If you’ve experienced chronically itchy, flaky, red patches of skin, you might have a condition called seborrhea, or seborrheic dermatitis. Seborrhea usually occurs on parts of the body where there are active oil glands, such as the scalp and on the sides of the nose. For most people, it never truly goes away, but there are ways to keep it under control.
What You Need to Know About Seborrhea
No one is quite sure exactly what causes seborrhea, though there are theories about its cause. Many researchers think it is triggered by the overproduction of sebum (oil) from the oil gland, combined with irritation activated from a naturally-occurring yeast found on the surface of skin called Malassezia. It seems that the yeast itself isn't the problem; rather, it's the chemical compounds produced by its metabolic processes that generate inflammatory fatty acids that generate seborrhea for some people.
There are also several potential secondary factors that play a role in causing seborrhea. These include family history, stress, weight, weather, and other health issues, especially autoimmune disorders.
Age is also a factor in seborrhea: it's often seen in infants three months or younger and then again in adults between the ages of 30 and 60.
Seborrhea often appears as red patches of greasy flaking skin, which can appear almost anywhere on the body, but most often occurs on the scalp (where it's commonly known as dandruff) and on the sides of the nose and eyebrows.
In infants, parents notice thick, oily scales on a child's scalp, eyebrows, behind the ears, or on the chest. Infant seborrhea (commonly known as cradle cap) differs from other forms of the condition in that it is only temporary and almost always goes away on its own.
Medical Treatments for Seborrhea
What clears up seborrhea in one person might not work for another, so there's a lot of trial and error involved in finding the right fix for you. Although this is frustrating, it's important not to give up; the next treatment you try could be the one that works! The first step is to see a dermatologist to determine if what you have is truly seborrhea. Once you have a diagnosis and know exactly what you're dealing with, it's much easier to devise a plan of attack. Following are the chief medical options available to get seborrhea under control:
- Topical antifungal agents, such as ketoconazole. Ketoconazole is available by prescription and is included in some medicated over-the-counter shampoos such as Nizoral. It is also found in topical anti-fungal medications that can be applied to affected areas on the face.
- Creams or lotions containing corticosteroids. These are available both in over-the-counter and prescription strengths that can reduce the inflammation that's a major component of this condition. Keep in mind that chronic use of steroids can have negative impact on the skin but for short term use it can keep seborrhea under control.
- Topical immunomodulators. For more stubborn or pronounced forms of seborrhea prescription medications that suppress or alter the immune system, such as pimecrolimus cream, can greatly calm overactive oil glands and reduce the amount of sebum they produce. These are serious drugs that will require a clear understanding between you and your doctor to weigh out the pros and cons.
Most likely you will need to experiment to find the best combination for your skin so be patient and don’t give up. Don't assume that what your dermatologist first prescribed is your only option, check back to find out what other options you should consider.
Gentle Daily Skincare Suitable Even for Those with Seborrhea
Aside from prescription and over-the-counter medications, the way you take care of your skin can have a big impact on the severity of your seborrhea and can even help keep the condition under control. Here are the steps of an essential skincare routine to ease the appearance of flaky skin:
- Cleanse skin with a gentle, water-soluble cleanser that will help remove excess surface oil and help remove dead skin cells. Using a soft washcloth can also help manually remove areas of flaking but if you’re not gentle you will only make matters worse.
- Use a toner loaded with soothing ingredients and antioxidants. A well-formulated toner helps restore moisture and calming ingredients to skin after cleansing.
- Exfoliate with a leave-on BHA exfoliant. This is a very important step to consider. BHA (beta hydroxy acid) can reduce the redness and diminish oil production and flaking caused by seborrhea. You can use a BHA exfoliant once or twice daily on your face, body, and scalp.
- Use a moisturizer with sunscreen rated SPF 30 or higher every day of your life. Not only will a gentle moisturizer help restore skin’s delicate barrier, but the SPF will protect from sun damage.
- At night use a moisturizer or serum for your skin type. This is vitally important to strengthen your skin’s barrier and protect it from dehydration.
For recommendations on gentle, effective products in each of these categories, see our Best Products section.
Ingredients to Avoid
When choosing a skincare routine for seborrheic dermatitis, it’s also critical to consider what the products you use should not contain. Many skincare products, including some designed to treat red, flaky skin, contain ingredients that can actually damage skin over time. Here are some ingredients to avoid:
- Drying alcohol, such as alcohol denatured. Although alcohol does degrease oily skin, it is so drying and irritating that it triggers increased oil production, which is the last thing you need if you're suffering from seborrheic dermatitis.
- Fragrance, both natural and synthetic, which irritates skin.
- Sensitizing ingredients such as menthol, menthol derivatives, and citrus extracts or oils that can all lead to increased inflammation.
Although seborrhea can be a chronic, frustrating condition, it's certainly not one that you have to tolerate. Armed with the right tools, you can fight back and look and feel great.
References for this information:
American Journal of Clinical Dermatology, April 2017, pages 193 – 213
Stress and Skin Disorders, December 2016, pages 165 - 169
PLOS One, February 2015, e Publication
Journal of the American Medical Association Dermatology, February 2015, pages 221 – 222
American Family Physician, February 2015, pages 185 – 190