True seborrheic dermatitis is a monstrous cousin of little, old, annoying dandruff. It is a condition that expresses as abundant scaling, itching, redness, and irritation of the scalp. However, it can also affect other hair bearing or oily areas such as; the face (especially eyebrows, eyelids, & beards), ears, upper chest, upper back, and skin fold areas.
The cause is hypothesized to be genetics and response to the presence of a skin yeast called Malassezia Furfur. It is also thought to be a pre-cursor to scalp psoriasis. The skin in people with seborrheic dermatitis sheds much faster (9-10 days) compared to the normal 25-30. This condition tends to worsen during periods of increased sweating or changes in weather, summer to winter, or winter to summer. No matter when it flakes, Seb. Derm. as we call it in the dermatology community, can be pesky, irritating, and a visual eye-sore.
You can’t cure yourself of Seborrheic Dermatitis, but there are many OTC and RX products available to help you bust the crust.
Special shampoos help destroy scalp and skin yeast, but should be left to soak into the scalp over 5-10 minutes. However, such shampoos also tend to be drying for your locks, so use a regular shampoo on the length of the hair but the medicated solely on the scalp. A few of the most popular are Zinc Pyrithione, Selenium Sulfide, Sulfur, and Ketoconazole. Zinc Pyrithione can be found in the multiple versions Dry Scalp Head & Shoulders while the Clinical Solutions strength has 1% Selenium Sulfide. Melaluca Shampoo like Jason Normalizing Tea Tree Treatment Shampoo, has a mild but natural anti-bacterial and anti-fungicidal effect. Its combination with calendula and grape seed oil also sooth irritation. Kiehls (which has a salicylic acid combo) and DHS are also standards in the scalp care community. Alpecin Dandruff Killer Shampoo is a heavy hitter with four active ingredients, zinc pyrithione, piroctone olamine, fumaric acid and salicylic acid. The first two materials are yeast/fungi combating elements while the latter two help remove dead skin flakes. My favorite, Nizoral 1% shampoo, an OTC of the stronger RX version, also clears yeasty buildup quite well.
Of course, shampoos have such a short contact time with the scalp, their affect may be limited. For those with severe Seb. Derm., try leave on products containing the same proven ingredients. D’ Free Scalp lotion is one example and it contains Zinc Pyrithione, Climbazole and Piroctone Olamine, or Aveda Scalp Remedy Solution infuses salicylic acid with rosemary and sage. Glover’s Dandruff Control Medicine provides relief in the form of its sulfur content.
Salicylic acid, coal tar, and hydrocortisone all help to damper flake dusting. Salicylic acid in products like Neutrogena T-Sal, is great at shedding off skin scales, but it may sting if there are scratched, open areas. Coal tar, in products like Neutrogena T-Gel, is an age old remedy which is underutilized due to the odor, despite some who swear by its power. Scalpicin Anti-itch liquid contains 1% hydrocortisone, plus aloe and melaleuca, rendering it helpful for not only flake but also itching and inflammation. Aquanil HC lotion is another similar option, but a more moisturizing form.
For yeast and flake fighting efforts, it’s best to pick one product in each category and use them in rotation. For those with stubborn a stubborn scalp, a leave on treatment would be optimal.
However, when Seb. Derm. plagues the face & ears, OTC products are limited. Facial skin is sensitive and requires mild topicals which are meant for that specific use. These products are available by prescription.
The variety and strength of prescription treatments will provide a profound alleviation for Seborrheic Dermatitis. Ask your clinician about anti-yeast/fungal products like Sebuderm, Xolegel, Nizoral (ketoconazole) 2% shampoo, ketoconazole cream, and Promiseb (made from licorice root). Find the manufacturers websites and research these online.
Anti-inflammatory medications to quell itch and irritation are in the topical steroid category ranging from creams, lotions, gels, foams, and solutions. Brands like Luxiq, Olux, Synalar, Sernivo, and Topicort Spray are often used for the scalp. For severe facial irritation, milder topical steroids may be used, or non-steroidal anti-inflammatory agents such as Elidel or Protopic. Use of any topical steroid for long periods can cause things like stretch marks, discoloration, acne, and skin thinning. Thus, they are typically advised to use sparingly and for short spurts on sensitive skin areas like the face.
Although you will always have the genetic tendency to flake, you don’t have to sport the equivalent of Mother Nature’s flurries scattered about your shoulders. Utilize products with proven ingredients and seek care with your dermatology clinician for those fighting a stubborn nature.
*The information provided above or in any blogs on this site is for educational purposes only. I does not replace advice or necessary examination and diagnosis from your healthcare clinician. Please see your healthcare provider for any and all concerns with changes in your health or treatment of disease.*