SEBORRHEIC DERMATITIS

Seborrheic dermatitis (SD) is akin to bad dandruff. The skin is red and scaly, most commonly on the scalp, but it may affect the face and other areas as well. It appears to be caused by an immune response to overgrowth of the fungus Malassezia that likes oil.

Risk Factors

• Naturally oily skin
• Family history of psoriasis
• Shampoo infrequently
• Age 20-50

What Does Seborrheic Dermatitis Look Like?

• While the hair is normal, the scalp is scaly and mildly red.
• People with SD often say, "My scalp itches." Or they may say their skin is "dry" and no amount of moisturizing helps. They may worry that other people think they have poor hygiene--which of course is not true.
• SD occasionally affects the face as well. It particularly likes the eyebrows and along the sides of the nose and the ears. Occasionally, the folds of the axilla may become involved.

What Can I Do?

• Shampoo regularly and lather any involved areas.
• Use a topical steroid as needed.
• SD is chronic in nature so treatment needs to be ongoing.

SD of the Scalp

Many people with SD think shampooing less often is best, but the opposite is true. Frequent, e.g. daily, shampooing with a medicated shampoo is recommended. Shampooing infrequently, e.g. once a week, can make SD worse.

• Mild disease may be managed by shampooing alone. Ketaconazole (Nizoral) shampoo is to be used at least 3 times a week. You may use any other shampoo on other days. Lather the scalp and any other areas that tend to be involved.
• For moderate disease, or where there is significant itch, a topical steroid liquid is needed, (e.g., clobetasol solution) applied twice a day to the affected areas ("part the hair, dab it in; part the hair, dab it in").
• Don't scratch! (Scratching makes it worse).

SD of the Face, Axilla or other Areas.

• Lather any affected areas with the medicated shampoo and apply a topical steroid (e.g., desonide cream) twice a day.
• Once cleared, continue lathering daily with the shampoo, but use the topical medication only on active areas.

SD in Darker Skin

• SD is common in those with darker skin, in part because they typically shampoo less often and may apply oils to their hair and scalp.
• Unfortunately, the oil may aggravate SD by "feeding" the fungus (Malassezia). Reducing the use of oils and a focused application of oils on the distal hair shaft avoiding the scalp may be helpful.
• The skin may lighten or darken in response to the inflammation of SD. The key here is to control the SD, allowing the skin color to return to normal over time. Elidel has been helpful here.
• Shampooing daily may be difficult for darker-skinned patients. Shampooing only 2 times per week is appropriate. Some have found Ketaconazole shampoo can dry out the hair. Zinc pyrithione (e.g. Head and Shoulders) 2-3/week is preferred by some.
• Topical steroids: Ointment (e.g., clobetasol) or oil (Derma-Smoothe) vehicles may be preferred.
• For dyspigmentation: Elidel can be helpful.
• Roflumilast foam seems to do well in skin of color.
• Tight curls and extensions increase the tendency towards SD. Avoid if possible.

Zoryve

Zoryve (roflumilast) foam, 0.3%, is a new non-steroid medication and is FDA-approved for the treatment of SD in adult and pediatric patients 9 years of age and older. It is applied once daily. It is excellent and very safe, but most insurances don't cover it unless you have failed a topical steroid.