View source for Seborrhoeic dermatitis

{{Short description|Skin disease}}
{{distinguish|Seborrhoeic keratosis}}
{{Use dmy dates|date=November 2024}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Infobox medical condition
| name = Seborrhoeic dermatitis
| image = Seborrhoeic dermatitis highres.jpg
| width = 
| caption = Seborrhoeic dermatitis of the face
| field = [[Dermatology]]
| synonyms = Sebopsoriasis, seborrhoeic eczema, pityriasis capitis<ref name=Des201ca3 />
| symptoms = Flaking, dry or greasy, red, itchy, and inflamed skin<ref name=Mer2019/><ref name=Bor2019/>
| complications = 
| onset = 
| duration = Several weeks to lifelong<ref name=Ij2017/>
| types = 
| causes = Multiple factors<ref name=Ij2017/>
| risks = [[psychological stress|Stress]], dry skin or excessive sebum, winter, [[immunocompromised|poor immune function]], [[Parkinson disease]],<ref name=Ij2017/> genetics
| diagnosis = Based on symptoms<ref name=Ij2017/>
| differential = [[Psoriasis]], [[atopic dermatitis]], [[tinea capitis]], [[rosacea]], [[systemic lupus erythematosus]]<ref name=Ij2017/>
| prevention = 
| treatment = [[Humidifier]]
| medication = [[antifungal medications|Antifungal cream]], [[anti-inflammatory agents]], [[coal tar]], [[phototherapy]]<ref name=Bor2019/>
| prognosis = 
| frequency = ~5% (adults),<ref name=Ij2017/> ~10% (babies)<ref name=Stat2019/>
| deaths = 
}}
[[File:Cradle cap new photo help in diagnosis.jpg|thumb|Cradle cap, which is seborrhoeic dermatitis of the infant scalp]]<!-- Definition and symptoms -->
'''Seborrhoeic dermatitis''' (also spelled '''seborrheic dermatitis''' in American English) is a long-term [[skin disorder]].<ref name="Ij2017" /> Symptoms include flaky, scaly, greasy, and occasionally itchy and inflamed skin.<ref name="Mer2019" /><ref name="Bor2019" /> Areas of the skin rich in [[sebum|oil]]-producing [[gland]]s are often affected including the [[scalp]], face, and chest.<ref name="Ij2017" /> It can result in social or self-esteem problems.<ref name="Ij2017" /> In babies, when the scalp is primarily involved, it is called [[cradle cap]].<ref name="Mer2019" /> Mild seborrhoeic dermatitis of the scalp may be described in lay terms as [[dandruff]] due to the dry, flaky character of the skin.<ref name="BMJ2015" /> However, as dandruff may refer to any dryness or scaling of the scalp, not all dandruff is seborrhoeic dermatitis.<ref name="BMJ2015" />  Seborrhoeic dermatitis is sometimes inaccurately referred to as [[seborrhoea]].<ref name="Ij2017" />

<!-- Cause and diagnosis -->
The cause is unclear but believed to involve a number of genetic and environmental factors.<ref name=Mer2019>{{cite web |title=Seborrheic Dermatitis - Dermatologic Disorders |url=https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis |website=Merck Manuals Professional Edition |access-date=22 November 2019 |archive-date=26 January 2020 |archive-url=https://web.archive.org/web/20200126133903/https://www.merckmanuals.com/professional/dermatologic-disorders/dermatitis/seborrheic-dermatitis |url-status=live }}</ref><ref name=Ij2017/> Risk factors for seborrhoeic dermatitis include [[immunocompromised|poor immune function]], [[Parkinson's disease]], and [[alcoholic pancreatitis]].<ref name=Ij2017/><ref name=BMJ2015/> The condition may worsen with [[psychological stress|stress]] or during the winter.<ref name=Ij2017/> ''[[Malassezia]]'' yeast is believed to play a role.<ref name=BMJ2015>{{cite journal | vauthors = Naldi L, Diphoorn J | title = Seborrhoeic dermatitis of the scalp | journal = BMJ Clinical Evidence | volume = 2015 | date = May 2015 | pmid = 26016669 | pmc = 4445675 }}</ref> It is not a result of poor [[hygiene]].<ref>{{cite web|title=Seborrheic dermatitis|url=https://www.aad.org/public/diseases/scaly-skin/seborrheic-dermatitis|website=American Academy of Dermatology|access-date=20 October 2017|url-status=live|archive-url=https://web.archive.org/web/20171021060831/https://www.aad.org/public/diseases/scaly-skin/seborrheic-dermatitis|archive-date=21 October 2017}}</ref> Diagnosis is typically clinical and based on the symptoms present.<ref name=Ij2017/><ref name=":2" /> The condition is not [[Contagious disease|contagious]].<ref>{{Cite web | url = https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis | title = Seborrheic Dermatitis: What is It, Diagnosis & Treatment | publisher = Cleveland Clinic | location = Cleveland, Ohio | access-date = 2021-10-12 | archive-date = 2021-10-17 | archive-url = https://web.archive.org/web/20211017232734/https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis | url-status = live }}</ref>

