treatment.

For reasons that are not known, people who have had a traumatic medical crisis like a heart attack can also develop SD. Because they have been hospitalized for life-threatening ailments, the SD may go unnoticed and untreated. Additionally, the elderly in nursing homes or in hospitals for prolonged stays can develop SD. Seborrheic dermatitis will not develop into other, more serious skin conditions like skin cancer and cannot be spread from one person to another.

Can Seborrheic Dermatitis Be Prevented and Cured?
There is no way to prevent SD. While it can be treated and controlled, it cannot be permanently cured. Treating SD often requires patience — treatment can last many months until the scaling subsides.

Living with Seborrheic Dermatitis
People with SD can live normal, active lives. The condition can be kept under control so that the embarrassing scaling is minimized. It is not known whether emotional stress, diet or food allergies trigger the condition. To control it, a treatment program should be developed and followed, often under the supervision of a physician.

How is Seborrheic Dermatitis Treated and Controlled?
Treatment for SD varies, depending on the affected areas and the severity of the condition. Mild cases can be treated with medicated shampoos and application of over-the-counter hydrocortisone cream. For more stubborn cases, consult a physician who can confirm the diagnosis. Such cases may require consultation by a dermatologist, a type of medical doctor who specializes in the diagnosis and treatment of skin conditions.

Washing your face two or three times a day with a drying soap can help control facial oiliness.

When SD affects the scalp, the doctor may recommend shampooing daily with one of many non-prescription medicated shampoos.

Shampooing Tips-Scalp SD Look for a shampoo that contains one of four important ingredients: coal tar, zinc pyrithione, selenium sulfide, or salicylic acid. Shampoo as often as every day, or as occasionally as two to three times per week. After applying the shampoo, leave it on your hair and scalp for at least five minutes to make sure that the medication reaches the scalp.

If these medicated shampoos do not provide relief, then it’s time to take a more aggressive approach and discuss further treatment with your doctor. In more severe cases, prescription medications may be required to control SD. Mild-to-medium strength topical steroid preparations are often prescribed by the doctor.

If the SD still persists, your doctor should be consulted to determine what treatments may be available. In some cases, you may need to see a dermatologist, a specialist in skin diseases.

Prescription Topical Corticosteroid Formulations Lotions. Many lotions contain alcohol, which may be drying or irritating to the skin, but can be useful in hairy areas. Creams and ointments. These formulations coat the skin better than lotions, but may be difficult to wash from hair or clothing and tend to leave behind a greasy residue. Foam. Newly developed and designed to carry the steroid drug into the skin without leaving a greasy residue, this formulation may be especially practical for scalp applications or wherever else a greasy residue is not desired.

Conclusions
Seborrheic dermatitis is a good news/bad news skin condition. The bad news is that it cannot be permanently cured. The good news is that it is not contagious and, with patience and care, can be brought under control.

This information sets forth current opinions from recognized authorities, but it does not dictate an exclusive treatment course. Persons with questions about a medical condition should consult a physician who is knowledgeable about that condition.

The National Eczema Association for Science and Education is a national, patient-oriented organization which is governed by a Board of directors and guided by a Scientific Advisory Committee comprised of physicians and scientists who donate their time and expertise. NEASE is entirely supported through individual and corporate contributions and is a 501(c)(3) tax-exempt organization. For additional information or to receive a sample of our quarterly newsletter, The Advocate, please contact: