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Seborrhoeic dermatitis
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<h2 id="signs-and-symptoms">Signs and symptoms</h2> <p>Seborrhoeic dermatitis typically appears as dry, white, flaky skin. The flakes can be fine, loose, and diffuse or thick and adherent.<a class="footnote-ref" id="fnref:29" href="#fn:29"><sup>29</sup></a><a class="footnote-ref" id="fnref:30" href="#fn:30"><sup>30</sup></a> Additionally, flakes can appear yellow and oily or greasy.<a class="footnote-ref" id="fnref:31" href="#fn:31"><sup>31</sup></a><a class="footnote-ref" id="fnref:32" href="#fn:32"><sup>32</sup></a> In addition to flaky skin, seborrhoeic dermatitis can have areas of red, inflamed, and itchy skin that coincide with the area of skin flaking, but not all individuals have this symptom.<a class="footnote-ref" id="fnref:33" href="#fn:33"><sup>33</sup></a> </p><p>Seborrhoeic dermatitis of the scalp can appear similarly to dandruff.<a class="footnote-ref" id="fnref:34" href="#fn:34"><sup>34</sup></a> When the scalp is affected, there can be associated temporary hair loss.<a class="footnote-ref" id="fnref:35" href="#fn:35"><sup>35</sup></a> Such hair loss varies in appearance from diffuse thinning to patchy areas of hair loss.<a class="footnote-ref" id="fnref:36" href="#fn:36"><sup>36</sup></a> On close inspection, the locations where hair has thinned may have broken stubs of hair and pustules around the hair follicles.<a class="footnote-ref" id="fnref:37" href="#fn:37"><sup>37</sup></a> Individuals with more pigmented skin tones may experience increased or decreased skin pigmentation in affected areas.<a class="footnote-ref" id="fnref:38" href="#fn:38"><sup>38</sup></a> </p><p>Various locations can be affected by seborrhoeic dermatitis. Commonly affected areas include the face, ears, scalp, and across the body. It is less common in intertriginous areas, which are areas where the skin folds and comes into contact with itself, such as the groin or underarm.<a class="footnote-ref" id="fnref:39" href="#fn:39"><sup>39</sup></a> </p><p>Seborrhoeic dermatitis' symptoms are typically mild and appear gradually but are often persistent, lasting weeks to years.<a class="footnote-ref" id="fnref:40" href="#fn:40"><sup>40</sup></a><a class="footnote-ref" id="fnref:41" href="#fn:41"><sup>41</sup></a><a class="footnote-ref" id="fnref:42" href="#fn:42"><sup>42</sup></a> Individuals with seborrhoeic dermatitis are subject to recurrent bouts and it may be a lifelong condition.<a class="footnote-ref" id="fnref:43" href="#fn:43"><sup>43</sup></a> Seborrhoeic dermatitis can also occur quickly and severely in patients with <a href="/facts/HIV/ulY2rgzu">Human Immunodeficiency Virus</a> (HIV). In fact, this is sometimes the first indication of HIV.<a class="footnote-ref" id="fnref:44" href="#fn:44"><sup>44</sup></a> </p> <h2 id="causes">Causes</h2> <p>The cause of seborrhoeic dermatitis has not been fully clarified.<a class="footnote-ref" id="fnref:45" href="#fn:45"><sup>45</sup></a><a class="footnote-ref" id="fnref:46" href="#fn:46"><sup>46</sup></a> </p><p>In addition to the presence of <i>Malassezia</i>, genetic, environmental, hormonal, and immune-system factors are necessary for and/or modulate the expression of seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:47" href="#fn:47"><sup>47</sup></a><a class="footnote-ref" id="fnref:48" href="#fn:48"><sup>48</sup></a> The condition may be aggravated by illness, psychological stress, fatigue, sleep deprivation, change of season, and reduced general health.<a class="footnote-ref" id="fnref:49" href="#fn:49"><sup>49</sup></a> </p> <h3>Fungi</h3> <p>The condition is thought to be due to a local <a href="/facts/Inflammatory_response/Ura86MIy">inflammatory response</a> to overgrowth by <i><a href="/facts/Malassezia/3uoNQqbL">Malassezia</a></i> <a href="/facts/Fungi/BHo5DP59">fungi</a> species in <a href="/facts/Sebum/HKMXmv1Y">sebum</a>-producing <a href="/facts/Skin/4havlLzG">skin</a> areas including the <a href="/facts/Scalp/yfnQt0n5">scalp</a>, <a href="/facts/Face/I1PQ5YLY">face</a>, <a href="/facts/Chest/lwtzfc8K">chest</a>, <a href="/facts/Back/vKY15qyA">back</a>, <a href="/facts/Underarm/Q0EaYG2p">underarms</a>, and <a href="/facts/Groin/49jqnbc3">groin</a>.<a class="footnote-ref" id="fnref:50" href="#fn:50"><sup>50</sup></a><a class="footnote-ref" id="fnref:51" href="#fn:51"><sup>51</sup></a> This is based on observations of high counts of <i>Malassezia</i> species in skin affected by seborrhoeic dermatitis and on the effectiveness of <a href="/facts/Antifungal/WEk5nS2B">antifungals</a> in treating the condition.