Get expert advice on the causes, symptoms and treatment of seborrhoeic eczema or dermatitis.
Medically reviewed by Dr Louise Wiseman MBBS, BSc (Hons), DRCOG, MRCGP and Based on a text by Dr Dan Rutherford
Suffering from red, flaky and itchy skin on your upper back, nose or scalp? It sounds like you might have seborrhoeic eczema or dermatitis, a common inflammation of the skin which occurs in areas rich in sebaceous glands.
Seborrhoeic eczema symptoms can vary from mild dandruff to widespread patches of red, itchy skin. We look at seborrhoeic eczema causes, symptoms and treatment options:
What is seborrhoeic eczema?
Seborrhoeic eczema or dermatitis is thought to affect around 4 per cent of the UK population. Dandruff is a mild form of seborrhoeic dermatitis that affects the scalp.
‘Seborrhoeic’ means that the rash affects the areas where the sebaceous glands are including the face, scalp, chest and upper back.
Seborrhoeic eczema or dermatitis is thought to affect around 4 per cent of the UK population.
It is present in men slightly more than women and can affect us from puberty into adulthood.
A short-lived type of seborrhoeic eczema is also seen in babies during the first year of life affecting the scalp (cradle cap) and nappy area.
Seborrhoeic eczema symptoms
In seborrhoeic eczema symptoms four common patterns are seen:
• Scalp and face
Skin is greasy, red and scaly. Affects the central face and forehead, the sides of the nose down to the outer ends of the mouth, eyebrow area, the edges of the scalp and behind or in the ears. The scalp itself can become very scaly with dandruff. If the areas around the eyelids are affected blepharitis can develop and need specific treatment.
• Chest and trunk
On the front of the chest and back of the trunk between the shoulder blades well defined pink patches with mild scaling are seen.
• Skin folds
A moist red skin reaction in the groins, under the breasts and in the armpits is seen.
In babies the skin folds are most affected, but there can be a yellowish scaly crust on the scalp which is what we know as cradle cap.
In darker skins, affected areas can look extra pigmented (hyperpigmented) or lighter (hypopigmented).
The condition varies in severity. A mild case would be a little bit of dandruff and flaky skin over the face. In severe cases, the skin is widely affected and very itchy and inflamed. Subsequent bacterial infections may then occur in affected areas that need specific treatment.
Seborrhoeic eczema causes
Seborrhoeic eczema has a number of potential causes:
- It is thought that increased sensitivity to or overgrowthof a yeast called Malassezia, a normal organism living on the skin, plays a part.
- Stress, hormonal change and tiredness can cause seborrhoeic eczema flare ups.
- Seborrhoeic eczema is more common in warm weather and not thought to be linked to what we eat.
- Seborrhoeic eczema can be triggered by irritants on skin so be careful what you use.
- Seborrhoeic eczema is not usually linked to any underlying illness but it can be stubborn and more severe in those with diseases affecting the immunity such as with HIV infection or psoriasis.
- Seborrhoeic eczema is also seen more frequently in those with Parkinson’s diseaseand can be more common in people with epilepsy, alcoholism, acne, rosacea.
- Seborrhoeic eczema is not contagious.
Seborrhoeic eczema treatments
The following seborrhoeic eczema treatments can be affective in managing the condition:
✔️ Scalp treatments
Medicated shampoos containing anti-yeast medication may be prescribed or advised to keep seborrhoeic dermatitis under control. These may have ingredients such as zinc pyrithione, selenium sulphide or ketoconazole. There will be instructions given about the use of these shampoos as the ingredients can be potent.
✔️ Face, trunk and skin fold treatments
In adults a mixture of anti-fungal cream and mild steroid (1per cent hydrocortisone) is the usual regime for flare-ups. This is used for up to two weeks at a time under strict medical guidance.
Washing your body with a medicated shampoo may be recommended by your doctor (and leaving it on for 5 minutes to work) and can help to control symptoms or prevent relapse. Your doctor will advise how often to use.
Specific treatment will be needed for the eye area. For within the ears sometimes drops are given. It is not advised to use a cotton bud to probe as this can make symptoms worsen.
Treating seborrhoeic eczema in children
The main treatments for infants where skin folds are affected by seborrhoeic eczema are emollient creams or moisturisers, but mild steroid or antifungal creams may be needed. You would need to see your GP for these. In simple cases the pharmacist may be able to advise you further.
Treating cradle cap
Cradle cap does not bother the baby, only the parents due to its unsightly appearance. Be reassured it will usually resolve on its own.
✔️ Wash the babies scalp with baby shampoo and gently remove loose flakes with a very soft brush.
✔️ Do not pick areas off as this may cause infection.
✔️ Olive oil can sometimes be used to soften the areas. Some find success leaving olive oil on the scalp over night and washing off with baby shampoo in the morning.
✔️ Do not use a peanut based oil as this could trigger allergies.