<!-- Treatment -->
The typical treatment is topical [[antifungal medications|antifungal cream]] and [[anti-inflammatory agents]].<ref name=Bor2019>{{cite journal | vauthors = Borda LJ, Perper M, Keri JE | title = Treatment of seborrheic dermatitis: a comprehensive review | journal = The Journal of Dermatological Treatment | volume = 30 | issue = 2 | pages = 158–169 | date = March 2019 | pmid = 29737895 | doi = 10.1080/09546634.2018.1473554 | s2cid = 13686180 }}</ref> Specifically, [[ketoconazole]] or [[ciclopirox]] are effective.<ref name=Ok2015>{{cite journal | vauthors = Okokon EO, Verbeek JH, Ruotsalainen JH, Ojo OA, Bakhoya VN | veditors = Okokon EO | title = Topical antifungals for seborrhoeic dermatitis | journal = The Cochrane Database of Systematic Reviews | volume = 4 | issue = 5 | article-number = CD008138 | date = May 2015 | pmid = 25933684 | pmc = 4448221 | doi = 10.1002/14651858.CD008138.pub3 }}</ref> Seborrhoeic dermatitis of the scalp is often treated with shampoo preparations of [[ketoconazole]], [[zinc pyrithione]], and [[selenium]].<ref name=":1" />

<!-- Epidemiology -->
The condition is common in infants within the first three months of age or adults aged 30 to 70 years.<ref name=Mer2019/><ref name=Ij2017>{{cite journal | vauthors = Ijaz N, Fitzgerald D | title = Seborrhoeic dermatitis | journal = British Journal of Hospital Medicine | volume = 78 | issue = 6 | pages = C88–C91 | date = June 2017 | pmid = 28614013 | doi = 10.12968/hmed.2017.78.6.C88 }}</ref><ref name=Stat2019>{{cite book | vauthors = Nobles T, Harberger S, Krishnamurthy K | chapter = Cradle Cap | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK531463/ | date = August 2021 | title = StatPearls [Internet] | location = Treasure Island (FL) | publisher = StatPearls Publishing | pmid = 30285358 | access-date = 2022-02-26 | archive-date = 2021-01-21 | archive-url = https://web.archive.org/web/20210121064801/https://www.ncbi.nlm.nih.gov/books/NBK531463/ | url-status = live }}</ref> It tends to affect more males.<ref name=":3">{{cite journal |vauthors=Jackson JM, Alexis A, Zirwas M, Taylor S |date=December 2022 |title=Unmet needs for patients with seborrheic dermatitis |journal=Journal of the American Academy of Dermatology |volume=90 |issue=3 |pages=S0190–9622(22)03307–2 |doi=10.1016/j.jaad.2022.12.017 |pmid=36538948 |s2cid=254843412 |doi-access=free}}</ref> Seborrhoeic dermatitis is more common in African Americans, among immune-compromised individuals, such as those with HIV, and individuals with [[Parkinson's disease]].<ref name=":1" /><ref name=":3" />
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==Signs and symptoms==
[[File:Sequeira Plate 18.jpg|thumb|Seborrhoeic dermatitis on upper face/head]]
[[File:Sequeira Plate 19.jpg|thumb|Seborrhoeic dermatitis on the shoulder]]
[[File:Dermatitis of eyelids.jpg|thumb|Seborrhoeic dermatitis on eyelids]]
[[File:Riehl Zumbusch Tafel XLIV (1).jpg|thumb|Seborrhoeic dermatitis on the eyebrows and scalp]]
Seborrhoeic dermatitis typically appears as oily, yellowish, flaky skin. Although commonly associated with oily skin, it can also appear on dry scalps or skin, where the flaking may look similar to dandruff. The flakes can be fine, loose, and diffuse or thick and adherent.<ref name=":1">{{Cite book | vauthors = Dinulos JG |title=Habif's Clinical Dermatology, Seventh Edition |publisher=Elsevier Inc |year=2021 |isbn=978-0-323-61269-2 |edition=7th}}</ref><ref name=":2">{{Cite book | vauthors = Papadakis MA, McPhee SJ | title=Quick Medical Diagnosis & Treatment 2023 |publisher=McGraw-Hill Education |year=2023 |isbn=978-1-264-68734-3 |edition=2023 |chapter=Dermatitis, Seborrheic}}</ref> In addition to flaky skin, seborrhoeic dermatitis can have areas of red, rashy, inflamed, and itchy skin that coincide with the area of skin flaking, but not all individuals have this symptom.<ref name=":2" />

