Seborrheic dermatitis is a common chronic, relapsing skin disorder that presents as erythematous plaques with greasy, yellow scales in susceptible areas (scalp, face, and trunk). Seborrheic dermatitis has a biphasic incidence, occurring in two peaks: first in infants, then in adolescence and early adulthood. Although the exact etiology is unknown, pathologic mechanisms have been observed involving the sebaceous glands and Malassezia on the skin. Topical medications are used for acute exacerbation or maintenance treatment. These options aim to inhibit skin colonization (antifungal agents), reduce inflammation (steroids, calcineurin inhibitors), and loosen scales and crusts (keratolytic agents). Severe and refractory seborrheic dermatitis may warrant the use of systemic antifungal medications.
Last updated: Mar 4, 2024
Seborrheic dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) ( SD SD The standard deviation (SD) is a measure of how far each observed value is from the mean in a data set. Measures of Central Tendency and Dispersion) is a common chronic skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions disorder that is characterized by erythematous patches Patches Vitiligo with greasy, yellowish scales Scales Dry or greasy masses of keratin that represent thickened stratum corneum. Secondary Skin Lesions that most often appear in areas with prominent sebaceous glands (scalp, face, upper trunk, and anogenital area).[1,2]
Unclear, but may be affected by the following:
Affected areas:
Images demonstrate typical findings of seborrheic dermatitis in newborns. Note the common involvement of intertriginous areas and the scalp.
Image: “Seborrheic dermatitis.” by Siegfried EC, Hebert AA. License: CC BY 4.0
Seborrheic dermatitis in a renal transplant recipient.
Note the erythematous scaly papules on the chin and nasolabial folds.
The diagnosis is typically based on clinical findings. Additional studies may be performed if the diagnosis is uncertain or to rule out other conditions.[1‒3,8]
Differential diagnosis[2,3,6]
Seborrheic dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) must be differentiated from other dermatologic conditions, which is typically done based on history and exam features alone.
| Alternative diagnosis | Typical location(s) | Classic differentiating features |
|---|---|---|
| Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis | ||
| Rosacea Rosacea Rosacea is a chronic inflammatory disease of the skin that is associated with capillary hyperreactivity. This condition is predominantly seen in middle-aged women, and is more common in fair-skinned patients. Rosacea | Central face: nose Nose The nose is the human body’s primary organ of smell and functions as part of the upper respiratory system. The nose may be best known for inhaling oxygen and exhaling carbon dioxide, but it also contributes to other important functions, such as tasting. The anatomy of the nose can be divided into the external nose and the nasal cavity. Nose Anatomy (External & Internal) and medial cheeks Cheeks The part of the face that is below the eye and to the side of the nose and mouth. Melasma, forehead Forehead The part of the face above the eyes. Melasma | |
| Atopic dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema)/ eczema Eczema Atopic dermatitis, also known as eczema, is a chronic, relapsing, pruritic, inflammatory skin disease that occurs more frequently in children, although adults can also be affected. The condition is often associated with elevated serum levels of IgE and a personal or family history of atopy. Skin dryness, erythema, oozing, crusting, and lichenification are present. Atopic Dermatitis (Eczema) | ||
| Pemphigus foliaceus | ||
| Lupus erythematosus ( SLE SLE Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. Systemic Lupus Erythematosus) | ||
| Tinea versicolor Tinea versicolor A common chronic, noninflammatory and usually symptomless disorder, characterized by the occurrence of multiple macular patches of all sizes and shapes, and varying in pigmentation from fawn-colored to brown. It is seen most frequently in hot, humid, tropical regions and is mostly caused by Malassezia furfur (formerly Pityrosporum orbiculare). Malassezia Fungi | Trunk | |
| Tinea capitis Tinea capitis Ringworm of the scalp and associated hair mainly caused by species of Microsporum; Trichophyton; and Epidermophyton, which may occasionally involve the eyebrows and eyelashes. Dermatophytes/Tinea Infections or corporis | ||
| Pityriasis rosea Pityriasis rosea Pityriasis rosea is an acute, self-limited skin disease. The etiology is not known, and it commonly occurs in young adults. Patients initially present with a single, ovoid “herald patch.” This is followed by diffuse, pruritic, scaly, oval lesions over the trunk (often in a “Christmas tree” distribution on the back) and extremities. Pityriasis Rosea | ||
| Secondary syphilis Secondary Syphilis Syphilis |
| Potential alternative diagnosis | Typical location(s) | Classic differentiating features |
|---|---|---|
| Tinea capitis Tinea capitis Ringworm of the scalp and associated hair mainly caused by species of Microsporum; Trichophyton; and Epidermophyton, which may occasionally involve the eyebrows and eyelashes. Dermatophytes/Tinea Infections | Scalp | |
| Impetigo Impetigo Impetigo is a highly contagious superficial bacterial infection typically caused by Staphylococcus aureus (most common) and Streptococcus pyogenes. Impetigo most commonly presents in children aged 2 to 5 years with lesions that evolve from papules to vesicles to pustules, which eventually break down to form characteristic “honey-colored” crusts. Impetigo | ||