<a class="footnote-ref" id="fnref:52" href="#fn:52"><sup>52</sup></a> Species of <i>Malassezia</i> implicated in Seborrhoeic dermatitis include <i><a href="/facts/M._furfur/TqoSD8V1">M. furfur</a></i> (formerly <i><a href="/facts/Pityrosporum_ovale/TqoSD8V1">Pityrosporum ovale</a></i>), <i><a href="/facts/M._globosa/3uoNQqbL">M. globosa</a></i>, <i><a href="/facts/M._restricta/3uoNQqbL">M. restricta</a></i>, <i><a href="/facts/M._sympodialis/P84ASCKA">M. sympodialis</a></i>, and <i><a href="/facts/M._slooffiae/3uoNQqbL">M. slooffiae</a></i>.<a class="footnote-ref" id="fnref:53" href="#fn:53"><sup>53</sup></a> </p><p><i>Malassezia</i> appears to be the significant factor in seborrhoeic dermatitis but it is thought that other factors are necessary for the presence of <i>Malassezia</i> to result in the seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:54" href="#fn:54"><sup>54</sup></a> For example, summer growth of <i>Malassezia</i> in the skin alone does not result in seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:55" href="#fn:55"><sup>55</sup></a> Besides antifungals, the effectiveness of <a href="/facts/Anti-inflammatory_drug/W27poSUd">anti-inflammatory drugs</a>, which reduce inflammation, and <a href="/facts/Antiandrogen/AfyGmnAs">antiandrogens</a>, which reduce <a href="/facts/Sebum/HKMXmv1Y">sebum</a> production, provide further insights into the <a href="/facts/Pathophysiology/Tp3Dny0c">pathophysiology</a> of seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:56" href="#fn:56"><sup>56</sup></a><a class="footnote-ref" id="fnref:57" href="#fn:57"><sup>57</sup></a><a class="footnote-ref" id="fnref:58" href="#fn:58"><sup>58</sup></a> </p> <h3>Bacteria</h3> <p>Several bacteria, including Propionibacterium species and Staphylococcus aureus, have been shown to have some level of interaction with seborrhoeic dermatitis, though their exact impact is not known.<a class="footnote-ref" id="fnref:59" href="#fn:59"><sup>59</sup></a><a class="footnote-ref" id="fnref:60" href="#fn:60"><sup>60</sup></a> </p> <h3>Nutrition</h3> <p>Seborrhoeic dermatitis-like eruptions are also associated with pyridoxine (<a href="/facts/Vitamin_B6_deficiency/9IavWjwM">vitamin B6</a>) and riboflavin (<a href="/facts/Riboflavin/M8D8EbmD">vitamin B2</a>) deficiency.<a class="footnote-ref" id="fnref:61" href="#fn:61"><sup>61</sup></a><a class="footnote-ref" id="fnref:62" href="#fn:62"><sup>62</sup></a> In children and babies, issues with <a href="/facts/Delta-6_desaturase/IPu5B6o2">Δ6-desaturase</a> <a href="/facts/Enzyme/DSI1Fh7y">enzymes</a><a class="footnote-ref" id="fnref:63" href="#fn:63"><sup>63</sup></a> have been correlated with increased risk. </p> <h3>Immune dysfunction</h3> <p>Those with <a href="/facts/Immunodeficiency/CIEujXmc">immunodeficiency</a> (especially <a href="/facts/Infection/182XrncP">infection</a> with <a href="/facts/HIV/ulY2rgzu">HIV</a>) and with <a href="/facts/Neurological_disorder/eQKKs7jX">neurological disorders</a> that may impact immune system function such as <a href="/facts/Parkinson%27s_disease/xpekKj6x">Parkinson's disease</a> (for which the condition is an <a href="/facts/Signs_and_symptoms_of_Parkinson%27s_disease/y136z1tz">autonomic sign</a>) and <a href="/facts/Stroke/DwpjdzY0">stroke</a> are particularly prone to it.<a class="footnote-ref" id="fnref:64" href="#fn:64"><sup>64</sup></a>[<i>unreliable medical source?</i>] </p> <h3>Climate</h3> <p>Climate can affect seborrheic dermatitis, but there is a lack of consensus about which climates tend to exacerbate seborrheic dermatitis the most. Some studies show low <a href="/facts/Humidity/Nwb28VlT">humidity</a> and low <a href="/facts/Temperature/QyGe4gmj">temperature</a> are responsible for high frequency of seborrheic dermatitis.<a class="footnote-ref" id="fnref:65" href="#fn:65"><sup>65</sup></a> Others suggest hot environments may also worsen seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:66" href="#fn:66"><sup>66</sup></a> Yet another described that high humidity and low UV exposure are culpable.<a class="footnote-ref" id="fnref:67" href="#fn:67"><sup>67</sup></a> Dry skin and an impaired skin barrier contribute to the condition.<a class="footnote-ref" id="fnref:68" href="#fn:68"><sup>68</sup></a><a class="footnote-ref" id="fnref:69" href="#fn:69"><sup>69</sup></a> It is likely that climate and weather variations affect the water and lipid content of skin.<a class="footnote-ref" id="fnref:70" href="#fn:70"><sup>70</sup></a> </p> <h2 id="mechanism">Mechanism</h2> <p>Seborrhoeic dermatitis is a complex condition with many interacting factors that are not yet fully explained.