Seborrhoeic dermatitis of the scalp can appear similarly to dandruff.<ref name=":1" /> When the scalp is affected, there can be associated temporary hair loss.<ref name=":1" /> Such hair loss varies in appearance from diffuse thinning to patchy areas of hair loss.<ref name=":1" /> On close inspection, the locations where hair has thinned may have broken stubs of hair and pustules around the hair follicles.<ref name=":1" /> Individuals with more pigmented skin tones may experience increased or decreased skin pigmentation in affected areas.<ref name=":3" />

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 the underarms.<ref name=":1" />

Seborrhoeic dermatitis' symptoms are typically mild and appear gradually but are often persistent, lasting weeks to years.<ref name=":2" /><ref name=":1" /><ref name="merckmanuals">{{cite web|url=http://www.merckmanuals.com/home/skin_disorders/itching_and_noninfectious_rashes/dermatitis.html|title=Dermatitis|access-date=June 11, 2010|url-status=live|archive-url=https://web.archive.org/web/20110925051718/http://www.merckmanuals.com/home/skin_disorders/itching_and_noninfectious_rashes/dermatitis.html|archive-date=September 25, 2011}}</ref> Individuals with seborrhoeic dermatitis are subject to recurrent bouts and it may be a lifelong condition.<ref name=":2" /> Seborrhoeic dermatitis can also occur quickly and severely in patients with [[HIV|Human Immunodeficiency Virus]] (HIV). This is sometimes the first indication of HIV.<ref name=":3" />

==Causes==
The cause of seborrhoeic dermatitis has not been fully clarified as of 2019.<ref name=Des2013>{{cite journal | vauthors = Dessinioti C, Katsambas A | title = Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies | journal = Clinics in Dermatology | volume = 31 | issue = 4 | pages = 343–351 | date = Jul–Aug 2013 | pmid = 23806151 | doi = 10.1016/j.clindermatol.2013.01.001 }}</ref><ref name="pmid31310695">{{cite journal | vauthors = Wikramanayake TC, Borda LJ, Miteva M, Paus R | title = Seborrheic dermatitis-Looking beyond Malassezia | journal = Experimental Dermatology | volume = 28 | issue = 9 | pages = 991–1001 | date = September 2019 | pmid = 31310695 | doi = 10.1111/exd.14006 | doi-access = free }}</ref>

In addition to the presence of ''Malassezia'', genetic, environmental, hormonal, and immune-system factors are necessary for and/or modulate the expression of seborrhoeic dermatitis.<ref name=pmid10821151>{{cite journal | vauthors = Johnson BA, Nunley JR | title = Treatment of seborrheic dermatitis | journal = American Family Physician | volume = 61 | issue = 9 | pages = 2703–10, 2713–4 | date = May 2000 | pmid = 10821151 | url = http://www.aafp.org/afp/20000501/2703.html | url-status = live | archive-url = https://web.archive.org/web/20100706024200/http://www.aafp.org/afp/20000501/2703.html | archive-date = 2010-07-06 }}</ref><ref>{{cite journal | vauthors = Janniger CK, Schwartz RA | title = Seborrheic dermatitis | journal = American Family Physician | volume = 52 | issue = 1 | pages = 149–55, 159–60 | date = July 1995 | pmid = 7604759 }}</ref> The condition may be aggravated by illness, psychological stress, fatigue, sleep deprivation, change of season, and reduced general health.<ref name="aafp" />

===Fungi===
The condition is thought to be due to a local [[inflammatory response]] to overgrowth by ''[[Malassezia]]'' [[fungi]] species in [[sebum]]-producing [[skin]] areas including the [[scalp]], [[face]], [[chest]], [[back]], [[underarm]]s, and [[groin]].<ref name="Bor2019" /><ref name="pmid31310695" /> This is based on observations of high counts of ''Malassezia'' species in skin affected by seborrhoeic dermatitis and on the effectiveness of [[antifungal]]s in treating the condition.<ref name="pmid31310695" /> Species of ''Malassezia''  implicated in Seborrhoeic dermatitis include ''[[M. furfur]]'' (formerly ''[[Pityrosporum ovale]]''), ''[[M. globosa]]'', ''[[M. restricta]]'', ''[[M. sympodialis]]'', and ''[[M. slooffiae]]''.<ref name="Bor2019" />

