Seborrheic dermatitis is a chronic, relapsing inflammatory skin condition that primarily affects sebaceous (oil-producing) areas of the body. It is considered a more severe, inflammatory form of dandruff. While dandruff is limited to flaky scalp skin, seborrheic dermatitis presents with reddened patches covered with greasy yellowish scales, and it often extends beyond the scalp to areas such as the forehead, eyebrows, eyelids, sides of the nose, behind the ears, and upper chest.

What Causes Seborrheic Dermatitis?

Seborrheic dermatitis is multifactorial, but the primary trigger is the overgrowth of a yeast-like fungus known as Malassezia, which naturally resides on the skin and feeds on sebum (skin oil). This overgrowth, in turn, leads to an inflammatory response.

Contributing Factors Include:

• Adolescence: The condition commonly begins or worsens during adolescence due to increased sebaceous gland activity under hormonal influence.
• Poor Scalp Hygiene: Infrequent hair washing or improper removal of applied oils creates an environment favorable for fungal proliferation.
• Oily Scalp and Hair: Excess oil serves as a nutrient source for Malassezia, worsening symptoms.
• Nutritional Deficiencies: Low levels of zinc, vitamin B complex, and essential fatty acids have been linked to a compromised skin barrier and increased susceptibility.
• Stress: Psychological and physiological stress can alter skin immunity, triggering or exacerbating flare-ups.
• Medical Conditions: Seborrheic dermatitis is notably more common in patients with:
  • Parkinson’s disease
  • HIV/AIDS (with studies showing up to 85% prevalence)
  • Chronic illnesses and immunosuppression

Recent literature (2023–2024) also highlights gut dysbiosis and altered skin microbiome diversity as contributing factors, suggesting the skin-gut connection may play a role in chronic cases.

Do You Have Dandruff or Seborrheic Dermatitis?

Distinguishing between the two is essential for effective treatment.

If you observe red patches with sticky, yellow scales along with dandruff, or if the flaking extends to your face or chest, you are likely dealing with seborrheic dermatitis.

Treatment

Mild Cases

Can often be managed with dandruff therapies:

• Anti-Dandruff Shampoos
  Over-the-counter shampoos containing zinc pyrithione, selenium sulfide, or ketoconazole are first-line.
• Scalp Hygiene
  Shampoo 2–3 times a week to remove excess oil and yeast buildup.

Moderate to Severe Cases

Require dermatological evaluation and prescription medications:

1. Prescription Anti-Dandruff Shampoos

• Ketoconazole 2%
• Ciclopirox 1%
• Selenium sulfide 2.5%
• Coal tar preparations Used 2–3 times a week and left on the scalp for 5–10 minutes.

2. Topical Steroids

• Betamethasone lotion or foam for the scalp.
• Hydrocortisone cream for the face or body lesions. Short-term use is advised to prevent skin thinning or steroid dependence.

3. Topical Antifungals

• Ketoconazole, ciclopirox, or miconazole creams can be used on facial or chest lesions to reduce yeast colonization.

4. Topical Keratolytics

• Salicylic acid (2–5%) and sulphur-based gels help loosen thick scales and facilitate shampoo penetration.

5. Oral Antifungals

• Itraconazole or terbinafine may be prescribed in resistant, widespread, or immunocompromised cases.

6. Oral Retinoids

• Isotretinoin may be used when seborrheic dermatitis coexists with oily skin or acne. It reduces sebaceous gland activity, which indirectly limits fungal growth.

Newer adjuncts: Studies in 2024 show that probiotics, low-dose calcineurin inhibitors (like pimecrolimus), and photodynamic therapy may offer promising benefits in recalcitrant cases.

Key Takeaways

• Seborrheic dermatitis is a chronic skin condition caused by fungal overgrowth and inflammation, often linked to oily skin, poor hygiene, and systemic factors.
• It differs from simple dandruff due to redness, greasy scaling, and extension beyond the scalp.
• Treatment varies by severity, ranging from OTC shampoos to prescription steroids, antifungals, and oral medications.
• Long-term maintenance with antifungal shampoos and lifestyle modification helps prevent relapses.

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