Seborrhea Dermatitis and Itchy, Oily Scalp: Shampoo and Dandruff Treatment

 

Updated on August 17, 2022


John was a Navy hospital corpsman. He worked the general sick bay, managed a carrier O.R., and treated heat rash, eczema, and dyshidrosis.


 
An example of cradle cap, also known as infantile or neonatal seborrheic dermatitis.
An example of cradle cap, also known as infantile or neonatal seborrheic dermatitis. | Source

What Is Seborrhea?

Seborrhea, or seborrheic dermatitis, is a fairly common skin condition, ranging in intensity from light, white dandruff to more serious dandruff with thick scales. It is characterized by excess sebum production and affects millions of people in the United States—men more often than women. Adults from 30-60 are most likely to develop this condition, although it can occur at any age. In babies, it is called "cradle cap." It is also referred to as seborrheic eczema (with a sack full of misspellings).

More specific names for this condition are given based on the affected body part. The names are "seborrhea" followed by the following suffixes:

  • Capitis (Cradle Cap): Located on scalp
  • Congestive: Cutaneous lupus erythematosus
  • Corporis: Located on the trunk (torso)
  • Facier: Located on the face
  • Nigra or Nigricans: Dark-colored seborrhea
  • Oliosa: Seborrhea with an oily content
  • Rosacea: Middle-age seborrhea that reappears
  • Sicca: Dry form of seborrhea with scales

Itchy, flaking, greasy, red, and inflamed skin commonly occurs on the face, at the corners of the nostrils.
Itchy, flaking, greasy, red, and inflamed skin commonly occurs on the face, at the corners of the nostrils. | Source

What Does Seborrheic Dermatitis Look Like?

The first sign of seborrhea is excess production of body oil, or sebum. The skin can become itchy, flaky, and sore. Flakes can range in size; some may get very thick and take multiple cleansings with a special shampoo to remove. Seborrheic patches can be white or yellow and can occur in various body parts, including the scalp, behind the ears, face, back, chest, armpits, and groin.

Picture of seborrheic dermatitis on the scalp.
Picture of seborrheic dermatitis on the scalp. | Source

What Is Causing My Seborrheic Dermatitis?

The reasons for seborrhea are not known for sure. There could be a hereditary factor. Most physicians believe the condition is also tied to hormonal activity. It has been observed in babies and seems to vanish when puberty starts.

A common yeast occurring on the skin called Malassezia is also thought to be responsible by feeding off the oil on the skin and metabolizing it to form oily scales or plaque (various thicknesses depending on the buildup of cells).

Scalp Care

Dandruff and other symptoms seem to improve when washing the scalp frequently. Typical dandruff shampoos should stay on the scalp for at least 5 minutes; most dermatologists and shampoo containers instruct to leave the lather on for at least 10 minutes.

In more serious cases, preparations may be applied to patches to help loosen them. For example, mineral oil can be applied to help loosen plaque at night, especially in children. I can attest to the effectiveness of mineral oil because one of my children was treated this way. Without such preparations, scratching off areas of heavy scaling can lead to bleeding, and as mentioned in other eczema articles, this can lead to crusting and/or infection.

Hair preparations containing alcohol (grooming products) most frequently increase inflammation and should be avoided.

Acute form of seborrheic dermatitis on scalp
Acute form of seborrheic dermatitis on scalp | Source

Medications for Seborrhea

Hydrocortisone 1%, available over the counter, is referred to as a keystone drug in treatment of seborrhea dermatitis. As with many skin ailments, itching and inflammation can be helped using low-strength corticosteroids. These medicines help reduce the inflammatory response. However, stronger corticosteroids are not recommended due to serious side effects that can occur. Higher concentrations are generally prescribed for intense flares.

Other, lower strength corticosteroids may also be prescribed:

  • Ketoconazole (e.g. Nizoral)
  • Loprox (Ciclopirox)
  • Clobetasol propionate
  • Fluocinolone

If the physician believes an anti-fungal is required for a severe case, Lotrimin cream, also known as clotrimazole, can be used for flares. Apply twice a day for up to two weeks after the rash decreases in intensity. However, there are varying intensities of flare-ups. If there is no improvement, you should see a dermatologist. Prescription-strength antifungals can only be written by a physician.