<a class="footnote-ref" id="fnref:71" href="#fn:71"><sup>71</sup></a> In general, the major factors that influence the development and severity include <i>Malassezia</i> yeast presents on and in the skin, skin production of oily sebum, and a subsequent inflammatory response against <i>Malassezia</i> and their byproducts.<a class="footnote-ref" id="fnref:72" href="#fn:72"><sup>72</sup></a> Additional factors involved in the condition are a compromised skin barrier, the makeup and amount of sebum produced, the character of the immune response and inflammation, and the presence of other microbes species inhabiting the skin.<a class="footnote-ref" id="fnref:73" href="#fn:73"><sup>73</sup></a><a class="footnote-ref" id="fnref:74" href="#fn:74"><sup>74</sup></a> </p><p>A suggested series of events leading to seborrhoeic dermatitis are initial damaged skin barrier and abnormal sebum production which leads to a change in the microbiome of the skin that in turn elicits an immune response.<a class="footnote-ref" id="fnref:75" href="#fn:75"><sup>75</sup></a> An alternative explanation is an increase in sebum production feeding an increase in the <i>Malassezia</i> population that instigates inflammation; the inflammation then causes cellular changes that damage the skin barrier. This barrier disruption then encourages additional <i>Malassezia</i> growth and inflammation and again worsened skin barrier function.<a class="footnote-ref" id="fnref:76" href="#fn:76"><sup>76</sup></a> </p> <h2 id="diagnosis">Diagnosis</h2> <p>Typically, seborrhoeic dermatitis is a clinical diagnosis based on a physician's expertise in identifying and differentiating skin conditions based on the history of the individual and the appearance of the skin.<a class="footnote-ref" id="fnref:77" href="#fn:77"><sup>77</sup></a> However, seborrhoeic dermatitis may also be diagnosed with additional testing. The least invasive test is a visual inspection in the clinic using a <a href="/facts/Blacklight/pAQ4hnUq">Wood's Lamp</a>.<a class="footnote-ref" id="fnref:78" href="#fn:78"><sup>78</sup></a> A <a href="/facts/KOH_test/h4ABfMRe">KOH test</a> can also be used, where skin scraping of the affected skin may also be taken and prepared with <a href="/facts/Potassium_hydroxide/NBhPBuXc">potassium hydroxide</a> (KOH) and visualized under a microscope to look for <i>Malassezia</i> or other microbiological cells. Additionally, a <a href="/facts/Microbiological_culture/y3VaXn9Q">fungal culture</a> of the affected skin may be taken to attempt to grow and identify the causative organism.<a class="footnote-ref" id="fnref:79" href="#fn:79"><sup>79</sup></a> </p> <h3>Differential diagnosis</h3> <p>Seborrhoeic dermatitis can look similar to other skin conditions that share its characteristic dry, flaky, scaly, and inflamed appearance but have different causes and treatments. Physicians use the history of the individual with the skin condition as well as other tests to identify which disorder is present. Other conditions that may be confused with seborrhoeic dermatitis based on appearance are listed below.<a class="footnote-ref" id="fnref:80" href="#fn:80"><sup>80</sup></a><a class="footnote-ref" id="fnref:81" href="#fn:81"><sup>81</sup></a> </p> <ul><li><a href="/facts/Atopic_dermatitis/DvmdVwWu">Atopic dermatitis</a> (eczema)<a class="footnote-ref" id="fnref:82" href="#fn:82"><sup>82</sup></a></li> <li><a href="/facts/Contact_dermatitis/Xm6PEgcw">Contact dermatitis</a><a class="footnote-ref" id="fnref:83" href="#fn:83"><sup>83</sup></a></li> <li><a href="/facts/Psoriasis/WW1k1LsH">Psoriasis</a><a class="footnote-ref" id="fnref:84" href="#fn:84"><sup>84</sup></a></li> <li><a href="/facts/Tinea_capitis/zJxfXcll">Tinea capitis</a> and <a href="/facts/Tinea_corporis/XSJeruaC">tinea corporis</a><a class="footnote-ref" id="fnref:85" href="#fn:85"><sup>85</sup></a></li> <li><a href="/facts/Candidiasis/gklGEfuq">Candidiasis</a><a class="footnote-ref" id="fnref:86" href="#fn:86"><sup>86</sup></a></li> <li><a href="/facts/Tinea_versicolor/y4wzgMrl">Tinea versicolor</a><a class="footnote-ref" id="fnref:87" href="#fn:87"><sup>87</sup></a></li> <li><a href="/facts/Pityriasis_rosea/MKaEnA0C">Pityriasis rosea</a><a class="footnote-ref" id="fnref:88" href="#fn:88"><sup>88</sup></a></li> <li><a href="/facts/Impetigo/hDuv14qE">Impetigo</a><a class="footnote-ref" id="fnref:89" href="#fn:89"><sup>89</sup></a></li> <li><a href="/facts/Adverse_drug_reaction/Ea0ktF6J">Drug reaction</a><a class="footnote-ref" id="fnref:90" href="#fn:90"><sup>90</sup></a></li> <li><a href="/facts/Cutaneous_T-cell_lymphoma/gVeNtJ9N">Cutaneous T-Cell Lymphoma</a><a class="footnote-ref" id="fnref:91" href="#fn:91"><sup>91</sup></a></li></ul> <h2 id="management">Management</h2> <h3>Medications</h3> <p>A variety of different types of medications are able to reduce symptoms of seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:92" href="#fn:92"><sup>92</sup></a> These include certain <a href="/facts/Antifungal_medication/WEk5nS2B">antifungals</a>, <a href="/facts/Anti-inflammatory_agent/W27poSUd">anti-inflammatory agents</a> like <a href="/facts/Corticosteroid/jeL2QeIL">corticosteroids</a> and <a href="/facts/Nonsteroidal_anti-inflammatory_drug/coIkzl4s">nonsteroidal anti-inflammatory drugs</a>, <a href="/facts/Antiandrogen/AfyGmnAs">antiandrogens</a>, and <a href="/facts/Antihistamine/HuMC25lt">antihistamines</a>, among others.