Core Dermatology Diagnoses / CategoriesInflammatory

Seborrheic dermatitis

Author: Deputy Editor: Faculty Reviewers:

Publish date: Posted on
Last updated: October 23, 2023

Keywords #

seborrheic dermatitis
seborrheic eczema
seborrhea
cradle cap
dandruff

Diagnosis #

Seborrheic dermatitis (SD) is a common inflammatory skin condition that is chronic and relapsing. It can affect both adults and infants.[1] It typically involves areas rich in sebaceous glands such as the scalp, face, and upper trunk.[2] The etiology of seborrheic dermatitis is not well understood but is considered to be multifactorial, involving sebaceous gland secretion abnormalities, Malassezia colonization (a commensal yeast) and immunologic alterations.

SD can substantially affect the quality of life of patients by causing psychological distress and low self–esteem.

Key Concepts #
  • Seborrheic dermatitis is not contagious.
  • Seborrheic dermatitis is not an allergic reaction.
  • It is characterized by an erythematous rash with scale and flaking.
  • A lot of dandruff is considered seborrheic dermatitis of the scalp in its mildest form, although other conditions can cause dandruff too.
  • Seborrheic dermatitis usually resolves spontaneously within a few months in infants.
  • The mainstay of treatment includes topical antifungals and topical corticosteroids.
Epidemiology #

SD affects 1%-3% of immunocompetent individuals. It is more prevalent in immunocompromised patients and its incidence in HIV patients can be as high as 83%, with increasingly more severe features as the CD4+ T lymphocyte count decreases.[3] SD is also more common in those with Parkinson’s disease, tardive dyskinesia, and Down Syndrome.[2]

Clinical Features #
  • SD is characterized by an erythematous, greasy-looking rash with scales and flaking.
  • In adults, it most often presents in the scalp, face (eyebrows, nasolabial creases), ears, upper chest, and genital region.[1]
  • It can be pruritic.
  • Infantile SD has a transient course with presentation and remission within the first 12 months of life, and commonly presents in the scalp (“cradle cap”), the face, body folds, and the diaper area, although it can also be widespread.
Differential Diagnoses #
Diagnostic Workup #

The diagnosis of SD is made clinically based on history, the distribution, and the characteristics of the skin lesions.

A biopsy is not necessary unless the diagnosis is uncertain. Under the microscope, SD may show superficial perivascular and perifollicular inflammatory lymphocytic and histiocytic infiltrates, with spongiosis, psoriasiform hyperplasia, and parakeratosis.[3]

Treatment #

There is no cure for SD, but several therapies can clear its signs and reduce inflammation and pruritus. Topical antifungals such as ketoconazole cream and topical corticosteroids are first-line.[2] Other therapies include selenium sulfide, zinc pyrithione, coal tar, and topical calcineurin inhibitors (tacrolimus and pimecrolimus). Our preferred treatment approach is a medical shampoo containing ketoconazole 2-3x/week and a low-potency corticosteroid (desonide, hydrocortisone 2.5% and similar).

Patients with mild SD limited to the scalp, also known as dandruff, benefit from antifungal/anti-dandruff shampoos.

Infantile SD is self-limited. For lesions confined to the scalp, a mild baby shampoo and gentle brushing can remove scales. For lesions on the face and body, topical antifungals such as ketoconazole cream can help.

Slide Viewer #
https://utahderm.med.utah.edu/image-viewer/
References #
  1. Del Rosso JQ. Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol. 2011;4(5):32-38.
  2. Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol. 2013;31(4):343-351.
  3. Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015;3(2).
Contents