How Seborrheic Dermatitis Is Treated
Medically reviewed by Leah Ansell, MDMedically reviewed by Leah Ansell, MD
Seborrheic dermatitis causes red patches with overlying yellowish, greasy-appearing scales that form on oily parts of the skin like the scalp, face, upper chest and back, armpits, and genitals. Seborrheic dermatitis of the scalp in infants often resolves on its own. In adults, it is often a chronic, relapsing condition that requires long-term treatment with antifungal shampoo or, if on areas other than the scalp, with topical steroids or antifungal creams.
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Over-the-Counter (OTC) Therapies
Over-the-counter (OTC) treatments are usually the first step in treating seborrheic dermatitis in both infants and adults.
Infants
Seborrheic dermatitis manifests most commonly on an infant's scalp and is known as "cradle cap." For most infants, the good news is that the rash will disappear over time on its own without any treatment (usually by the time the baby is six months to one year of age). However, if treatment is needed, an over-counter-treatment regimen usually suffices.
This regimen consists of first shampooing the baby's scalp gently with a baby shampoo along with using an emollient like mineral oil, baby oil, olive oil, or petroleum jelly to soften and loosen the scales.
Takeaway
To optimize scale softening and loosening, your healthcare provider may recommend leaving the emollient on overnight.
Once softened, the scales can be gently removed with a cloth, infant hairbrush, soft toothbrush, or cradle cap comb. After the scale removal, baby shampoo can be used daily to prevent a recurrence.
If an infant's cradle cap does not improve with the over-the-counter treatment regimen, or if an infant's rash extends beyond the scalp, an over-the-counter 1% hydrocortisone (steroid) cream may be recommended by your child's pediatrician or dermatologist.
Related: Cradle Cap Overview
Adults
Mild seborrheic dermatitis of the scalp in adults (called dandruff) can generally be treated with over-the-counter anti-dandruff shampoos, such as the following:
Selsun and Exelderm (selenium sulfide)
Head and Shoulders and Zincon ( Zinc pyrithione)
Nizoral 1% (ketoconazole)
T-Gel extra strength and DHS tar (Tar)
Related: Best Dandruff Shampoos
The shampoo should be applied to damp skin and left in place for five minutes before rinsing off completely. Once-daily use of the shampoo can be used initially, and then as symptoms improve, you can progress to two to three times weekly, and then once weekly to prevent relapses.
Takeaway
If symptoms do not improve, trying a different shampoo is a reasonable strategy; however, if the rash worsens at any point, be sure to reach out to your healthcare provider.
Prescriptions
Sometimes a prescription medication recommended by a primary care physician or dermatologist is needed to treat seborrheic dermatitisāthis is more often the case in adults, especially if the rash involves the face or body.
Infants
If an infant's cradle cap does not improve or is extensive, an antifungal cream, such as ketoconazole 2%, may be prescribed.
Adults
For some cases of scalp seborrheic dermatitis, a healthcare provider may prescribe an antiyeast shampoo, such as Nizoral 2% (ketoconazole) or Loprox (ciclopirox 1%). These shampoos are generally used three times a week for two to four weeks. Once a week or once every two-week use may be used to prevent a relapse. It's important to let the shampoo stay on the scalp for 10 to 15 minutes before washing off. For more severe cases, a prescription antifungal shampoo in combination with a prescribed topical steroid may be required. The prescription steroid is available in different forms, such as a lotion, foam, solution, or shampoo.
Related: How to Safely Use Topical Steroids
For seborrheic dermatitis of the face or body in adults, a topical steroid cream (either over-the-counter or prescription, depending on the location and severity of the rash), a topical antifungal cream (e.g., ketoconazole 2% or ciclopirox 1%), or a combination of the two is usually recommended.
Sometimes, for facial seborrheic dermatitis, in lieu of a topical steroid, a topical calcineurin inhibitor like Protopic (tacrolimus 0.1%) is recommended. Other prescription medications used to treat seborrheic dermatitis include Zoryve (roflumilast) topical foam, which is approved for people ages 9 and older.
Takeaway
In order to prevent side effects, it's important to follow your healthcare provider's guidance required the use of and duration of any prescribed medication.
Complementary Alternative Medicine (CAM)
Tea tree oil is perhaps the most common naturopathic agent used to treat scalp seborrheic dermatitis, and its use is backed up (albeit limitedly) by scientific research.
According to a study in the Journal of the American Academy of Dermatology, 126 men and women (ages 14 and older) with dandruff were randomly assigned to use a 5% tea tree oil shampoo or placebo every day for four weeks.
Results revealed that those who used the tea tree oil shampoo had a 41% improvement in the severity of the scalp rash compared to the placebo group, which had an 11% improvement.
The tea tree oil group also showed had significantly more improvement in rash itchiness and greasiness compared to the placebo group.
Takeaway
As with any therapy, even though tea tree oil is "natural," be sure to talk with your healthcare provider before using it. Many skin conditions can mimic that of dandruff, so a proper diagnosis is warranted first.
A Word From Verywell
If you think you may have symptoms of seborrheic dermatitis, please make an appointment with your healthcare provider. Properly treating seborrheic dermatitis can not only improve the rash's visible appearance, but also soothe any associated itching, redness, and swelling. Treatment can also prevent a skin infection from occurring on top of the rash.
Frequently Asked Questions
What causes seborrheic dermatitis?
Researchers are still determining the causes of seborrheic dermatitis. Some factors are thought to include:
Malassezia, a type of yeast that normally lives on our skin
Increased level of androgen hormones
Increased amount of oils in the skin
Family history of seborrheic dermatitis
Inflammatory reactions
What can trigger a flare-up of seborrheic dermatitis?
Seborrheic dermatitis may get worse for various reasons, including:
Cold, dry weather
Stress
Hormonal changes
Using certain medications
How long does seborrheic dermatitis last?
In infants, most cases of cradle cap resolve on their own without treatment around 6 months to 1 year of age. In adults, most cases last for years and need treatment to manage symptoms.
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