<a class="footnote-ref" id="fnref:93" href="#fn:93"><sup>93</sup></a><a class="footnote-ref" id="fnref:94" href="#fn:94"><sup>94</sup></a> Treatments must take into consideration potential side effects, especially with long-term use given the chronic nature of seborrhoeic dermatitis.[<i>neutrality is disputed</i>] Initial therapy is usually a topical preparation with an agreeable side effect profile.<a class="footnote-ref" id="fnref:95" href="#fn:95"><sup>95</sup></a> </p> <h4>Antifungals</h4> <p>Regular use of an <a href="/facts/Over-the-counter/QI3FcgRf">over-the-counter</a> or prescription <a href="/facts/Antifungal/WEk5nS2B">antifungal</a> <a href="/facts/Shampoo/ww9bFmT2">shampoo</a> or <a href="/facts/Cream/3zSQTkuK">cream</a> is a common treatment. The topical antifungal medications <a href="/facts/Ketoconazole/UQcvnER5">ketoconazole</a> and <a href="/facts/Ciclopirox/5GrxTMm1">ciclopirox</a> have the best evidence.<a class="footnote-ref" id="fnref:96" href="#fn:96"><sup>96</sup></a> Ketoconazole should be used twice per week.<a class="footnote-ref" id="fnref:97" href="#fn:97"><sup>97</sup></a> Shampoo or soap containing <a href="/facts/Zinc_pyrithione/KbheQdyH">zinc pyrithione</a> or <a href="/facts/Selenium_disulfide/SHzUNLyd">selenium disulfide</a> is also used.<a class="footnote-ref" id="fnref:98" href="#fn:98"><sup>98</sup></a> These options should be used on a daily basis but may also be used in conjunction with a ketoconazole shampoo regimen on alternate days.<a class="footnote-ref" id="fnref:99" href="#fn:99"><sup>99</sup></a> It is unclear if other antifungals are equally effective as this has not been sufficiently studied.<a class="footnote-ref" id="fnref:100" href="#fn:100"><sup>100</sup></a> Antifungals that have been studied and found to be effective in the treatment of seborrhoeic dermatitis include <a href="/facts/Ketoconazole/UQcvnER5">ketoconazole</a>, <a href="/facts/Fluconazole/UYpk9mKl">fluconazole</a>, <a href="/facts/Miconazole/PjA5UgFB">miconazole</a>, <a href="/facts/Bifonazole/GoRjU3vU">bifonazole</a>, <a href="/facts/Sertaconazole/m8cHLtC7">sertaconazole</a>, <a href="/facts/Clotrimazole/SRY1jAW9">clotrimazole</a>, <a href="/facts/Flutrimazole/btxIqodf">flutrimazole</a>, <a href="/facts/Ciclopirox/5GrxTMm1">ciclopirox</a>, <a href="/facts/Terbinafine/7qBCjoYW">terbinafine</a>, <a href="/facts/Butenafine/LrjCcy7L">butenafine</a>, <a href="/facts/Selenium_disulfide/SHzUNLyd">selenium disulfide</a>, and <a href="/facts/Lithium_(medication)/G6Gy0nJU">lithium salts</a> such as <a href="/facts/Lithium_gluconate/G6Gy0nJU">lithium gluconate</a> and <a href="/facts/Lithium_succinate/mWGnewzQ">lithium succinate</a>.<a class="footnote-ref" id="fnref:101" href="#fn:101"><sup>101</sup></a><a class="footnote-ref" id="fnref:102" href="#fn:102"><sup>102</sup></a> </p><p>Topical <a href="/facts/Climbazole/wwP50tCq">climbazole</a> appears to have little effectiveness in the treatment of seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:103" href="#fn:103"><sup>103</sup></a> Systemic therapy with oral antifungals including <a href="/facts/Itraconazole/x7IeB92o">itraconazole</a>, <a href="/facts/Fluconazole/UYpk9mKl">fluconazole</a>, <a href="/facts/Ketoconazole/UQcvnER5">ketoconazole</a> is effective, but adverse side effects have been documented for <a href="/facts/Fluconazole/UYpk9mKl">fluconazole</a> and <a href="/facts/Ketoconazole/UQcvnER5">ketoconazole</a>, with the latter not recommended for use, while <a href="/facts/Itraconazole/x7IeB92o">itraconazole</a>, with its good safety profile, is the most commonly prescribed.<a class="footnote-ref" id="fnref:104" href="#fn:104"><sup>104</sup></a> <a href="/facts/Terbinafine/7qBCjoYW">Terbinafine</a> is said to be effective, but with adverse side effects, while other sources state it is not effective and should not be used.<a class="footnote-ref" id="fnref:105" href="#fn:105"><sup>105</sup></a><a class="footnote-ref" id="fnref:106" href="#fn:106"><sup>106</sup></a> </p> <h4>Anti-inflammatory treatments</h4> <p>Topical <a href="/facts/Corticosteroid/jeL2QeIL">corticosteroids</a> have been shown to be effective in short-term treatment of seborrhoeic dermatitis and are as effective or more effective than antifungal treatment with <a href="/facts/Azole/Nj3CWSM2">azoles</a>. These sometimes are used for only a few weeks at a time.