How Is Seborrheic Dermatitis Treated?

Medically reviewed by Casey Gallagher, MD

Seborrheic dermatitis is an inflammatory skin condition that causes swelling, scales, and itchy rashes on the scalp, face, and other oil-rich parts of the body. Many providers consider dandruff, skin flakes, and itching on your scalp or face a mild form of this condition.

Symptoms go through periods of activity (flares) and remission, meaning you'll have periods when symptoms are active and periods when you don't experience symptoms at all.

This condition is common in different age groups, including infancy (within the first six months of life), adolescence, or in adults aged 40-60. Unfortunately, the condition can be very uncomfortable to experience and affect your self-image and quality of life. While there's no cure for seborrheic dermatitis, several treatments can help improve symptoms and offer relief—such as home remedies, medications, and procedures.

Medications

Medications for seborrheic dermatitis can help manage symptoms and reduce the frequency of flares. Prescribed medications and medicines available over the counter (OTC) can help. Healthcare providers often recommend taking medicines in combination to improve symptoms. Your medication options may include:

• Keratolytic agents: Shampoos, creams, or ointments with salicylic acid, urea, and alpha-hydroxy acids (glycolic and lactic acid) can help remove flakes and scales. These are often available OTC, but long-term use can irritate your scalp.

• Coal tar: Shampoos, ointments, gels, or creams made of coal tar reduce itching and remove skin flakes. You can apply these treatments to the scalp 1-2 times weekly. Potential side effects of long-term use may include folliculitis, contact dermatitis (an itchy rash) on the fingers, and bruising skin. Some research also shows that prolonged use raises the risk of squamous cell carcinoma, a type of skin cancer.

• Topical corticosteroids: Corticosteroid gels or creams like Locoid (hydrocortisone), Sernivo (betamethasone), and Desonate (desonide) reduce itching and swelling. While these are safe to use regularly, overuse can cause side effects including colored dots on your skin (known as telangiectasia), folliculitis, excessive hair growth, shiny skin, bruises, and discoloration.

• Calcineurin inhibitors: Calcineurin inhibitors, such as Elidel cream (pimecrolimus) or Prograf ointment (tacrolimus), change your immune function to reduce itching and swelling. In some cases, overuse of these medicines can raise the risk of skin cancer and lymphoma (lymph node cancer).

• Topical antifungal agents: Available in prescription and OTC strength, antifungal creams, ointments, and shampoos include Ciclodan (ciclopirox), Nizoral (ketoconazole), and Zeasorb (miconazole). You can use these multiple times a day, but potential side effects may include burning or itchy skin.

• Metrogel (metronidazole): This prescribed antibiotic cream or gel works by stopping bacteria growth on the skin, which can prevent symptoms. Potential side effects include skin irritation, redness, dryness, burning, stinging, teary eyes, pink eye, and nausea.  

• Oral antifungal medications: For severe cases, Terbinex (terbinafine) is an oral antifungal medication that you take once daily for four to six weeks. In rare cases, this medication may cause liver damage. Sporanox (itraconazole) is an alternative to Terbinex, which you can take once a day for one week. After this period, you'll need two maintenance doses a month. Side effects of this medication may include insomnia and an elevated heart rate.

Procedures

When other treatments aren’t yielding results, dermatologists (doctors who specialize in skin conditions) may consider phototherapy (also called light therapy). This involves regularly exposing your affected skin to ultraviolet (UV) rays, which act on your body’s inflammatory response. Light therapy can ease itching and gradually clear skin patches.

In a hospital or clinical setting, a dermatologist uses a specialized light for sessions that last up to 15 minutes. Generally, the course of treatment will involve two to three sessions a week for eight weeks or until symptoms improve. Sometimes, you might use salicylic acid alongside phototherapy. Researchers found that this combined therapy was successful 86.7% of the time at 12 weeks, significantly more than using either treatment alone.

Side effects of phototherapy are rare. However, light therapy can sometimes cause itchiness and burning in the skin, which can linger. Using this therapy for a prolonged period can also raise the risk of genital tumors.

Complementary and Alternative Medicine

There is some evidence that regularly applying tea tree oil to the scalp or affected skin can help with seborrheic dermatitis. Side effects of applying concentrates of this oil (derived from a tree native to Australia called Melaleuca alternifolia) are rare.

According to a review of tea tree use for skin conditions, regularly using 5% concentrations of tea tree shampoo led to a 41% improvement in symptoms at four weeks. How this substance helps is unknown, but researchers theorize that it kills fungi and yeasts that can cause seborrheic dermatitis. However, before trying any complementary methods, it's important to seek advice and approval from your healthcare provider to ensure these strategies are safe for you.

Home Remedies

Adopting certain lifestyle habits and trying home remedies can be an additional means of managing seborrheic dermatitis. These include the following:

• Use gentle, fragrance-free soaps

• Apply moisturizer and ointments right after showering or bathing

• Avoid alcohol or chemical-based products that can irritate the skin

• Limit heat and sun exposure, which can trigger flares

• Wear hats and use sunscreen made of zinc oxide and titanium dioxide, which are less likely to irritate the skin

• Reduce alcohol intake

• Manage stress through strategies like meditation, yoga, and deep breathing

• Learn what triggers your symptoms and then avoid those triggers

Common Triggers

Several things can trigger seborrheic dermatitis symptoms to flare up or worsen. Triggers can vary from person to person but common ones include:

• Stress

• Cold weather

• Dry or hot air

• Hot baths or showers

• Certain detergents and chemicals
  

Living With and Managing Seborrheic Dermatitis

In adults, seborrheic dermatitis can be more severe. This condition is chronic (long-term) and can cycle between periods of remission and activity. In infants, seborrheic dermatitis is milder, typically resolving on its own within 4-6 months.

Complications of this skin condition are rare, but flares can raise the risk of bacterial skin infections in the eyelids or areas where your skin folds. Unfortunately, people with this condition may experience a lower self-image and quality of life.

Getting appropriate medical treatment and speaking with a mental health professional who specializes in self-esteem and body image may help you learn how to shift your thoughts about the condition.

A Quick Review

Seborrheic dermatitis is a skin condition that causes rashes, swelling, itchiness, and dandruff on the scalp and face. How dermatologists treat this chronic condition can depend from person to person.

Common treatment options include medicated shampoos, ointments, creams, gels, and other home remedies. Additional therapies (like phototherapy) and medications can also help relieve symptoms and improve your quality of life.

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