Seborrheic dermatitis is a common, inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp or inside the ear. It can occur with or without reddened skin.
Cradle cap is the term used when seborrheic dermatitis affects the scalp of infants.
Causes
Seborrheic
dermatitis is thought to be due to a combination of an over production
of skin oil and irritation from a yeast called malessizia.
Seborrheic
dermatitis appears to run in families. Stress, fatigue, weather
extremes, oily skin, infrequent shampoos or skin cleaning, use of
lotions that contain alcohol, skin disorders (such as acne), or obesity
may increase the risk.
Neurologic conditions, including Parkinson's disease, head injury and stroke may be associated with seborrheic dermatitis. Human immunodeficiency
virus (HIV) has also been linked to increased cases of seborrheic
dermatitis.
Symptoms
Seborrheic
dermatitis can occur on many different body areas. Usuallky it forms
where the skin is oily or greasy. Commonly affected areas include the
scalp, eyebrows, eyelids, creases of the nose, lips, behind the ears, in
the outer ear, and middle of the chest.
Seborrheic dermatitis in
infants, also called cradle cap, is a harmless, temporary condition. It
appears as thick, crusty, yellow or brown scales over the child's scalp.
Similar scales may also be found on the eyelids, ear, around the nose,
and in the groin. Cradle cap may be seen in newborns and small children
up to age 3 .
Cradle cap is not contagious, nor is it caused by
poor hygiene. It is not an allergy, and it is not dangerous. Cradle cap
may or may not itch. If it itches, excessive scratching of the area may
cause additional inflammation, and breaks in skin may cause mild
infections or bleeding.
In general, symptoms of seborrheic dermatitis include:
Skin lesions
Plagues over large area
Greasy, oily areas of the skin
Skin scales - white and flaking, or yellowish, oily and adherent -- dandruff
Itching - may become more itchy if it gets infected
Mild redness
Hair loss
Signs & Tests
The diagnosis is based on the appearance and location of the skin lesions.
Treatment
You
can treat flaking and dryness with over-the-counter dandruff or
medicated shampoos. Shampoo the hair vigorously and frequently
(preferably daily). Loosen scales with the fingers, scrub for at least 5
minutes, and rinse thoroughly. Active ingredients in these shampoos
include salicylic acid, coal tar, zinc, resorcin, ketoconazole, or selenium.
Shampoos or lotions containing selenium,ketoconazole,
or corticosteroids may be prescribed for severe cases. To apply
shampoos, part the hair into small sections, apply to a small area at a
time, and massage into the skin. If on face or chest, apply medicated
lotion twice per day. Recently, creams classified as topical immune
modulators are being used.
Seborrheic dermatitis may improve in the summer, especially after outdoor activities.
For infants with cradle cap:
Massage your baby's scalp gently with your fingers or a soft brush to loosen the scales and improve scalp circulation.
Give
your child daily, gentle shampoos with a mild soap while scales are
present. After scales have disappeared, you may reduce shampoos to twice
weekly.
Be sure to rinse off all soap.
Brush your child's hair with a clean, soft brush after each shampoo and several times during the day.
If
scales do not easily loosen and wash off, apply some mineral oil to the
baby's scalp and wrap warm, wet cloths around his head for up to an
hour before shampooing. Then, shampoo as directed above. Remember that
your baby loses a lot of heat through his scalp. If you use warm, wet
cloths with the mineral oil, check frequently to be sure that the cloths
have not become cold. Cold, wet cloths could drastically reduce your
baby's temperature.
If the scales continue to be a
problem or concern, or if you child seems uncomfortable or scratches his
scalp, contact your physician. He may prescribe a cream or lotion to
apply to your baby's scalp several times a day.
Expectations - Prognosis
Seborrheic
dermatitis is a chronic (life-long) condition that can be controlled
with treatment. It often has extended inactive periods followed by
flare-ups. A more extreme form of this condition overlaps with psoriasis
of the scalp and is called sebopsoriasis.
Complications
Psychological distress, low self esteem, embarrassment
Secondary bacterial or fungal infections
Calling Your Health Care ProviderCall
for an appointment with your health care provider if seborrheic
dermatitis symptoms do not respond to self-care or over-the-counter
treatments.
Also call if patches of seborrheic dermatitis drain fluid or pus, form crusts, or become very red or painful.
Prevention
The
severity of seborrheic dermatitis can be lessened by controlling the
risk factors and by paying careful attention to skin care.
References
Hbif TP, ed. Clinical Dermatology, 5th ed. Philadelphia, PA: Mosby Elsevier; 2009.
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