Seborrheic Dermatitis

Inflammatory ICD: L21

Also known as: Seborrhoeic Eczema, Dandruff, Cradle Cap (infantile)

Description

Seborrheic dermatitis is a common chronic relapsing inflammatory condition affecting sebum-rich areas of the skin. It is mediated by Malassezia yeast and characterised by erythematous patches with greasy yellowish scales. Dandruff is considered a mild non-inflammatory variant limited to the scalp.

Symptoms

  • Erythematous patches with greasy yellow-white scales
  • Scalp flaking (dandruff) with pruritus
  • Nasolabial folds, eyebrows, behind ears affected
  • Blepharitis (eyelid involvement)
  • Chest and intertriginous areas in extensive cases

Causes & Triggers

  • Malassezia yeast overgrowth and inflammatory response to its metabolites
  • Sebaceous gland activity (lipid-rich environment)
  • Immune dysregulation (more severe in immunocompromised)
  • Neurological association (Parkinson's disease)
  • Stress, fatigue, and seasonal flares (winter)

Severity Classification

Mild Scalp flaking (dandruff) with minimal erythema
Moderate Facial and scalp involvement with visible scales and erythema
Severe Widespread facial, scalp, and truncal involvement

Treatment Ladder

  1. 1 Mild scalp: Antifungal shampoo (ketoconazole 2%, zinc pyrithione)
  2. 2 Face: Low-potency topical corticosteroids or topical antifungals
  3. 3 Moderate: Combination antifungal + anti-inflammatory
  4. 4 Maintenance: Intermittent antifungal shampoo or cream 1–2× per week
  5. 5 Severe / Refractory: Oral antifungal (itraconazole) short course

Relevant Compounds

Aloe Vera

Soothing adjunct for irritated skin

Aloe vera is derived from the inner gel of Aloe barbadensis miller leaves. It contains over 75 activ…

Capryloyl Glycine

Seboregulatory and pH-normalizing agent — controls excess sebum in seborrheic areas while restoring optimal skin surface pH to support acid mantle defense

Capryloyl glycine is a lipoamino acid formed by the conjugation of caprylic acid (octanoic acid, C8)…

Hydrocortisone

Mild steroid for facial involvement

Hydrocortisone is a low-potency topical corticosteroid identical to endogenous cortisol. It is the m…

Niacinamide

Anti-inflammatory and barrier support

Niacinamide is the physiologically active amide form of vitamin B3. It is a versatile, well-tolerate…

Panthenol

Calming and barrier repair

Panthenol (D-panthenol or dexpanthenol) is the alcohol analogue of pantothenic acid (vitamin B5). Up…

Phytosphingosine

Antifungal — disrupts Malassezia cell membranes and reduces associated inflammation

Phytosphingosine is a sphingoid base naturally present in the stratum corneum, where it serves as a …

Piroctone Olamine

Anti-Malassezia antifungal — chelates iron to disrupt fungal mitochondrial respiration, reduces oleic acid production, and controls Malassezia colonization driving inflammation

Piroctone olamine (trade name Octopirox) is a second-generation hydroxypyridone antifungal agent wid…

Salicylic Acid

Keratolytic — loosens and removes scales

Salicylic acid is a lipophilic beta hydroxy acid with keratolytic, comedolytic, and mild anti-inflam…

Tea Tree Oil

Antifungal activity against Malassezia

Tea tree oil is a volatile essential oil derived from the Australian plant Melaleuca alternifolia. I…

Witch Hazel Extract

Sebum-regulating astringent — helps control oiliness in seborrheic areas while providing anti-inflammatory support through LOX inhibition

Witch hazel extract is derived from the bark and leaves of Hamamelis virginiana, a North American sh…

Zinc PCA

Antimicrobial and sebum-regulating

Zinc PCA is the zinc salt of pyrrolidone carboxylic acid (PCA), a natural component of the skin's Na…

Recommended Drugs

Cortaid OTC hydrocortisone for facial flares (short-term use)

