Seborrheic Dermatitis

In my dermatology practice I see a lot of patients who think their scaly, red skin is “dry skin”, but it is actually dandruff. Dandruff, or seborrheic dermatitis, is so common that almost everyone will suffer from it at some point in their lifetime. Some of its possible forms are:

  • Red, greasy, scaly skin in the nose crease or between the eyebrows in teens
  • ‘Dry’ and itchy scalp starting in the teen years and going on throughout life
  • ‘Dry’, red, scaly skin in the T-zone of the face at any time in life
  • Crusty skin on, in, and behind the ears
  • Flaking of the eyebrows
  • Crusty scale and itching of the eyelashes (blepharitis), especially in the morning when you wake from sleep
  • Greasy, red scaly skin on the chest and upper back

The good news is that with the right complete skin care routine using over-the-counter products, you can control your seborrhea to keep your skin and scalp healthy and attractive (instead of red and scaly). Here are the important points in building your skin care routine to treat seborrheic dermatitis:

  1. Don’t use harsh products on actively inflamed seborrhea or you will add irritation on top of the seborrhea – and irritation looks red and scaly! This applies to cleansers, acne products, anti-aging products, exfoliating products, and sunscreens.
  2. Medicated cleansers and shampoos are really helpful for seborrhea, so pick the right cleanser for the skin area you are treating. Pyrithione zinc is my favorite medicated cleanser and shampoo ingredient. Other ingredients for non-facial areas include shampoos with salicylic acid, selenium sulfide, tar, ketoconazole, and prescription ciclopirox.
  3. Over my 30 years of practicing dermatology, I’ve found pharmaceutical-grade green tea creams to be the most important skin care product along with medicated pyrithione zinc. I use these as the cornerstone of any skin care routine I build to treat seborrhea.
  4. For thick crusty scale, pre-treating skin with oil for 30 minutes before cleansing or shampooing really helps. Use coconut oil, mineral oil, olive oil, or any other oil. Wet the skin, towel dry, apply the oil, then wait 30 minutes or more. Shampoo or cleanse off the oil and as a last lather, use your medicated shampoo or soap.
  5. Always moisturize non-scalp areas of seborrhea to help the skin heal. Dry skin heals more slowly.
  6. Apply facial sunscreen daily if you have seborrhea because, as with most rashes, the barrier of the skin is compromised and sun may pass through to cause damage more easily. Use non-irritating mineral zinc oxide sunscreens matched to your skin type.
  7. For stubborn seborrhea, I use clotrimazole cream twice a day until the rash is clear plus a month or so. One-percent hydrocortisone cream on top of the clotrimazole is helpful if the rash won’t budge, but this medicine has side effects that include skin thinning of the application site and, if applied near the eyes, can cause eye damage. It should only be used under a doctor’s supervision.

My favorite products to create a complete skin care routine to control seborrhea are:

Cleanse: Calming Zinc Soap for facial seborrhea. It can be used on the trunk and ears, too. For hairy areas like the scalp, I use Foaming Zinc. A Buf Puf, Salux Cloth, or the Clarisonic system can help to remove scale. Gentle exfoliation with a rough scrub can work as well. It is important not to be too rough with exfoliation, as the skin barrier of actively inflamed seborrhea is compromised and the skin is easily irritated. When non-medicated cleanser is used it needs to be gentle. Some complexions may find medicated pyrithione zinc is drying and if so, I have patients alternate the medicated product with a gentle non-medicated product to cleanse affected skin.

Correct: I have my patients apply my Green Tea Antioxidant Skin Therapy to facial seborrhea. Acne-prone skin may need an oil-free alternative and Replenix CF Cream works well. If the rash is flaring up, I have my patients apply clotrimazole cream to the area of involvement. Clotrimazole can be applied to ear and trunk involvement, too. The cream base makes it impractical for hairy areas like the scalp.

Hydrate: I have patients apply one of my Daily Face Creams or All Natural Body Butter or All Natural Lotion to involved non-hairy skin.

Protect: I recommend one of my mineral zinc sunscreens be applied daily. Pick a sunscreen based on your skin type.

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