Hello Dr. Bailey,
I am curious about the potential of seborrheic dermatitis (dandruff) to spread. If it does spread then can you tell me how this happens? Also, if someone has it in one place, is it likely they will get it in another?
Thank you, Rebecca B
Seborrheic dermatitis (aka dandruff) spreads out from its areas of initial involvement, but it’s not because of contagion. Like many rashes, dandruff starts small and gets bigger. We don’t know what causes seborrheic dermatitis and so we don’t know why it does what it does when it does it….. it’s just what it does. We do know that it’s more likely to do it now in the winter though.
Dandruff usually occurs on the scalp where it’s important to differentiate it from ‘ring worm’ of the scalp (fungus infection), psoriasis and other more ‘exotic’ scalp rashes. For my patients with scalp seborrhea I start treatment with my zinc pyrithione shampoo and body cleanser called OTB SKIN Medicated Cleanser #2.
This is a great professional strength, medicated shampoo as well as a back and chest acne cleanser. If the medicated pyrithione zinc alone doesn’t do the trick then we rotate through 3 different medicated shampoo ingredients as I outlined in my scalp dandruff treatment post titled Remedies For The Dry Itchy Scalp Of Seborrheic Dermatitis. In that post I also explain how to use medicated shampoos most effectively for successful dandruff treatment. It’s worth having a look at that post if you have scalp dandruff.
On the face, dandruff usually starts around the nose, eyebrows and chin. It works out from there to the forehead, mid cheeks and in front of the ears. It’s often mistaken as skin dryness because of the flaking. People tend to put gobs of moisturizer on the rash, to no avail. Treatment needs to target the rash and my favorite way to do this is with the products in my Facial Redness Relief Kit.
I have additional skin care suggestions for facial dandruff and you can find them in my post titled Dr. Cynthia Bailey’s Tips For Facial Seborrheic Dermatitis Control.
Dandruff can also involve the mid chest and back and even the skin folds. For chest and back treatment I usually recommend the same OTB Medicated Cleanser/Shampoo #2 treatment applied with a Body Buf Puf Sponge with Handle.
As for the evolution of a typical case of dandruff (seborrheic dermatitis), in most cases the rash starts as dryness and itch on the scalp, then the face jumps in, then the back and chest. I rarely see it in the body folds though. Even though it seems like the rash is ‘spreading’ it’s really just the rash getting worse and ‘evolving’.
I hope that helps your understanding of this common and frustrating skin problem. I also hope it gives you some ideas about the treatment approaches that I recommend to my dermatology patients who have dandruff.
Cynthia Bailey MD, Dermatologist
If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.
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