Patient education: Seborrheic dermatitis (including dandruff and cradle cap) (Beyond the Basics)
- Denis Sasseville, MD, FRCPC
Denis Sasseville, MD, FRCPC
- Professor of Dermatology and Research Coordinator, Division of Dermatology
- McGill University Health Centre
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Joseph Fowler, MD
Joseph Fowler, MD
- Section Editor — Dermatitis
- Clinical Professor of Dermatology
- University of Louisville School of Medicine
SEBORRHEIC DERMATITIS OVERVIEW
Seborrheic dermatitis is an inflammatory condition that usually occurs in areas of the body that have many oil-producing glands, including the scalp, face, upper chest, and back. Dandruff is a mild form of seborrheic dermatitis. It is also common during infancy; this is called cradle cap. Cradle cap usually resolves by eight to 12 months of age.
This topic discusses the symptoms and treatment of seborrheic dermatitis in infants and adults. Other types of dermatitis are discussed separately. (See "Patient education: Atopic dermatitis (eczema) (Beyond the Basics)" and "Patient education: Contact dermatitis (including latex dermatitis) (Beyond the Basics)".)
SEBORRHEIC DERMATITIS CAUSES
The cause of seborrheic dermatitis is not completely clear, but may involve an inflammatory reaction to a yeast naturally present on the skin surface. Symptoms may come and go, and may be worse during particular seasons (eg, during cold weather). Flares can also occur during periods of stress, hormonal changes, or illness. Certain neurologic conditions, such as Parkinson disease, may increase the risk of developing seborrheic dermatitis. (See "Patient education: Parkinson disease symptoms and diagnosis (Beyond the Basics)".)
SEBORRHEIC DERMATITIS SYMPTOMS
Infants — In infants, seborrheic dermatitis can cause a condition known as cradle cap. This causes redness and greasy scales, most commonly on the scalp, but also on the face, ears, neck, and in the diaper area (picture 1) and skin folds (picture 2). Unlike in adults, seborrheic dermatitis does not usually cause itching in infants.
The condition usually resolves without treatment in weeks to months, although treatment may be used if needed. (See 'Infant treatment' below.)
Adults — Seborrheic dermatitis usually affects skin that contains many oil glands, including the scalp and face; dandruff of the scalp is a mild form of seborrheic dermatitis. It can also occur on the ears, eyebrows, the bridge and sides of the nose, in the crease between the nose and lip (picture 3), and central chest. It can affect the upper back, armpits, and groin. In men, seborrheic dermatitis is usually worse in hair bearing areas of the face.
Common symptoms of seborrheic dermatitis in adults include redness, greasy, scaly patches, and itching of the affected skin.
SEBORRHEIC DERMATITIS DIAGNOSIS
There is no specific test for diagnosing seborrheic dermatitis. The diagnosis is usually based upon a person's history and physical examination. In rare cases, a skin biopsy (removing a small sample of skin) may be necessary to confirm the diagnosis or rule out other conditions that mimic seborrheic dermatitis.
SEBORRHEIC DERMATITIS TREATMENT
The symptoms of seborrheic dermatitis can be effectively controlled with a combination of self-care measures and drug therapy.
Infant treatment — Although cradle cap usually resolves without treatment, it may require treatment in some cases. Suggestions for treatment include:
●Shampoo frequently with baby shampoo and gently remove scaly skin with a soft brush (eg, a soft toothbrush) or fine-tooth comb after shampooing.
●Apply a small amount of an emollient (white petroleum jelly, vegetable oil, mineral oil, baby oil) to the scalp (overnight, if necessary) to loosen the scaly patches, followed by gentle scalp massage with a soft brush (to lift the scale), then shampoo with a nonmedicated baby shampoo.
If cradle cap persists despite these measures, a healthcare provider should be consulted. They may recommend mild topical corticosteroids or a prescription antifungal shampoo.
Adult treatment — Seborrheic dermatitis in adults is a chronic condition. Long-term maintenance treatment is often necessary.
Scalp seborrheic dermatitis — Dandruff (mild seborrheic dermatitis of the scalp) can be treated with over-the-counter anti-dandruff shampoos. Several types of anti-dandruff shampoos are available, with the main difference between them being the active ingredient. All of these treatments are equally effective after four weeks of use.
●Selenium sulfide (Selsun and Exelderm)
●Tar (Z-Tar, Pentrax, DHS tar, Ionil T plus, and T-Gel extra strength)
●Zinc pyrithione (Head and Shoulders, Zincon, and DHS zinc)
●Ketoconazole (Nizoral 1%)
For best results, the shampoo should be left in place for 5 to 10 minutes before rinsing. The shampoo should be rinsed out of the hair completely.
The shampoo may be used every day initially, and then every other day as symptoms improve. These shampoos can be used for as long as needed. If one type of shampoo does not improve symptoms after four to six weeks, a different shampoo may be tried. If the condition worsens, consult with a healthcare provider.
For seborrheic dermatitis of the scalp that does not improve or worsens with the above measures, the healthcare provider may prescribe topical corticosteroids or antifungal drugs to treat itching and inflammation.
Nonscalp seborrheic dermatitis — Seborrheic dermatitis of the face, trunk, and skin folds generally is treated with topical corticosteroids or antifungal agents.
Low potency topical corticosteroids (eg, hydrocortisone 1% cream, available over the counter) may be tried initially. The cream is applied once or twice a day until symptoms improve. If there is no improvement after two weeks, a healthcare provider should be consulted.
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Atopic dermatitis (eczema) (Beyond the Basics)
Patient education: Contact dermatitis (including latex dermatitis) (Beyond the Basics)
Patient education: Parkinson disease symptoms and diagnosis (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Cradle cap and seborrheic dermatitis in infants
Seborrheic dermatitis in adolescents and adults
Approach to the patient with a scalp disorder
The following organizations also provide reliable health information.
●National Library of Medicine
●American Academy of Dermatology
- Gupta AK, Bluhm R. Seborrheic dermatitis. J Eur Acad Dermatol Venereol 2004; 18:13.
- Danby FW, Maddin WS, Margesson LJ, Rosenthal D. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol 1993; 29:1008.
- Shuster S, Meynadier J, Kerl H, Nolting S. Treatment and prophylaxis of seborrheic dermatitis of the scalp with antipityrosporal 1% ciclopirox shampoo. Arch Dermatol 2005; 141:47.
- Stefanaki I, Katsambas A. Therapeutic update on seborrheic dermatitis. Skin Therapy Lett 2010; 15:1.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.