Dandruff and an itchy scalp can be frustrating to deal with, but they don’t have to last forever. These symptoms may indicate seborrheic dermatitis or seborrheic eczema. Learn how to treat this issue at home and with medications. Keep reading to learn more about this issue and what can be done to treat it.
Seborrheic dermatitis, sometimes called seborrheic eczema, is a common skin disease that causes itching, scaly patches, and red skin on areas of the body with overworked sebaceous glands or the scalp. It can also occur in other parts of the body where oil secretion is high, such as the face, upper chest, and back.
There are a variety of treatment options available, from self-care and antifungal medications to medicated shampoos, creams, and lotions. Seborrheic dermatitis is very common, with more than 3 million U.S. cases occurring every year. Because it’s so common, there is ongoing research for new treatments. There have been studies to determine if certain medications can keep seborrheic dermatitis in remission and reduce the incidence of exacerbation.
Though an exact cause of seborrheic dermatitis hasn’t been determined, some doctors think it’s caused by a yeast called Malassezia that’s found in oil secretions on the skin, an irregular response of the immune system, stress, cold and dry weather, changes in skin barrier function, or your genes.
Those most at risk for seborrheic dermatitis include the following:
If you think you have seborrheic dermatitis, look for the following symptoms:
If you’re not sure whether you have seborrheic dermatitis, schedule an appointment with your primary healthcare provider, as he or she can help diagnose the problem and provide further medical advice.
Though there is no test for diagnosing seborrheic dermatitis, here’s what you can expect at your doctor’s appointment:
During your appointment, your provider may ask the following questions to better inform the diagnosis of seborrheic dermatitis:
If you do have seborrheic dermatitis, it’s important to understand the causes and treatments for the short- and long-term. Here are some of the most important questions to ask during your appointment:
Though primary care providers and pediatricians can usually treat seborrheic dermatitis, they may refer you to a dermatologist for more specialized treatment.
After you receive a diagnosis, your specialist should provide you with different options to treat seborrheic dermatitis. The treatment will depend on the severity of dermatitis, but in most cases, treatment will involve self-care practices (like applying moisturizer or aloe), antifungal medications, or other medicated shampoos, creams, and ointments.
Seborrheic dermatitis is treated symptomatically, and repeated treatments may be necessary to manage symptoms. In mild cases, topical antifungal creams or medicated shampoos may be enough to control symptoms. In other cases where topical corticosteroids aren’t appropriate, topical calcineurin inhibitors (TCIs), which are non-corticosteroid topical medications, can be used by adults and children 2 years of age or older.
To manage your seborrheic dermatitis and prevent it from recurring, here are a few steps you can take:
Below is information on different types of medications and shampoos used to treat seborrheic dermatitis.
Antifungals, also called antimycotics, can kill fungus or slow its growth. They are effective in treating fungal infections like athlete’s foot, ringworm, candidiasis, and preventing fungal cells from growing and reproducing. Popular antifungals include Lotrimin (clotrimazole), Spectazole (econazole), Nizoral (ketoconazole), and Lamisil (terbinafine). Some side effects of topical antifungals are local itching, stinging, or irritation.
Antiseborrheic drugs are specifically used to treat seborrheic dermatitis and work by reducing skin cell production and inhibiting fungal growth. Common antiseborrheic drugs include selenium sulfide, zinc pyrithione, and salicylic acid. Popular brand names include Promiseb and Dermazinc. Side effects include rash, itching, or in rare cases, tightness in the chest.
Corticosteroids reduce inflammation in the body and decrease activity in the immune system. Popular corticosteroids used to treat seborrheic dermatitis include Synalar (fluocinolone), Clobex (clobetasol), Cormax, DesOwen (desonide), and Desonate. This type of drug relieves swelling, itching, redness, and allergic reactions. Side effects of steroid creams generally include local irritation, burning, and stinging. Your healthcare provider will advise you on how long you can use the medication.
Pyrithione zinc has antimicrobial and antifungal properties that help relieve itching and inflammation. Shampoos like Head & Shoulders Dry Scalp Care or Selsun Blue Dandruff Shampoo with pyrithione zinc can help relieve symptoms of seborrheic dermatitis. Some side effects that may occur include stinging or burning of the scalp, skin peeling, or skin irritation.