| Contact dermatitis Contact dermatitis A type of acute or chronic skin reaction in which sensitivity is manifested by reactivity to materials or substances coming in contact with the skin. It may involve allergic or non-allergic mechanisms. Male Genitourinary Examination | Diaper region | |
| Candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis |
| Site | Differential Diagnosis |
|---|---|
| Scalp | Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, dandruff Dandruff Excessive shedding of dry scaly material from the scalp in humans. Seborrheic Dermatitis, atopic dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema), tinea capitis Tinea capitis Ringworm of the scalp and associated hair mainly caused by species of Microsporum; Trichophyton; and Epidermophyton, which may occasionally involve the eyebrows and eyelashes. Dermatophytes/Tinea Infections |
| Face | Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, rosacea Rosacea Rosacea is a chronic inflammatory disease of the skin that is associated with capillary hyperreactivity. This condition is predominantly seen in middle-aged women, and is more common in fair-skinned patients. Rosacea, impetigo Impetigo Impetigo is a highly contagious superficial bacterial infection typically caused by Staphylococcus aureus (most common) and Streptococcus pyogenes. Impetigo most commonly presents in children aged 2 to 5 years with lesions that evolve from papules to vesicles to pustules, which eventually break down to form characteristic “honey-colored” crusts. Impetigo, contact dermatitis Contact dermatitis A type of acute or chronic skin reaction in which sensitivity is manifested by reactivity to materials or substances coming in contact with the skin. It may involve allergic or non-allergic mechanisms. Male Genitourinary Examination, pemphigus foliaceus |
| Eyelids Eyelids Each of the upper and lower folds of skin which cover the eye when closed. Blepharitis | Atopic dermatitis Dermatitis Any inflammation of the skin. Atopic Dermatitis (Eczema) |
| Chest and trunk | Pityriasis rosea Pityriasis rosea Pityriasis rosea is an acute, self-limited skin disease. The etiology is not known, and it commonly occurs in young adults. Patients initially present with a single, ovoid “herald patch.” This is followed by diffuse, pruritic, scaly, oval lesions over the trunk (often in a “Christmas tree” distribution on the back) and extremities. Pityriasis Rosea, tinea versicolor Tinea versicolor A common chronic, noninflammatory and usually symptomless disorder, characterized by the occurrence of multiple macular patches of all sizes and shapes, and varying in pigmentation from fawn-colored to brown. It is seen most frequently in hot, humid, tropical regions and is mostly caused by Malassezia furfur (formerly Pityrosporum orbiculare). Malassezia Fungi, tinea corporis Tinea corporis Dermatophytes/Tinea Infections |
| Intertriginous areas Intertriginous areas Malassezia Fungi | Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis |
| All sites, rule out | Secondary syphilis Secondary Syphilis Syphilis, pemphigus, scabies Scabies Scabies is an infestation of the skin by the Sarcoptes scabiei mite, which presents most commonly with intense pruritus, characteristic linear burrows, and erythematous papules, particularly in the interdigital folds and the flexor aspects of the wrists. Scabies |
Management may vary depending on practice location. The following information is primarily based on US literature. Additional information from the National Institute for Health and Care Excellence is available for members for the UK.
The goal of treatment is to reduce erythema Erythema Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of disease processes. Chalazion and pruritus Pruritus An intense itching sensation that produces the urge to rub or scratch the skin to obtain relief. Atopic Dermatitis (Eczema).
Treatment options include topical antifungal Antifungal Azoles agents, topical antiinflammatory agents ( steroids Steroids A group of polycyclic compounds closely related biochemically to terpenes. They include cholesterol, numerous hormones, precursors of certain vitamins, bile acids, alcohols (sterols), and certain natural drugs and poisons. Steroids have a common nucleus, a fused, reduced 17-carbon atom ring system, cyclopentanoperhydrophenanthrene. Most steroids also have two methyl groups and an aliphatic side-chain attached to the nucleus. Benign Liver Tumors and calcineurin inhibitors Calcineurin Inhibitors Compounds that inhibit or block the phosphatase activity of calcineurin. Immunosuppressants), and several miscellaneous agents. Combination therapy can be used for more severe cases.
Since SD SD The standard deviation (SD) is a measure of how far each observed value is from the mean in a data set. Measures of Central Tendency and Dispersion is a chronic condition, rotating treatment options helps to reduce adverse reactions associated with persistent monotherapy.
Topical antifungals (and other agents with antifungal Antifungal Azoles properties):
1st-Line therapy on the face and body (a mainstay of therapy to help reduce Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi):
Topical antiinflammatory agents:
2nd-Line agents are best used to treat acute flares, but they are not recommended for continuous long-term use owing to the risks of potential adverse effects.
Miscellaneous topical agents:
Oral antifungal Antifungal Azoles agents:
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