<a class="footnote-ref" id="fnref:107" href="#fn:107"><sup>107</sup></a>[<i>additional citation(s) needed</i>] There is also evidence for the effectiveness of topical <a href="/facts/Calcineurin_inhibitor/ctlB3Hda">calcineurin inhibitors</a> like <a href="/facts/Tacrolimus/Apj3X5S6">tacrolimus</a> and <a href="/facts/Pimecrolimus/RVtEK3Dk">pimecrolimus</a> as well as <a href="/facts/Lithium_(medication)/G6Gy0nJU">lithium salt</a> therapy.<a class="footnote-ref" id="fnref:108" href="#fn:108"><sup>108</sup></a> Calcineurin inhibitors were also effective in reducing growth of Malassezia, offering two routes by which they may treat seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:109" href="#fn:109"><sup>109</sup></a> Medications such as the calcineurin inhibitors should not be used in individuals with seborrhoeic dermatitis who are immune compromised because they cause further immune suppression.<a class="footnote-ref" id="fnref:110" href="#fn:110"><sup>110</sup></a> </p><p>Oral immunosuppressive treatment, such as with <a href="/facts/Prednisone/eGgPIauI">prednisone</a>, has been used in short courses for seborrhoeic dermatitis, as a last resort due to its potential side effects.<a class="footnote-ref" id="fnref:111" href="#fn:111"><sup>111</sup></a> </p> <h4>Antihistamines</h4> <p><a href="/facts/Antihistamine/HuMC25lt">Antihistamines</a> are used primarily to reduce <a href="/facts/Itching/MBWq6SPc">itching</a>, if present. However, research studies suggest that some antihistamines have anti-inflammatory properties.<a class="footnote-ref" id="fnref:112" href="#fn:112"><sup>112</sup></a> </p> <h4>Keratolytics</h4> <p><a href="/facts/Keratolytic/hEtMwHCa">Keratolytics</a> help the skin via exfoliation built-up skin flakes and thereby remove scale. They are applied topically to the affected area. Keratolytics include <a href="/facts/Urea/6j84AoCG">urea</a>, <a href="/facts/Salicylic_acid/qz7RRQCR">salicylic acid</a>, <a href="/facts/Coal_tar/6lLDL4Ic">coal tar</a>, <a href="/facts/Lactic_acid/BsVRFx7s">lactic acid</a>, pyrithione zinc and propylene glycol.<a class="footnote-ref" id="fnref:113" href="#fn:113"><sup>113</sup></a> <a href="/facts/Coal_tar/6lLDL4Ic">Coal tar</a> shampoo formulations can be effective.<a class="footnote-ref" id="fnref:114" href="#fn:114"><sup>114</sup></a><a class="footnote-ref" id="fnref:115" href="#fn:115"><sup>115</sup></a> Although no significant increased risk of cancer in human treatment with coal tar shampoos has been found, caution is advised since coal tar is <a href="/facts/Carcinogenic/soH8Y9CE">carcinogenic</a> in animals, and heavy human occupational exposures do increase cancer risks.<a class="footnote-ref" id="fnref:116" href="#fn:116"><sup>116</sup></a> </p> <h4>Other treatments</h4> <ul><li><a href="/facts/Isotretinoin/XBKv4fQJ">Isotretinoin</a>, a sebosuppressive agent, may be used to reduce sebaceous gland activity as a last resort in <a href="/facts/Flareup/55eeQlGL">refractory disease</a>.<a class="footnote-ref" id="fnref:117" href="#fn:117"><sup>117</sup></a> However, isotretinoin has potentially serious side effects, and few patients with seborrhoeic dermatitis are appropriate candidates for therapy.<a class="footnote-ref" id="fnref:118" href="#fn:118"><sup>118</sup></a></li> <li>Topical 0.75% and 1% <a href="/facts/Metronidazole/pY5K5twk">Metronidazole</a><a class="footnote-ref" id="fnref:119" href="#fn:119"><sup>119</sup></a><a class="footnote-ref" id="fnref:120" href="#fn:120"><sup>120</sup></a></li> <li>Topical 4% <a href="/facts/Nicotinamide/5GQcLC5K">nicotinamide</a><a class="footnote-ref" id="fnref:121" href="#fn:121"><sup>121</sup></a></li> <li>Topical <a href="/facts/Sulfacetamide/sulfur/58V76NEa">sulfacetamide</a><a class="footnote-ref" id="fnref:122" href="#fn:122"><sup>122</sup></a></li> <li>Tea tree oil<a class="footnote-ref" id="fnref:123" href="#fn:123"><sup>123</sup></a></li> <li>Cannabidiol shampoo<a class="footnote-ref" id="fnref:124" href="#fn:124"><sup>124</sup></a></li> <li>Frequent washing to avoid the build-up of scale, especially on the scalp, but while avoiding overly drying the skin<a class="footnote-ref" id="fnref:125" href="#fn:125"><sup>125</sup></a><a class="footnote-ref" id="fnref:126" href="#fn:126"><sup>126</sup></a><a class="footnote-ref" id="fnref:127" href="#fn:127"><sup>127</sup></a></li> <li>Avoiding damaging skin with harsh grooming or chemical irritants<a class="footnote-ref" id="fnref:128" href="#fn:128"><sup>128</sup></a></li> <li>Bicalutamide, an antiandrogen, has been observed in one patient to have potentially been the cause of seborrheic dermatitis relief. However, even if it were demonstrated that bicalutamide or any other antiandrogen is a treatment, it is not recommended due to side effects and price.