Ketoconazole inhibits fungus growth. Popular shampoos include OTC Nizoral A-D Anti-Dandruff Shampoo 1% and prescription Nizoral 2% Shampoo. Some side effects include mild skin itching, dry skin, and abnormal hair texture.
Coal tar belongs to a class of drugs known as keratoplastics and is known to reduce fungal growth, decrease inflammation, reduce itching, and even lower sebum production. It works by causing the skin to shed its top layer of skin cells and slowing the growth of skin cells, in general. Some common shampoos that have coal tar as an ingredient include DHS Fragrance-Free Tar Shampoo and Neutrogena T/Gel Therapeutic Shampoo. Some side effects of these shampoos are itching, burning, and redness. Coal tar shampoo may stain skin, hair, nails, clothing, and sheets.
The best medication for seborrheic dermatitis depends on the patient’s medical condition, medical history, and medications they may already be taking that could interact with seborrheic dermatitis medication as well as the patient’s response to treatment.
This table will act as a comparison chart for the most commonly prescribed seborrheic dermatitis medications.
Seborrheic dermatitis shampoos and medications | ||||
---|---|---|---|---|
Drug name | Drug class | Administration route | Standard dosage | Common side effects |
Synalar Solution (fluocinolone) | Corticosteroid | Topical | Apply a thin film 2-4 times daily as directed | Local burning, itching, irritation |
Nizoral (ketoconazole) | Antifungal | Topical | Apply shampoo to wet hair, lather, and rinse thoroughly. Use twice a week | Dry skin, itching, oily scalp |
Spectazole (econazole nitrate) | Antifungal | Topical | Apply a thin layer to the affected area once or twice a day for 2 weeks | Burning, irritation, redness |
Promiseb | Anti-seborrheic | Topical | Apply a thin layer to the affected region | Rash, itching, redness |
Dosage is determined by your doctor based on your medical condition, response to treatment, and age. Other possible side effects exist.
The most common side effects of seborrheic dermatitis medications are listed individually in each drug class in the treatment section above. They include severe itching, burning, redness in treated skin areas, hair loss, and swelling. Other common side effects of shampoos include mild skin itching, dry skin, scalp pustules, and oiliness of hair.
Note: This is not a full list of side effects. Talk to a healthcare professional for a complete list of possible adverse events and drug interactions.
In addition to taking medicine, there are a few home remedies that may help seborrheic dermatitis:
To get rid of seborrheic dermatitis, most treatment focuses on loosening scales, reducing inflammation and swelling, and stopping the itching. With most mild cases, an antifungal cream or medicated shampoo will be able to alleviate symptoms.
Some at-home remedies include taking fish oil supplements, applying aloe vera to the affected area, taking probiotics, using tea tree oil, applying an apple cider vinegar soak to loosen the scales on your scalp, coating your scalp with olive oil to loosen the scales, and eating a diet that includes plenty of leafy vegetables, fruits that contain antioxidants, foods that are high in vitamin C, such as oranges and bell peppers, and foods with plenty of vitamin E, like avocados.
Seborrheic dermatitis is a superficial fungal disease that occurs on oily parts of your skin. Although debated, it is thought that Malassezia yeasts and seborrheic dermatitis are connected due to an abnormal inflammatory response to the yeasts.
Most medications for seborrheic dermatitis are creams or ointments, but oral Sporanox (itraconazole) has been used to treat severe seborrhoeic dermatitis cases.
Common treatments for seborrheic dermatitis include antifungals like econazole, ketoconazole, and clotrimazole, corticosteroids like clobetasol, and shampoos containing coal tar, selenium sulfide, coal tar, pyrithione zinc, salicylic acid, or ketoconazole.
After receiving her doctorate from the University of Pittsburgh School of Pharmacy, Karen Berger, Pharm.D., has worked in both chain and independent community pharmacies. She currently works at an independent pharmacy in New Jersey. Dr. Berger enjoys helping patients understand medical conditions and medications—both in person as a pharmacist, and online as a medical writer and reviewer.
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