For a list of 76 medications for seborrheic dermatitis, see the Drugs.com page on seborrheic dermatitis treatment.

Shampoos for Seborrheic Dermatitis

There are four fundamental types of shampoos for the treatment of seborrheic dermatitis of the scalp: coal tar shampoo, selenium sulfide shampoo, tea tree oil shampoo, and zinc pyrithione shampoo.

Some popular dandruff shampoos are:

  • Selsum: contains selenium sulfide (kills fungus and yeast)
  • Head & Shoulders: contains zinc pyrithione
  • Sebulon: contains zinc pyrithione
  • Sebutone: contains coal tar
  • Tegrin: contains coal tar
  • Nizoral: which contains ketoconazole (medication)

For treatment of seborrhea on other parts of the body, daily washing with a mild cleanser containing 2% zinc pyrithione followed by a moisturizing lotion is recommended. Creams with salicylic acid and sulfur or coal tar can help to loosen scales on the body.

It should be noted that oily, sebum-rich areas of the body other than the scalp can be treated by using the shampoos as lotions. Most shampoo instructions call for daily use. When scales have gone away and inflammation has decreased, most shampoos direct the patient to use them 2-3 times per week. The patient can adjust the frequency of use based on their needs. For loosening scales, the patient can use oil-based preparations. Wearing a swim cap can keep the oil in place while sleeping at night.

Moisturizers, Lotions, and Creams for Seborrhea

Using moisturizing lotions or creams after washing has been recommended in many reviews to reduce flaking and irritation. The creams most commonly referred to are:

  • Aveeno
  • CeraVe
  • Cetaphil
  • Eucerin
  • Lubriderm

Similar Skin Conditions

In conclusion, there are several positive notes about seborrheic dermatitis. A doctor or pharmacist can direct you to the most common medications, which can often be found over-the-counter. This also means the cost of treatment can be reasonable. Even though this can often be a long-lasting problem in adolescents and adults, these medicines can control the symptoms well.

If symptoms do not get better with treatment, contact your doctor immediately because several other skin disorders can have similar symptoms, such as rosacea or psoriasis.

Sources

Gary W. Cole, M.D., MedicineNet.com, Sebhorrheic Dermatitis, http://www.medicinenet.com/seborrheic_dermatitis/article.htm#seborrheic_dermatitis_facts

Staff, WebMD, What is Seborrheic Dermatitis?, 2005-2018, Causes, Symptoms, Treatment, https://www.webmd.com/skin-problems-and-treatments/seborrheic-dermatitis-medref#1

National Eczema Association, 2002 - 2018, https://nationaleczema.org/eczema/types-of-eczema/seborrheic-dermatitis/

List of Corticosteroids, 13 April 2018, https://en.wikipedia.org/wiki/List_of_corticosteroids

Dr. Cynthia Bailey Skin Care, Dr. Cynthia Bailey, February 5, 2018, https://www.drbaileyskincare.com/info/blog/dr-cynthia-baileys-tips-for-facial-seborrheic-dermatitis-control

Drugs.com, Know More, Be Sure, 2000 - 2018, https://www.drugs.com/condition/seborrheic-dermatitis.html

Betty Ann Johnson, M.D, PH.D and Julia R. Nunley, May 1, 2000, treatment of Sebhorheic Dermatitis. https://www.aafp.org/afp/2000/0501/p2703.html

Dr. Axe, Food is Medicine, 2018, 7 Natural treatments for Seborrheic Dermatitis, https://draxe.com/seborrheic-dermatitis/

Dr. Ira Ruben, University of Chicago Pritzker School of Medicine, July 11, 2014, https://www.healthtap.com/user_questions/1399154-what-is-recommended-for-sensitive-skin-atopic-dermatitis-for-daily-use-after-work-outside-cream

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