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Seborrheic dermatitis, also called seborrheic eczema, is a chronic skin condition that predominantly affects the scalp, damages the hair follicles and hinders hair growth. Seborrheic dermatitis is a fungal disease, and it’s among the many different dermatitis skin conditions.

“Seborrhea” characterizes chronic inflammatory conditions that cause scaly skin and oily skin due to excessive sebum production by the sebaceous glands. 

Hair loss is closely associated with seborrheic dermatitis because increased sebum production can create irritation and inflammation on the scalp, which can cause intense itchiness. Scratching the scalp can damage hair follicles, which obstructs natural hair growth, causing hair to fall out. 

Excess sebum production can also cause an imbalance in Malassezia on the skin. Malassezia is a type of naturally-occurring yeast that can cause inflammation and further damage to hair follicles if produced in excess and left untreated. Just like increased sebum production, increased Malassezia production can cause hair loss. 

Cause of Seborrheic Dermatitis

There is no direct cause of seborrheic dermatitis, as this condition often develops in people who are otherwise healthy. Although, there are a few risk factors that may increase a person’s chances of developing this chronic condition:

  • Weakened immune system
  • Various medications
  • Chronic stress
  • Genetics
  • Pre-existing conditions, including psoriasis, HIV, acne, rosacea, Parkinson disease, depression, alcoholism, eating disorders, recovery from stroke or heart attack

Symptoms of Seborrheic Dermatitis

Seborrheic dermatitis has a direct impact on the scalp and the hair follicles’ ability to produce hair naturally. Because this condition causes the sebaceous glands to secrete more sebum than usual, the symptoms are each a byproduct of excessive oil on the skin and within the hair follicles.

Common symptoms include:

  • Scaly skin (sometimes referred to as a “cradle cap” when present in infants)
  • Flaking skin
  • Greasy patches of skin on the head
  • Dandruff
  • Itchy scalp
  • Rash on the scalp
  • Redness on the skin
  • Inflammation on the skin
  • Thinning hair
  • Hair loss

How is Seborrheic Dermatitis Treated?

To effectively treat the unpleasant symptoms of this skin condition, the condition itself has to be treated. Treating hair loss, hair thinning and flaking skin without treating the source of these symptoms (the fungal infection) can exacerbate this condition and make the symptoms worse.

There are a number of available treatment options to cure seborrheic dermatitis, including over-the-counter antifungal medications, natural treatment methods, and prescription medications. 

Over-the-Counter & Natural Treatments

Pyrithione zinc can be an effective treatment for seborrheic dermatitis. This ingredient has antifungal, antibacterial properties. Pyrithione zinc is often infused into shampoos to treat dandruff by eliminating the fungi that cause itchy, flaky skin. It’s also available in creams and face washes, depending on the location of the irritated skin. 

The potential side effects of pyrithione zinc include a stinging or burning sensation on the scalp and skin peeling. 

Selenium Sulfide, another antifungal agent, can treat seborrheic dermatitis by eliminating Malassezia yeast and reducing skin inflammation. This treatment is also available in medicated shampoos, creams, face washes, and body washes. 

The potential side effects of selenium sulfide include skin irritation, oiliness, dryness, and increased hair loss. 

Ketoconazole is a highly-effective agent used to treat fungal infections on the skin. This ingredient is a considerably strong antifungal medication that stops and prevents the growth of fungi, specifically the ones that cause seborrheic dermatitis flare-ups. 

The potential side effects of ketoconazole include nausea, vomiting, stomach pain, dizziness, headaches, and skin rash. 

Salicylic acid can soften the scales on the head caused by irregular sebum production. Salicylic acid is an ingredient found in many dandruff shampoos. Although there isn’t much data to support salicylic acid as a treatment for seborrheic dermatitis on its own, it’s often combined with other ingredients in medicated shampoos to treat scaly scalp.

The potential side effects of using salicylic acid topically include burning or itching sensation on the skin, and peeling skin.

Medicated shampoo is the predominant treatment method for seborrheic dermatitis. Because this skin condition mainly affects the scalp, applying a medicated shampoo directly on the area can treat the infection and alleviate the symptoms. Medicated shampoos that include selenium sulfide, pyrithione zinc, ketoconazole or salicylic acid have proven effective for reducing dandruff, healing redness and inflammation, and relieving itching.

The potential side effects of medicated shampoo with antifungal agents (specifically ketoconazole) include skin itching or irritation, oiliness, and dryness on the scalp, abnormal hair texture, skin rash, and headache.

Topical corticosteroids have also proven highly effective for treating seborrheic dermatitis. These medications reduce inflammation, relieve erythema (red patches on the skin) and relieve itchy skin. Some corticosteroids have shown anti-inflammatory effects and antifungal properties. Topical corticosteroids typically come in creams and ointment solutions. 

The potential side effects of topical corticosteroids, specifically hydrocortisone, include skin redness and skin peeling, nausea, blistering skin, headache, dizziness, increased sweating, acne, and insomnia. 

Calcineurin inhibitor creams are immunomodulating agents known to treat seborrheic dermatitis. ‘Immunomodulating’ means this treatment acts directly on the immune system to reduce skin inflammation. Calcineurin inhibitors block the chemicals that trigger inflammation and cause redness and itchiness. (These medications have not been approved by the FDA.)

The potential side effects of calcineurin inhibitor creams include skin irritation, facial acne, skin redness, rosacea, and flushing of the face.  

What triggers a seborrheic dermatitis flare-up?

When seborrheic dermatitis flares up, it can cause increased redness, flaky rashes, and intense itchiness. Seborrheic dermatitis flare-ups can be rather hard to manage. These symptoms are uncomfortable and unpleasant for anyone experiencing them.

Flare-ups may be triggered by:

  • Increased stress
  • Cold weather
  • Dry weather
  • Hormonal changes
  • Harsh ingredients (especially in detergent or soap)

Is seborrheic dermatitis treatable?

The condition itself is not treatable. Because seborrheic dermatitis is a chronic disease, it is likely to persist as a lifelong condition. Flare-ups may occur seasonally, or when a person experiences periods of stress. 

Although, the symptoms of this condition are treatable and hair can grow back. Over-the-counter medications and topical medications are available to cure the fungal infection on the skin to effectively treat the symptoms (like hair loss) caused by the infection.

Hair will grow back once the source of this symptom (inflammation) is treated, by way of antifungal medications and anti-inflammatory treatments.

The right treatment for each patient will depend on the patient’s lifestyle preferences, specific symptoms, and the severity of their condition. It’s important to consider the potential risks and side effects of each treatment method before deciding on a treatment option.

If you are experiencing the symptoms of seborrheic dermatitis, our dermatologists will work with you to create a personalized treatment plan that treats the source of your condition to effectively alleviate the associated symptoms. 

Throughout all of our UCF Health Services, it’s our goal to help you achieve your greatest quality of life. You shouldn’t have to live with irritated, flaking skin. Our Orlando dermatologists are here to help you weigh your options and decide on a treatment that reverses hair loss and cures the source of the condition.