''Malassezia'' appears to be a significant factor in seborrhoeic dermatitis, but it is thought that other factors are necessary for the presence of ''Malassezia'' to result in seborrhoeic dermatitis.<ref name="pmid31310695" /> For example, summer growth of ''Malassezia'' in the skin alone does not result in seborrhoeic dermatitis.<ref name="pmid31310695" /> Besides antifungals, the effectiveness of [[anti-inflammatory drug]]s, which reduce inflammation, and [[antiandrogen]]s, which reduce [[sebum]] production, provide further insights into the [[pathophysiology]] of seborrhoeic dermatitis.<ref name="Bor2019" /><ref name="TrivediShinkai2017">{{cite journal |vauthors=Trivedi MK, Shinkai K, Murase JE |date=March 2017 |title=A Review of hormone-based therapies to treat adult acne vulgaris in women |journal=International Journal of Women's Dermatology |volume=3 |issue=1 |pages=44–52 |doi=10.1016/j.ijwd.2017.02.018 |pmc=5419026 |pmid=28492054}}</ref><ref name="ParadisiFabbri2010">{{cite journal |vauthors=Paradisi R, Fabbri R, Porcu E, Battaglia C, Seracchioli R, Venturoli S |date=October 2011 |title=Retrospective, observational study on the effects and tolerability of flutamide in a large population of patients with acne and seborrhea over a 15-year period |journal=Gynecological Endocrinology |volume=27 |issue=10 |pages=823–829 |doi=10.3109/09513590.2010.526664 |pmid=21117864 |s2cid=20250916}}</ref>

=== Bacteria ===
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.<ref name=":4">{{cite journal | vauthors = Mangion SE, Mackenzie L, Roberts MS, Holmes AM | title = Seborrheic dermatitis: topical therapeutics and formulation design | journal = European Journal of Pharmaceutics and Biopharmaceutics | volume = 185 | pages = 148–164 | date = April 2023 | pmid = 36842718 | doi = 10.1016/j.ejpb.2023.01.023 | s2cid = 257214910 }}</ref><ref name=":3" />

=== Nutrition ===
Seborrhoeic dermatitis-like eruptions are also associated with pyridoxine ([[Vitamin B6 deficiency|vitamin B<sub>6</sub>]]) and riboflavin ([[Riboflavin|vitamin B<sub>2</sub>]]) deficiency.<ref>{{cite book | vauthors = Alamgir AN |title=Therapeutic Use of Medicinal Plants and their Extracts: Volume 2: Phytochemistry and Bioactive Compounds |date=2018 |publisher=Springer |isbn=978-3-319-92387-1 |page=435}}</ref><ref name=":2" /> In children and babies, issues with [[delta-6 desaturase|Δ<sup>6</sup>-desaturase]] [[enzyme]]s<ref name="aafp">{{cite journal | vauthors = Schwartz RA, Janusz CA, Janniger CK | title = Seborrheic dermatitis: an overview | journal = American Family Physician | volume = 74 | issue = 1 | pages = 125–130 | date = July 2006 | pmid = 16848386 | url = http://www.aafp.org/link_out?pmid=16848386 | access-date = 2010-04-15 | archive-date = 2020-01-26 | archive-url = https://web.archive.org/web/20200126133858/https://www.aafp.org/link_out%3Fpmid%3D16848386 }}</ref> have been correlated with increased risk.

=== Immune dysfunction ===
Those with [[immunodeficiency]] (especially [[infection]] with [[HIV]]) and with [[neurological disorder]]s that may impact immune system function such as [[Parkinson's disease]] (for which the condition is an [[Signs and symptoms of Parkinson's disease#Autonomic|autonomic sign]]) and [[stroke]] are particularly prone to it.<ref>{{cite web |url=http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html |title=Seborrhoeic dermatitis and dandruff (seborrheic eczema). DermNet NZ |publisher=. DermNet NZ |date=2012-03-20 |access-date=2012-06-10 |url-status=live |archive-url=https://web.archive.org/web/20120615003138/http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html |archive-date=2012-06-15 }}</ref>{{Unreliable medical source|date=November 2024}}