Suggested Cosmetics

Advantan Cream (Methylprednisolone Aceponate 0.1%) Safer potent steroid for facial seborrheic dermatitis Batrafen Cream (Ciclopirox Olamine 1%) Ciclopirox for fungal skin infections and seborrheic dermatitis Bioderma Sébium Global Intensive Purifying Care Sebum-regulating serum CeraVe Foaming Facial Cleanser Non-stripping cleanser for oily seborrheic skin Cetaphil Gentle Skin Cleanser Gentle non-stripping cleanser Cipla Excela Moisturiser Lightweight moisturiser that won't exacerbate oiliness Coal Tar Solution / Ointment (LCD 5–10%) Coal tar for scalp seborrheic dermatitis Deconstruct Pore Control Serum — 2% Salicylic Acid + 3% Niacinamide Niacinamide anti-inflammatory with salicylic acid exfoliation The Derma Co 10% Niacinamide Face Serum Anti-inflammatory oil-control serum Desonate Gel (Desonide 0.05%) Mild steroid for facial seborrheic dermatitis Ebernet Cream (Eberconazole 1%) Newer azole antifungal with anti-inflammatory properties Elidel Cream (Pimecrolimus 1%) Steroid-free option for facial seborrheic dermatitis Elocon Cream (Mometasone Furoate 0.1%) Short-term potent steroid for severe seborrheic flares Episoft AC Moisturiser with SPF 30 Oil-free moisturiser that won't aggravate oiliness Eumovate Cream (Clobetasone Butyrate 0.05%) Moderate steroid for facial seborrheic dermatitis Flutivate Cream (Fluticasone Propionate 0.05%) Moderate steroid for facial seborrheic dermatitis Ketomac Cream (Ketoconazole 2%) Topical ketoconazole for Malassezia-driven seborrheic dermatitis KZ Shampoo (Ketoconazole 2%) Ketoconazole shampoo for scalp seborrheic dermatitis and hair loss adjunct La Roche-Posay Effaclar Duo (+) Anti-Acne Moisturiser Oil-control moisturiser with piroctone olamine Locoid Cream (Hydrocortisone Butyrate 0.1%) Mild-moderate steroid for seborrheic dermatitis Lulican Cream (Luliconazole 1%) Potent antifungal for fungal skin infections Mamaearth Tea Tree Face Wash Tea tree oil has antifungal properties against Malassezia Minimalist 10% Niacinamide Face Serum Anti-inflammatory care for seborrheic-prone skin Nizoral Anti-Dandruff Shampoo (Ketoconazole 2%) Gold-standard ketoconazole shampoo for scalp seborrheic dermatitis Onabet Cream (Sertaconazole 2%) Antifungal with anti-inflammatory activity for fungal skin infections Pond's Super Light Gel Oil-Free Moisturiser with Hyaluronic Acid + Vitamin E Lightweight gel that won't exacerbate oiliness Scalpe Pro Anti-Dandruff Shampoo (Zinc Pyrithione 1% + Ketoconazole 2%) Dual-action antifungal + zinc pyrithione shampoo for severe dandruff Suganda White Lotus Moisturiser with 5% Niacinamide Lightweight niacinamide moisturiser Tacroz Ointment (Tacrolimus 0.03% / 0.1%) Steroid-free option for facial seborrheic dermatitis Terbicip Cream (Terbinafine 1%) Fungicidal terbinafine for dermatophyte skin infections The Ordinary Niacinamide 10% + Zinc 1% Zinc PCA antimicrobial + niacinamide anti-inflammatory

Lifestyle Tips

  • Use medicated shampoos 2–3× per week, leaving on for 5 minutes before rinsing
  • Alternate between different antifungal shampoos to prevent resistance
  • Avoid heavy oily hair products
  • Manage stress — flares correlate with stress levels
  • Continue maintenance therapy even during remission periods

When to Refer

  • Resistant to standard topical therapy
  • Widespread or atypical distribution
  • Immunocompromised patients with severe disease
  • Diagnostic uncertainty (psoriasis, tinea, lupus overlap)