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Seborrheic dermatitis treatment and medications

Cropped SingleCare logo By | May 5, 2020
Medically reviewed by Karen Berger, Pharm.D.

What is seborrheic dermatitis? | Seborrheic dermatitis diagnosis | Seborrheic dermatitis treatment options | Seborrheic dermatitis medications | Best seborrheic dermatitis medications | Side effects of seborrheic dermatitis | Seborrheic dermatitis home remedies | FAQ | Resources

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.

What is seborrheic dermatitis?

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.

How is seborrheic dermatitis diagnosed?

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:

  • People with oily skin/acne
  • Newborns
  • Adults ages 30-60 years old
  • People who drink alcohol excessively or have alcoholic pancreatitis
  • People who have Parkinson’s disease
  • People who have a weakened immune system
  • Organ transplant recipients
  • People with HIV/AIDS
  • Heart attack patients

If you think you have seborrheic dermatitis, look for the following symptoms:

  • Itching (can be constant)
  • Red skin
  • Dandruff/white or yellow flaking on your scalp, hair, eyebrows, beard, or mustache
  • Scaly skin

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:

  • Your provider will perform a physical examination of your skin and ask about your medical history.
  • They may take a skin biopsy, or scraping of your skin, and mix it with a chemical to rule out other skin conditions like eczema, psoriasis, tinea versicolor, rosacea, or another form of contact dermatitis.
  • Your doctor may prescribe a KOH prep test to rule out a fungal infection.
  • Your doctor may order blood tests if he or she thinks your seborrheic dermatitis is the result of an underlying health condition.

Questions your healthcare provider may ask

During your appointment, your provider may ask the following questions to better inform the diagnosis of seborrheic dermatitis:

  • When did you first notice your symptoms?
  • Are you experiencing itching on your scalp?
  • Have you noticed scaly skin or dandruff on your scalp?
  • Have you been under stress lately?
  • Where on your body have you noticed scaling or itching?
  • Have you had a heart attack recently?
  • Do you drink alcohol excessively?
  • Are you taking any vitamins, medications, or supplements?
  • Have you tried any at-home remedies to alleviate symptoms?

Questions you should ask your healthcare professional

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:

  • What is the cause of my seborrheic dermatitis?
  • What treatments are safe to apply on my baby who has seborrheic dermatitis, aka cradle cap?
  • Are there lifestyle changes I can make to get rid of the itching or scaling?
  • What medications or at-home treatments do you recommend to alleviate symptoms?

Though primary care providers and pediatricians can usually treat seborrheic dermatitis, they may refer you to a dermatologist for more specialized treatment.

Seborrheic dermatitis treatment options

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.

How to prevent seborrheic dermatitis flare-ups

To manage your seborrheic dermatitis and prevent it from recurring, here are a few steps you can take:

  • Wash your skin regularly and rinse well, but avoid harsh soaps.
  • Wash your scalp with an over-the-counter dandruff shampoo that contains pyrithione zinc, selenium sulfide, ketoconazole, or salicylic acid.
  • Apply a mild corticosteroid cream or antifungal cream to affected areas.
  • Wear smooth-textured cotton clothing to reduce skin irritation.
  • Men should shampoo facial hair regularly to ease symptoms. Shaving may also relieve symptoms.
  • If your baby has seborrheic dermatitis, or cradle cap, wash your baby’s scalp with non-medicated shampoo once a day and use a soft-bristled brush to remove scales.

Seborrheic dermatitis shampoo and medications

Below is information on different types of medications and shampoos used to treat seborrheic dermatitis.

Antifungals

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.

Anti-seborrheic drugs

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

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.

Shampoos with pyrithione zinc

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.

Shampoos with ketoconazole

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.

Shampoos with coal tar

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.

What is the best medication for seborrheic dermatitis?

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 to 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 two 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.

What are common side effects of seborrheic dermatitis medication?

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.

What is the best home remedy for seborrheic dermatitis?

In addition to taking medicine, there are a few home remedies that may help seborrheic dermatitis:

  • Apply coconut oil to your scalp. Coconut oil is thought to have antimicrobial and antifungal properties that can help relieve itching and inflammation. Start with a small amount, and increase if needed. Apply one teaspoon of coconut oil to your scalp twice a week, leave it on for a few hours, and rinse your hair thoroughly.
  • Use tea tree oil. Tea tree oil has antibacterial, antifungal, and anti-inflammatory properties that make it ideal for treating seborrheic dermatitis. Dilute it with mineral oil or carrier oil, such as coconut oil, or honey before applying it to your scalp. Leave the mixture on for up to five minutes before rinsing.
  • Put honey in your hair. Raw honey has antimicrobial properties and can moisturize and soothe the skin. Mix 2 tablespoons of raw, unfiltered honey with 3/4 cup of water. Apply the mixture to your scalp and then rinse after a few minutes.
  • Wash your skin with apple cider vinegar. Dilute apple cider vinegar with water (1:1, 1:2, or 1:4) and apply the solution to your skin. Let it sit for 10–15 minutes before rinsing it off. You may need to apply this solution a few times a week to see results.
  • Take fish oil supplements. These pills contain omega-3 fatty acids, which may help treat seborrheic dermatitis.
  • Avoid styling products. Products that contain alcohol may make scaling and irritation worse, so avoid these whenever possible.
  • Try baby shampoo. If you notice that your eyelids are red or scaling, mix a small amount of baby shampoo with warm water. Use a cotton swab to apply a thin layer of the mixture, then rinse with clear water.
  • Change up your diet. Avoid consuming alcohol, bread, sugar, and processed foods, and eat more antioxidant-rich foods, like berries and leafy greens, and anti-inflammatory foods like garlic and avocado.

Frequently asked questions about seborrheic dermatitis

How do you get rid of 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.

How can I treat seborrheic dermatitis at home?

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.

Is seborrheic dermatitis a fungus?

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.

Is there an oral medication for seborrheic dermatitis?

Most medications for seborrheic dermatitis are creams or ointments, but oral Sporanox (itraconazole) has been used to treat severe seborrhoeic dermatitis cases.

What are successful treatments for Seborrheic dermatitis?

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.

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