===Climate===
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 [[humidity]] and low [[temperature]] are responsible for the high frequency of seborrheic dermatitis.<ref>{{cite journal | vauthors = Araya M, Kulthanan K, Jiamton S | title = Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country | journal = Indian Journal of Dermatology | volume = 60 | issue = 5 | page = 519 | date = September 2015 | pmid = 26538714 | pmc = 4601435 | doi = 10.4103/0019-5154.164410 | doi-access = free }}</ref> Others suggest hot environments may also worsen seborrhoeic dermatitis.<ref name=":3" /> Yet another described that high humidity and low UV exposure are culpable.<ref name=":5">{{cite journal | vauthors = Leroy AK, Cortez de Almeida RF, Obadia DL, Frattini S, Melo DF | title = Scalp Seborrheic Dermatitis: What We Know So Far | journal = Skin Appendage Disorders | volume = 9 | issue = 3 | pages = 160–164 | date = June 2023 | pmid = 37325288 | pmc = 10264915 | doi = 10.1159/000529854 }}</ref> Dry skin and an impaired skin barrier contribute to the condition.<ref name=":3" /><ref name=":4" /> It is likely that climate and weather variations affect the water and lipid content of skin.<ref name=":4" />

== Mechanism ==
Seborrhoeic dermatitis is a complex condition with many interacting factors that are not yet fully explained.<ref name="pmid31310695" /> In general, the major factors that influence the development and severity include ''Malassezia'' yeast present on and in the skin, skin production of oily sebum, and a subsequent inflammatory response against ''Malassezia'' and their byproducts.<ref name=":3" /> 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 microbe species inhabiting the skin.<ref name="pmid31310695" /><ref name=":3" />

A suggested series of events leading to seborrhoeic dermatitis is an initially 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.<ref name="pmid31310695" /> An alternative explanation is an increase in sebum production feeding an increase in the ''Malassezia'' population that instigates inflammation; the inflammation then causes cellular changes that damage the skin barrier. This barrier disruption then encourages additional ''Malassezia'' growth and inflammation and again worsens skin barrier function.<ref name=":3" />

== Diagnosis ==

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.<ref name=":2" /> However, seborrhoeic dermatitis may also be diagnosed with additional testing. The least invasive test is a visual inspection in the clinic using a [[Blacklight|Wood's Lamp]].<ref name=":1" /> A [[KOH test]] can also be used, where skin scraping of the affected skin may also be taken and prepared with [[potassium hydroxide]] (KOH) and visualized under a microscope to look for ''Malassezia'' or other microbiological cells. Additionally, a [[Microbiological culture|fungal culture]] of the affected skin may be taken to attempt to grow and identify the causative organism.<ref name=":1" />

=== Differential diagnosis ===
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.<ref name=":2" /><ref name=":1" />
* [[Atopic dermatitis]] (eczema)<ref name=":1" />
* [[Contact dermatitis]]<ref name=":2" />
* [[Psoriasis]]<ref name=":1" />
* [[Tinea capitis]] and [[tinea corporis]]<ref name=":2" />
* [[Candidiasis]]<ref name=":3" />
* [[Tinea versicolor]]<ref name=":2" />
* [[Pityriasis rosea]]<ref name=":2" />
* [[Impetigo]]<ref name=":3" />
* [[Adverse drug reaction|Drug reaction]]<ref name=":3" />
* [[Cutaneous T-cell lymphoma|Cutaneous T-Cell Lymphoma]]<ref name=":1" />

==Management==

===Medications===
A variety of different types of medications can reduce symptoms of seborrhoeic dermatitis.<ref name=Bor2019/> These include certain [[antifungal medication|antifungal]]s, [[anti-inflammatory agent]]s like [[corticosteroid]]s and [[nonsteroidal anti-inflammatory drug]]s, [[antiandrogen]]s, and [[antihistamine]]s, among others.<ref name=Bor2019/><ref name=Des2013 /> Treatments must take into consideration potential side effects, especially with long-term use given the chronic nature of seborrhoeic dermatitis.{{POV statement|date=July 2024}} Initial therapy is usually a topical preparation with an agreeable side effect profile.<ref name=":3" />