<a class="footnote-ref" id="fnref:129" href="#fn:129"><sup>129</sup></a></li></ul> <h3>Phototherapy</h3> <p class="note">See also: <a href="/facts/Photodynamic_therapy/qHIQzT5K">Photodynamic therapy</a></p> <p>Another option is natural and artificial <a href="/facts/Ultraviolet_radiation/kncBUqn5">UV radiation</a> since it can inhibit the growth of <i><a href="/facts/Malassezia/3uoNQqbL">Malassezia</a></i> yeast.<a class="footnote-ref" id="fnref:130" href="#fn:130"><sup>130</sup></a> Some recommend <a href="/facts/Photodynamic_therapy/qHIQzT5K">photodynamic therapy</a> using <a href="/facts/UV-A/kncBUqn5">UV-A</a> and <a href="/facts/UV-B/kncBUqn5">UV-B</a> laser or red and blue <a href="/facts/LED/gE8x4MDb">LED</a> light to inhibit the growth of <i>Malassezia</i> fungus and reduce seborrhoeic inflammation.<a class="footnote-ref" id="fnref:131" href="#fn:131"><sup>131</sup></a><a class="footnote-ref" id="fnref:132" href="#fn:132"><sup>132</sup></a><a class="footnote-ref" id="fnref:133" href="#fn:133"><sup>133</sup></a> </p> <h2 id="outcome">Outcome</h2> <p>Seborrhoeic dermatitis is generally a chronic and recurring condition. Individuals may have the condition for several weeks to months, but it may also last years or their lifetime. There may be periods of relapse and worsening.<a class="footnote-ref" id="fnref:134" href="#fn:134"><sup>134</sup></a><a class="footnote-ref" id="fnref:135" href="#fn:135"><sup>135</sup></a> </p> <h2 id="epidemiology">Epidemiology</h2> <p>Seborrhoeic dermatitis affects 1 to 5% of the general population.<a class="footnote-ref" id="fnref:136" href="#fn:136"><sup>136</sup></a><a class="footnote-ref" id="fnref:137" href="#fn:137"><sup>137</sup></a><a class="footnote-ref" id="fnref:138" href="#fn:138"><sup>138</sup></a> It is slightly more common in men, but affected women tend to have more severe symptoms.<a class="footnote-ref" id="fnref:139" href="#fn:139"><sup>139</sup></a> The condition usually recurs throughout a person's lifetime.<a class="footnote-ref" id="fnref:140" href="#fn:140"><sup>140</sup></a> Seborrhoeic dermatitis can occur in any age group<a class="footnote-ref" id="fnref:141" href="#fn:141"><sup>141</sup></a> but often occurs during the first three months of life then again at puberty and peaks in incidence at around 40 years of age.<a class="footnote-ref" id="fnref:142" href="#fn:142"><sup>142</sup></a><a class="footnote-ref" id="fnref:143" href="#fn:143"><sup>143</sup></a> It can reportedly affect as many as 31% of older people.<a class="footnote-ref" id="fnref:144" href="#fn:144"><sup>144</sup></a> Infants may also have this condition, though it is typically milder, and is referred to as <a href="/facts/Cradle_cap/AzVMmS3f">cradle cap</a>.<a class="footnote-ref" id="fnref:145" href="#fn:145"><sup>145</sup></a> Seborrhoeic dermatitis is more common in African-Americans.<a class="footnote-ref" id="fnref:146" href="#fn:146"><sup>146</sup></a> </p><p>Severity is worse in dry climates<a class="footnote-ref" id="fnref:147" href="#fn:147"><sup>147</sup></a> as well as hot weather as dry skin can exacerbate the condition.<a class="footnote-ref" id="fnref:148" href="#fn:148"><sup>148</sup></a> <a href="/facts/COVID-19/YsUgvsaX">COVID-19</a> related mask usage may also cause or exacerbate facial seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:149" href="#fn:149"><sup>149</sup></a> </p><p>Individuals who are immune compromised have increased risk of seborrhoeic dermatitis.<a class="footnote-ref" id="fnref:150" href="#fn:150"><sup>150</sup></a> Conditions that are associated with increased rates of seborrhoeic dermatitis include individuals with HIV, <a href="/facts/Hepatitis_C/kwb7IIht">Hepatitis C</a>, alcoholic pancreatitis, <a href="/facts/Parkinson%27s_disease/xpekKj6x">Parkinson's disease</a>, and alcohol abuse.<a class="footnote-ref" id="fnref:151" href="#fn:151"><sup>151</sup></a> Seborrhoeic dermatitis is common in people with alcoholism, between 7 and 11 percent, which is twice the normal expected occurrence.<a class="footnote-ref" id="fnref:152" href="#fn:152"><sup>152</sup></a> </p> <h2 id="external-links">External links</h2> <p> Media related to Seborrhoeic dermatitis at Wikimedia Commons </p> <h2 id="references">References</h2> <ol> <li id="fn:1"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></p></li> <li id="fn:2"><p>"Seborrheic Dermatitis - Dermatologic Disorders". Merck Manuals Professional Edition. Archived from the original on 26 January 2020. Retrieved 22 November 2019. <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis" target="_blank">https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></p></li> <li id="fn:3"><p>Borda LJ, Perper M, Keri JE (March 2019). "Treatment of seborrheic dermatitis: a comprehensive review". The Journal of Dermatological Treatment. 