Why Seborrheic Dermatitis Causes Red, Flaky Skin

Topical steroids and anti-fungal shampoos can provide relief

A flaky, itchy scalp is a symptom of seborrhea.
A flaky, itchy scalp is a symptom of seborrhea. BSIP/UIG/Getty Images

Have you noticed red, flaky skin around your nose or in your eyebrows? How about on your scalp—especially over your forehead or ears? If the answer is yes, then you may have something called seborrheic dermatitis or seborrhea (or dandruff, if it's on the scalp).

Causes

Seborrhea is a chronic, inflammatory skin disorder that affects the areas of the head and trunk that have sebaceous glands. A type of yeast that has an affinity for these glands called Pityrosporum ovale may be the cause, but this has not yet been proven.

It is believed that the build-up of this particular yeast in these glands may irritate the skin, causing redness and flaking.

Prevalence

Seborrhea is more common in men than women, and it affects 3 percent of the general population. It occurs more commonly in older people who are bedridden or have neurologic conditions such as Parkinson's disease. Seborrhea also affects almost 85 percent of people who have AIDS.

Treatments

Adults who have seborrhea usually experience a waxing and waning—in other words, outbreaks often come and go and the condition can't be "cured." The good news is that, with proper maintenance, seborrhea can be controlled. Furthermore, most of the common treatments can be found over-the-counter.

Proper hygiene plays an important role in treatment. Frequent washing with soap gets rid of the oils in the affected areas and improves symptoms. Sunlight inhibits the growth of the yeast; therefore, exposure of the affected areas to the sun is helpful, although caution should be exercised to avoid sun damage.

The main medical treatments for this condition are antifungal shampoos and topical steroids.

Seborrhea Shampoos

There are several good antifungal shampoos on the market that can be purchased without a prescription. The ingredients to look for are selenium sulfide (found in Selsun), pyrithione zinc (found in Head & Shoulders), and Sebulon, which is coal tar (found in Sebutone and Tegrin), and ketoconazole (found in Nizoral).

All of these shampoos have a medicated smell. When you use one, lather the shampoo into your hair and scalp, leave it there for at least 10 minutes, and then rinse it off. The shampoo can be used on the face and other parts of the body as a lotion—follow the same instructions except be careful around the eyes. Do this daily until the redness and flaking are controlled; then use the shampoo two to three times a week to keep symptoms from returning.

Topical Steroids 

Topical steroids reduce the inflammatory response and help control itching. You can buy hydrocortisone cream (1 percent) over the counter, and it's safe to use on the face. Apply it twice a day to the affected area until the redness resolves. Save the hydrocortisone only for flare-ups and use the anti-fungal shampoo for regular maintenance because long-term steroid use can cause side effects like acne and thinning of the skin.

When to See a Doctor

You should see your doctor if you're not sure whether you have seborrhea. Other conditions that can look similar to seborrhea are psoriasis, rosacea, atopic dermatitis, and superficial fungal infections.

You should also consult your doctor if you have tried the over-the-counter treatments mentioned above and you still have symptoms—especially if you see very thick flakes.

Your doctor may recommend a stronger steroid or a combination medicine to help dissolve the dead skin. Finally, if it is not advised that you shampoo your hair daily, ask your doctor about a special steroid preparation in oil that can be used on the scalp like a pomade.

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