====Antifungals====
Regular use of an [[over-the-counter]] or prescription [[antifungal]] [[shampoo]] or [[cream]] is a common treatment. The topical antifungal medications [[ketoconazole]] and [[ciclopirox]] have the best evidence.<ref name="Ok2015" /> Ketoconazole should be used twice per week.<ref name=":2" /> Shampoo or soap containing [[zinc pyrithione]] or [[selenium disulfide]] is also used.<ref name=":2" /> These options should be used daily but may also be used in conjunction with a ketoconazole shampoo regimen on alternate days.<ref name=":2" /> It is unclear if other antifungals are equally effective, as this has not been sufficiently studied.<ref name="Ok2015" /> Antifungals that have been studied and found to be effective in the treatment of seborrhoeic dermatitis include [[ketoconazole]], [[fluconazole]], [[miconazole]], [[bifonazole]], [[sertaconazole]], [[clotrimazole]], [[flutrimazole]], [[ciclopirox]], [[terbinafine]], [[butenafine]], [[selenium disulfide]], and [[lithium (medication)|lithium salts]] such as [[lithium gluconate]] and [[lithium succinate]].<ref name="Ok2015" /><ref name=Bor2019/>

Topical [[climbazole]] appears to have little effectiveness in the treatment of seborrhoeic dermatitis.<ref name="Ok2015" /> Systemic therapy with oral antifungals including [[itraconazole]], [[fluconazole]], [[ketoconazole]] is effective, but adverse side effects have been documented for [[fluconazole]] and [[ketoconazole]], with the latter not recommended for use, while [[itraconazole]], with its good safety profile, is the most commonly prescribed.<ref name="Bor2019" /> [[Terbinafine]] is said to be effective, but with adverse side effects, while other sources state it is not effective and should not be used.<ref name="Bor2019" /><ref name=":1" />

====Anti-inflammatory treatments====
Topical [[corticosteroid]]s are effective in short-term treatment of seborrhoeic dermatitis and are as effective or more effective than antifungal treatment with [[azole]]s. These are sometimes used for only a few weeks at a time.<ref name=":1" />{{Additional citation needed|date=July 2024}} There is also evidence for the effectiveness of topical [[calcineurin inhibitor]]s like [[tacrolimus]] and [[pimecrolimus]] as well as [[lithium (medication)|lithium salt]] therapy.<ref>{{cite journal | vauthors = Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkkä J, Oravilahti T, Rannanheimo PK, Verbeek JH | title = Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp | journal = The Cochrane Database of Systematic Reviews | issue = 5 | article-number = CD009446 | date = May 2014 | volume = 2017 | pmid = 24838779 | pmc = 6483543 | doi = 10.1002/14651858.CD009446.pub2 }}</ref> Calcineurin inhibitors were also effective in reducing the growth of Malassezia, offering two routes by which they may treat seborrhoeic dermatitis.<ref name=":5" /> Medications such as calcineurin inhibitors should not be used in individuals with seborrhoeic dermatitis who are immune-compromised because they cause further immune suppression.<ref name=":1" />

Oral immunosuppressive treatment, such as with [[prednisone]], has been used in short courses for seborrhoeic dermatitis, as a last resort due to its potential side effects.<ref name="oral treatments"/>

====Antihistamines====
[[Antihistamine]]s are used primarily to reduce [[itching]], if present. However, research studies suggest that some antihistamines have anti-inflammatory properties.<ref>{{cite journal | vauthors = Grob JJ, Castelain M, Richard MA, Bonniol JP, Béraud V, Adhoute H, Guillou N, Bonerandi JJ | title = Antiinflammatory properties of cetirizine in a human contact dermatitis model. Clinical evaluation of patch tests is not hampered by antihistamines | journal = Acta Dermato-Venereologica | volume = 78 | issue = 3 | pages = 194–197 | date = May 1998 | pmid = 9602225 | doi = 10.1080/000155598441512 | doi-access = free }}</ref>

====Keratolytics====

[[Keratolytic]]s help the skin via exfoliation of built-up skin flakes and thereby remove scale. They are applied topically to the affected area. Keratolytics include [[urea]], [[salicylic acid]], [[coal tar]], [[lactic acid]], pyrithione zinc and propylene glycol.<ref name=":5" /> [[Coal tar]] shampoo formulations can be effective.<ref name=":2" /><ref name=":5" /> Although no significant increased risk of cancer in human treatment with coal tar shampoos have been found, caution is advised since coal tar is [[carcinogenic]] in animals, and heavy human occupational exposures do increase cancer risks.<ref>{{cite journal |vauthors=Roelofzen JH, Aben KK, Oldenhof UT, Coenraads PJ, Alkemade HA, van de Kerkhof PC, van der Valk PG, Kiemeney LA |date=April 2010 |title=No increased risk of cancer after coal tar treatment in patients with psoriasis or eczema |journal=The Journal of Investigative Dermatology |volume=130 |issue=4 |pages=953–961 |doi=10.1038/jid.2009.389 |pmid=20016499 |doi-access=free}}</ref>