30 (2): 158–169. doi:10.1080/09546634.2018.1473554. PMID 29737895. S2CID 13686180. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></p></li> <li id="fn:4"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></p></li> <li id="fn:5"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></p></li> <li id="fn:6"><p>"Seborrheic Dermatitis - Dermatologic Disorders". Merck Manuals Professional Edition. Archived from the original on 26 January 2020. Retrieved 22 November 2019. <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis" target="_blank">https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></p></li> <li id="fn:7"><p>Naldi L, Diphoorn J (May 2015). "Seborrhoeic dermatitis of the scalp". BMJ Clinical Evidence. 2015. PMC 4445675. PMID 26016669. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></p></li> <li id="fn:8"><p>Naldi L, Diphoorn J (May 2015). "Seborrhoeic dermatitis of the scalp". BMJ Clinical Evidence. 2015. PMC 4445675. PMID 26016669. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></p></li> <li id="fn:9"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></p></li> <li id="fn:10"><p>"Seborrheic Dermatitis - Dermatologic Disorders". Merck Manuals Professional Edition. Archived from the original on 26 January 2020. Retrieved 22 November 2019. <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis" target="_blank">https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis</a> <a href="#fnref:10" class="footnote-back-ref">↩</a></p></li> <li id="fn:11"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:11" class="footnote-back-ref">↩</a></p></li> <li id="fn:12"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:12" class="footnote-back-ref">↩</a></p></li> <li id="fn:13"><p>Naldi L, Diphoorn J (May 2015). "Seborrhoeic dermatitis of the scalp". BMJ Clinical Evidence. 2015. PMC 4445675. PMID 26016669. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675</a> <a href="#fnref:13" class="footnote-back-ref">↩</a></p></li> <li id="fn:14"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:14" class="footnote-back-ref">↩</a></p></li> <li id="fn:15"><p>Naldi L, Diphoorn J (May 2015). "Seborrhoeic dermatitis of the scalp". BMJ Clinical Evidence. 2015. PMC 4445675. PMID 26016669. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445675</a> <a href="#fnref:15" class="footnote-back-ref">↩</a></p></li> <li id="fn:16"><p>"Seborrheic dermatitis". American Academy of Dermatology. Archived from the original on 21 October 2017. Retrieved 20 October 2017. <a href="https://www.aad.org/public/diseases/scaly-skin/seborrheic-dermatitis" target="_blank">https://www.aad.org/public/diseases/scaly-skin/seborrheic-dermatitis</a> <a href="#fnref:16" class="footnote-back-ref">↩</a></p></li> <li id="fn:17"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:17" class="footnote-back-ref">↩</a></p></li> <li id="fn:18"><p>Papadakis MA, McPhee SJ (2023). "Dermatitis, Seborrheic". Quick Medical Diagnosis & Treatment 2023 (2023 ed.). McGraw-Hill Education. ISBN 978-1-264-68734-3. <a href="978-1-264-68734-3" target="_blank">978-1-264-68734-3</a> <a href="#fnref:18" class="footnote-back-ref">↩</a></p></li> <li id="fn:19"><p>"Seborrheic Dermatitis: What is It, Diagnosis & Treatment". Cleveland, Ohio: Cleveland Clinic. Archived from the original on 17 October 2021. Retrieved 12 October 2021. <a href="https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis" target="_blank">https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis</a> <a href="#fnref:19" class="footnote-back-ref">↩</a></p></li> <li id="fn:20"><p>Borda LJ, Perper M, Keri JE (March 2019). "Treatment of seborrheic dermatitis: a comprehensive review". The Journal of Dermatological Treatment. 30 (2): 158–169. doi:10.1080/09546634.2018.1473554. PMID 29737895. S2CID 13686180. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:20" class="footnote-back-ref">↩</a></p></li> <li id="fn:21"><p>Okokon EO, Verbeek JH, Ruotsalainen JH, Ojo OA, Bakhoya VN (May 2015). Okokon EO (ed.). "Topical antifungals for seborrhoeic dermatitis". The Cochrane Database of Systematic Reviews. 4 (5): CD008138. doi:10.1002/14651858.CD008138.pub3. PMC 4448221. PMID 25933684. