Seborrheic dermatitis
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Seborrheic dermatitis (SD, Latin: dermatitis seborrhoica) is a chronic, recurrent inflammatory skin disease that develops primarily in areas with the highest activity of sebaceous glands. It most commonly affects the scalp, face, eyebrows, the area around the nose, ears, and the upper chest. The disease has a complex background and results from the interaction of increased sebum production, the body's individual immune response, and the presence of Malassezia yeast, which naturally colonize human skin. Seborrheic dermatitis is not a contagious disease, nor is it the result of poor hygiene. It is characterized by periods of exacerbation and remission, therefore the goal of treatment remains long-term control of symptoms and reducing the frequency of recurrences.
Seborrheic dermatitis – characteristics
Seborrheic dermatitis is one of the most common chronic inflammatory dermatoses. It is estimated to affect about 2–5% of the general population, while milder forms may occur much more frequently. The disease occurs most frequently in infants, young adults, and people over 50 years of age. A higher prevalence is observed in men, which is associated with the stronger influence of androgens on sebaceous gland activity.
Typical symptoms include:
- erythema (skin redness),
- scaling of the epidermis,
- greasy, yellowish scales,
- itching of varying severity,
- a sensation of burning or tightness of the skin.
Lesions develop in areas rich in sebaceous glands, as the lipid-rich environment favors the proliferation of Malassezia yeasts. However, the microorganisms themselves do not cause the disease. An excessive inflammatory response of the skin to their metabolic products and impaired integrity of the epidermal barrier are of key importance.
The risk of developing seborrheic dermatitis is increased by, among other things:
- genetic predisposition,
- increased seborrhea,
- chronic stress,
- sleep deprivation,
- neurological diseases (especially Parkinson's disease),
- HIV infection,
- immunosuppression,
- certain medications and immune disorders.
Seborrheic dermatitis does not lead to permanent skin damage, but chronic inflammation can cause significant discomfort and a deterioration in the quality of life.
Seborrheic dermatitis – difference between seborrheic dermatitis and dandruff
Dandruff and seborrheic dermatitis belong to the same spectrum of disorders and share many common pathogenetic mechanisms. Both entities are associated with the presence of Malassezia yeasts, but they differ in the severity of the inflammatory process.
Dandruff is the mildest form of the disorder. It is dominated by accelerated exfoliation of the epidermis without pronounced inflammation. The scalp is covered with white or slightly yellowish scales, while erythema usually remains minimal or is absent.
Seborrheic dermatitis involves a much more severe inflammatory process. In addition to flaking, the following appear:
- pronounced redness,
- itching,
- greasy, adherent scales,
- skin irritation,
- involvement of other areas of the body besides the scalp.
In clinical practice, the boundary between severe dandruff and mild seborrheic dermatitis can be fluid. Untreated dandruff can gradually progress into an inflammatory form, especially in individuals with a predisposition to excessive seborrhea.
Seborrheic dermatitis must also be differentiated from other skin diseases, such as:
- psoriasis,
- atopic dermatitis,
- contact dermatitis,
- tinea capitis,
- lupus erythematosus.
Correct diagnosis is primarily based on the clinical picture and the location of the lesions.
Seborrheic dermatitis – why it recurs
One of the most characteristic features of seborrheic dermatitis is its chronic and recurrent course. Even after the complete resolution of lesions, the disease may reactivate after weeks or months.
Recurrences result from the persistence of factors responsible for the development of the disease:
- individual genetic predisposition,
- sebaceous gland activity,
- the presence of Malassezia yeasts,
- increased reactivity of the immune system.
The most common exacerbating factors include:
- mental stress,
- fatigue,
- sleep deprivation,
- body infections,
- the autumn-winter period,
- dry air,
- improper skin care,
- irritating or strongly degreasing cosmetics.
Damage to the skin's hydrolipid barrier is also significant. Paradoxically, overly intensive cleansing and frequent use of strong detergents can exacerbate symptoms by increasing inflammation.
For this reason, modern management is based not only on treating exacerbations, but also on maintenance therapy, the aim of which is to prolong periods of remission.
Seborrheic dermatitis – face, eyebrows, hairline – where to look for lesions
Skin lesions develop almost exclusively in areas with the highest concentration of sebaceous glands.
The most common locations include:
- the scalp,
- the hairline,
- the eyebrows,
- the nasolabial folds,
- the nasal alae,
- the areas behind the ears,
- the external auditory canals,
- the chin,
- the sternal area,
- the interscapular region of the back.
On the face, erythema and fine scaling dominate, often resembling dry skin. Within the eyebrows, a characteristic accumulation of greasy scales between the hairs is observed, accompanied by itching and periodic redness.
At the border of the forehead and the scalp, a distinct erythematous-scaling band often develops, referred to as the “seborrheic crown”. In more severe cases, the lesions may cover the entire scalp.
Chronic inflammation may temporarily increase hair loss, but SD itself does not lead to permanent hair loss. Once the inflammatory process is controlled, the hair growth cycle usually returns to normal.
Seborrheic dermatitis – treatment and care
Treatment of seborrheic dermatitis includes simultaneous reduction of inflammation, reducing the number of Malassezia yeasts, and rebuilding the skin's protective barrier.
Depending on the location and severity of the lesions, the following are used:
- antifungal preparations (e.g., ketoconazole, ciclopirox),
- topical glucocorticosteroids used short-term,
- calcineurin inhibitors (tacrolimus, pimecrolimus),
- keratolytic preparations facilitating the removal of scales,
- medicated shampoos containing ketoconazole, selenium sulfide, zinc pyrithione, or tars.
Daily skin care remains equally important.
It is recommended to:
- use gentle cleansing preparations with a physiological pH,
- regularly moisturize the skin,
- avoid cosmetics containing alcohol and strong irritants,
- protect the hydrolipid barrier,
- systematically use preparations maintaining remission.
In the case of persistent erythema or coexisting dilation of blood vessels, treatments utilizing IPL light technology and vascular lasers, which reduce chronic skin redness after the active inflammation is controlled, also find application. In some patients, professional therapy rebuilding the epidermal barrier and individually selected dermatological treatments supporting skin regeneration also bring beneficial results.
Effective management requires long-term cooperation with a dermatologist and systematic care. Thanks to appropriately selected therapy, it is possible for most patients to achieve multi-month periods of remission and significantly reduce the frequency of recurrences.