====Other treatments====
* [[Isotretinoin]], a sebosuppressive agent, may be used to reduce sebaceous gland activity as a last resort in [[flareup|refractory disease]].<ref name=":0">{{cite journal | vauthors = de Souza Leão Kamamoto C, Sanudo A, Hassun KM, Bagatin E | title = Low-dose oral isotretinoin for moderate to severe seborrhea and seborrheic dermatitis: a randomized comparative trial | journal = International Journal of Dermatology | volume = 56 | issue = 1 | pages = 80–85 | date = January 2017 | pmid = 27778328 | doi = 10.1111/ijd.13408 | s2cid = 13049459 }}</ref> However, isotretinoin has potentially serious side effects, and few patients with seborrhoeic dermatitis are appropriate candidates for therapy.<ref name="oral treatments">{{cite journal | vauthors = Gupta AK, Richardson M, Paquet M | title = Systematic review of oral treatments for seborrheic dermatitis | journal = Journal of the European Academy of Dermatology and Venereology | volume = 28 | issue = 1 | pages = 16–26 | date = January 2014 | pmid = 23802806 | doi = 10.1111/jdv.12197 | s2cid = 25441626 }}</ref>
* Topical 0.75% and 1% [[Metronidazole]]<ref name="Ok2015" /><ref name=":1" />
* Topical 4% [[nicotinamide]]<ref name=Bor2019/>
* Topical [[Sulfacetamide/sulfur|sulfacetamide]]<ref name=":1" />
* Tea tree oil<ref name=":3" />
* Cannabidiol shampoo<ref name=":5" />
* Frequent washing to avoid the build-up of scale, especially on the scalp, but while avoiding overly drying the skin<ref name=":3" /><ref name=":1" /><ref name=":4" />
* Avoiding damaging skin with harsh grooming or chemical irritants<ref name=":4" />
* 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.<ref name="AR2020">{{cite web |last1=Rebora |first1=Alfredo |title=Bicalutamide: A Novel Treatment of Seborrheic Dermatitis? |url=https://onlinescientificresearch.com/articles/bicalutamide-a-novel-treatment-of-seborrheic-dermatitis.pdf |website=Scientific Research and Community - Open Access Journals |publisher=Journal of Dermatology Research |access-date=8 June 2024 |ref=AR2020}}</ref>

===Phototherapy===
{{See also|Photodynamic therapy}}
Another option is natural and artificial [[ultraviolet radiation|UV radiation]] since it can inhibit the growth of ''[[Malassezia]]'' yeast.<ref name="the effect of UV-light-ADV">{{cite journal | vauthors = Wikler JR, Janssen N, Bruynzeel DP, Nieboer C | title = The effect of UV-light on pityrosporum yeasts: ultrastructural changes and inhibition of growth | journal = Acta Dermato-Venereologica | volume = 70 | issue = 1 | pages = 69–71 | year = 1990 | pmid = 1967880 | doi = <!-- 102340/00015555706971 --> }}</ref> Some recommend [[photodynamic therapy]] using [[UV-A#Explanation|UV-A]] and [[UV-B#Explanation|UV-B]] laser or red and blue [[LED]] light to inhibit the growth of ''Malassezia'' fungus and reduce seborrhoeic inflammation.<ref name="the effect of UV-light-ADV" /><ref>{{cite journal | vauthors = Calzavara-Pinton PG, Venturini M, Sala R | title = A comprehensive overview of photodynamic therapy in the treatment of superficial fungal infections of the skin | journal = Journal of Photochemistry and Photobiology B: Biology | volume = 78 | issue = 1 | pages = 1–6 | date = January 2005 | pmid = 15629243 | doi = 10.1016/j.jphotobiol.2004.06.006 | bibcode = 2005JPPB...78....1C }}</ref><ref>{{cite journal | vauthors = Maisch T, Szeimies RM, Jori G, Abels C | title = Antibacterial photodynamic therapy in dermatology | journal = Photochemical & Photobiological Sciences | volume = 3 | issue = 10 | pages = 907–917 | date = October 2004 | pmid = 15480480 | doi = 10.1039/B407622B | publisher = rsc.org | s2cid = 32215045 | doi-access = free | bibcode = 2004PhPhS...3..907M }}</ref>

== Outcome ==
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.<ref name=":1" /><ref name=":2" />

