Seborrheic dermatitis is a chronic condition which arises from inflammation of the skin on the areas of the face or scalp most commonly, but can also be found on the chest and even the groin region. Seborrheic dermatitis patients will start to experience a red discoloration of the skin with white flaking and scaling. Most times it occurs in the region of the eyebrows and the folds that arise for the corners of the nose and extend to the corners of the mouth. On scalp, many people use the lay term “dandruff” which really describes the effect of the inflammation on the skin with seborrheic dermatitis. The scale or flakes indicate inflammation of the skin tissue, which when the “fishnet” structure of the skin cells are disrupted, then leads to sloughing or flaking. Scientists do not understand why some patients develop seborrheic dermatitis and others do not. It is not infectious, but inflammatory. The inflammation seems to be driven or spurred on by the sebaceous glands which produce oil or sebum, and seem to allow for overgrowth of demodex which is a naturally occurring parasite that lives around those sebaceous glands. With oilier or seborrheic patients, the thought is that the demodex are over-populating and the immune system is creating an inflammatory response in return which appears as seborrheic dermatitis. Seborrheic dermatitis is not typically painful, but can be described as itchy. It is unsightly to patients, and embarrassing.
Treatment is long-term, as this is condition which becomes chronic in nature with periods of clearance and periods of relapse. Common treatments include topical therapies such as medicated shampoos used in a rotation week by week. These active ingredients in the these medicated shampoos are typically either anti-inflammatory or anti-fungal in nature. Although it is not a fungal infection, anti-fungal agents are quite effective at the reduction in the demodex parasite, as well as being anti-inflammatory as well. By treating the scalp alone, many times both scalp and face are positively influenced due to the overall decrease in demodex counts. Additionally, topical creams, ointments, gels and lotions can be used which contain either anti-fungal agents or anti-inflammatory agents. Although topicals, all of these agents are prescription only and require the care of a dermatologist or other physician.