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448221" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448221</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></p></li> <li id="fn:22"><p>Dinulos JG (2021). Habif's Clinical Dermatology, Seventh Edition (7th ed.). Elsevier Inc. ISBN 978-0-323-61269-2. <a href="978-0-323-61269-2" target="_blank">978-0-323-61269-2</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></p></li> <li id="fn:23"><p>"Seborrheic Dermatitis - Dermatologic Disorders". Merck Manuals Professional Edition. Archived from the original on 26 January 2020. Retrieved 22 November 2019. <a href="https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis" target="_blank">https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></p></li> <li id="fn:24"><p>Ijaz N, Fitzgerald D (June 2017). "Seborrhoeic dermatitis". British Journal of Hospital Medicine. 78 (6): C88 – C91. doi:10.12968/hmed.2017.78.6.C88. PMID 28614013. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></p></li> <li id="fn:25"><p>Nobles T, Harberger S, Krishnamurthy K (August 2021). "Cradle Cap". StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. PMID 30285358. Archived from the original on 21 January 2021. Retrieved 26 February 2022. <a href="https://www.ncbi.nlm.nih.gov/books/NBK531463/" target="_blank">https://www.ncbi.nlm.nih.gov/books/NBK531463/</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></p></li> <li id="fn:26"><p>Jackson JM, Alexis A, Zirwas M, Taylor S (December 2022). "Unmet needs for patients with seborrheic dermatitis". Journal of the American Academy of Dermatology. 90 (3): S0190–9622(22)03307–2. doi:10.1016/j.jaad.2022.12.017. PMID 36538948. S2CID 254843412. <a href="https://doi.org/10.1016%2Fj.jaad.2022.12.017" target="_blank">https://doi.org/10.1016%2Fj.jaad.2022.12.017</a> <a href="#fnref:26" class="footnote-back-ref">↩</a></p></li> <li id="fn:27"><p>Dinulos JG (2021). Habif's Clinical Dermatology, Seventh Edition (7th ed.). Elsevier Inc. ISBN 978-0-323-61269-2. <a href="978-0-323-61269-2" target="_blank">978-0-323-61269-2</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></p></li> <li id="fn:28"><p>Jackson JM, Alexis A, Zirwas M, Taylor S (December 2022). "Unmet needs for patients with seborrheic dermatitis". Journal of the American Academy of Dermatology. 90 (3): S0190–9622(22)03307–2. doi:10.1016/j.jaad.2022.12.017. PMID 36538948. S2CID 254843412. <a href="https://doi.org/10.1016%2Fj.jaad.2022.12.017" target="_blank">https://doi.org/10.1016%2Fj.jaad.2022.12.017</a> <a href="#fnref:28" class="footnote-back-ref">↩</a></p></li> <li id="fn:29"><p>Dinulos JG (2021). Habif's Clinical Dermatology, Seventh Edition (7th ed.). Elsevier Inc. ISBN 978-0-323-61269-2. <a href="978-0-323-61269-2" target="_blank">978-0-323-61269-2</a> <a href="#fnref:29" class="footnote-back-ref">↩</a></p></li> <li id="fn:30"><p>Papadakis MA, McPhee SJ (2023). "Dermatitis, Seborrheic". Quick Medical Diagnosis & Treatment 2023 (2023 ed.). McGraw-Hill Education. ISBN 978-1-264-68734-3. <a href="978-1-264-68734-3" target="_blank">978-1-264-68734-3</a> <a href="#fnref:30" class="footnote-back-ref">↩</a></p></li> <li id="fn:31"><p>Papadakis MA, McPhee SJ (2023). "Dermatitis, Seborrheic". Quick Medical Diagnosis & Treatment 2023 (2023 ed.). McGraw-Hill Education. ISBN 978-1-264-68734-3. <a href="978-1-264-68734-3" target="_blank">978-1-264-68734-3</a> <a href="#fnref:31" class="footnote-back-ref">↩</a></p></li> <li id="fn:32"><p>Jackson JM, Alexis A, Zirwas M, Taylor S (December 2022). "Unmet needs for patients with seborrheic dermatitis". Journal of the American Academy of Dermatology. 90 (3): S0190–9622(22)03307–2. doi:10.1016/j.jaad.2022.12.017. PMID 36538948. S2CID 254843412. <a href="https://doi.org/10.1016%2Fj.jaad.2022.12.017" target="_blank">https://doi.org/10.1016%2Fj.jaad.2022.12.017</a> <a href="#fnref:32" class="footnote-back-ref">↩</a></p></li> <li id="fn:33"><p>Papadakis MA, McPhee SJ (2023). "Dermatitis, Seborrheic". Quick Medical Diagnosis & Treatment 2023 (2023 ed.). McGraw-Hill Education. ISBN 978-1-264-68734-3. <a href="978-1-264-68734-3" target="_blank">978-1-264-68734-3</a> <a href="#fnref:33" class="footnote-back-ref">↩</a></p></li> <li id="fn:34"><p>Dinulos JG (2021). Habif's Clinical Dermatology, Seventh Edition (7th ed.). Elsevier Inc. ISBN 978-0-323-61269-2. <a href="978-0-323-61269-2" target="_blank">978-0-323-61269-2</a> <a href="#fnref:34" class="footnote-back-ref">↩</a></p></li> <li id="fn:35"><p>Dinulos JG (2021). Habif's Clinical Dermatology, Seventh Edition (7th ed.). Elsevier Inc. ISBN 978-0-323-61269-2. <a href="978-0-323-61269-2" target="_blank">978-0-323-61269-2</a> <a href="#fnref:35" class="footnote-back-ref">↩</a></p></li> <li id="fn:36"><p>Dinulos JG (2021). Habif's Clinical Dermatology, Seventh Edition (7th ed.). Elsevier Inc. 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