==Epidemiology==
Seborrhoeic dermatitis affects 1 to 5% of the general population.<ref name=Des2013 /><ref name="GoldsteinGoldstein2009">{{cite book| vauthors = Goldstein MA, Goldstein MC, Credit LP |title=Your Best Medicine: From Conventional and Complementary Medicine--Expert-Endorsed Therapeutic Solutions to Relieve Symptoms and Speed Healing|url=https://books.google.com/books?id=fZtCudGcuVwC&pg=PA462|date=17 March 2009|publisher=Rodale|isbn=978-1-60529-656-2|pages=462–|url-status=live|archive-url=https://web.archive.org/web/20171105193918/https://books.google.com/books?id=fZtCudGcuVwC&pg=PA462|archive-date=5 November 2017}}</ref><ref name="FarageMiller2009">{{cite book| vauthors = Farage MA, Miller KW, Maibach HI |title=Textbook of Aging Skin|url=https://books.google.com/books?id=9-ALWZhXomAC&pg=PA534|date=2 December 2009|publisher=Springer Science & Business Media|isbn=978-3-540-89655-5|pages=534–|url-status=live|archive-url=https://web.archive.org/web/20171105193918/https://books.google.com/books?id=9-ALWZhXomAC&pg=PA534|archive-date=5 November 2017}}</ref> It is slightly more common in men, but affected women tend to have more severe symptoms.<ref name="FarageMiller2009" /> The condition usually recurs throughout a person's lifetime.<ref name="Jacknin2001" /> Seborrhoeic dermatitis can occur in any age group<ref name="Jacknin2001">{{cite book| vauthors = Jacknin J |title=Smart Medicine for Your Skin: A Comprehensive Guide to Understanding Conventional and Alternative Therapies to Heal Common Skin Problems |url= https://books.google.com/books?id=DQEZvR-IPeIC&pg=PA271|year=2001|publisher=Penguin|isbn=978-1-58333-098-2|pages=271–|url-status=live|archive-url=https://web.archive.org/web/20171105193918/https://books.google.com/books?id=DQEZvR-IPeIC&pg=PA271|archive-date=2017-11-05}}</ref> but often occurs during the first three months of life then again at puberty and peaks in incidence at around 40 years of age.<ref name="pmid24689165">{{cite journal | vauthors = Ooi ET, Tidman MJ | title = Improving the management of seborrhoeic dermatitis | journal = The Practitioner | volume = 258 | issue = 1768 | pages = 23–6, 3 | date = February 2014 | pmid = 24689165 }}</ref><ref name=":4" /> It can reportedly affect as many as 31% of older people.<ref name="FarageMiller2009" /> Infants may also have this condition, though it is typically milder, and is referred to as [[cradle cap]].<ref name=":3" /> Seborrhoeic dermatitis is more common in African-Americans.<ref name=":3" />

Severity is worse in dry climates<ref name="Jacknin2001" /> as well as hot weather, as dry skin can exacerbate the condition.<ref name=":3" /> [[COVID-19]] related mask usage may also cause or exacerbate facial seborrhoeic dermatitis.<ref name=":3" />

Individuals who are immunocompromised have an increased risk of seborrhoeic dermatitis.<ref name=":3" /> Conditions that are associated with increased rates of seborrhoeic dermatitis include individuals with HIV, [[Hepatitis C]], alcoholic pancreatitis, [[Parkinson's disease]], and alcohol abuse.<ref name=":3" /> Seborrhoeic dermatitis is common in people with alcoholism, between 7 and 11 percent, which is twice the normal expected occurrence.<ref>{{cite journal | vauthors = Kostović K, Lipozencić J | title = Skin diseases in alcoholics | journal = Acta Dermatovenerologica Croatica | volume = 12 | issue = 3 | pages = 181–190 | year = 2004 | pmid = 15369644 | url = https://www.researchgate.net/publication/8344438 }}</ref>

== References ==
{{Reflist}}

== External links ==
{{Commons category-inline}}
{{Medical resources
|  DiseasesDB     = 11911 
|  ICD10          = {{ICD10|L|21||l|20}} 
|  ICD9           = {{ICD9|690.1}} 
|  ICDO           = 
|  OMIM           = 
|  MedlinePlus    = 000963 
|  eMedicineSubj  = derm 
|  eMedicineTopic = 396 
|  MeshID         = D012628
}}

{{Diseases of the skin and appendages by morphology}}
{{Diseases of the skin and subcutaneous tissue}}
{{Other dermatological preparations}}
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[[Category:Seborrheic dermatitis| ]]
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