Medically reviewed by Dr. A.M. van Coevorden, dermatologist
Seborrheic eczemaredness and greasy flakes on the face and scalp
Seborrheic eczema is a skin condition with redness and flaking, mainly on the face and scalp. It affects about 5% of people, slightly more often men, and usually starts at the beginning of puberty. It is not contagious and has no link with internal illnesses.
What is seborrheic eczema?
Seborrheic eczema is a skin condition with redness and flaking, mainly visible on the face and the scalp. It affects about 5% of the population, slightly more often men than women, and usually starts at the beginning of puberty. It barely occurs in children, except in young infants (cradle cap). It has no link with internal illnesses. Its course varies: quiet periods alternate with times when the condition is more active. The eczema treats well, but can return after stopping treatment.
How does seborrheic eczema develop?
The yeast Pityrosporum ovale (also called malassezia furfur), naturally present on everyone's scalp, plays an important role. The yeast, and therefore the condition, sits mainly where there are many sebaceous glands. In people with seborrheic eczema this yeast is present in larger amounts. Some people's immune system reacts to it with an inflammatory response, which causes the redness. Why some people react to the yeast and others do not is unknown. Emotional stress can worsen the eczema, as can cold in autumn and winter and dry air in centrally heated rooms.
What are the symptoms?
Dandruff is the mildest form and looks like fine flakes on the scalp, sometimes with itch. With more extensive eczema the scalp becomes red and itch and flaking increase, sometimes so much that the whole scalp is covered in flakes and temporary hair loss occurs. On non-hairy skin it also sometimes causes itch, redness and flaking; that flaking is often yellowish and feels waxy or greasy. The itch is usually milder than in other forms of eczema. The eczema mainly appears at the hairlines, the eyebrows, the folds beside the nose and in and behind the ears. Less often on the eyelashes, chest, back and in the body folds, where the flaking has usually disappeared through sweating and the skin is only red.
Is seborrheic eczema contagious?
No. Seborrheic eczema develops from a reaction to a yeast naturally present on the skin and cannot be passed from person to person.
How is the diagnosis made?
Usually the features are clear enough for the doctor to make the diagnosis by sight. In case of doubt a piece of skin can be removed under local anaesthetic for examination, or allergy tests or flake examination can be done to rule out other skin diseases.
What is the treatment?
Seborrheic eczema treats well but cannot be permanently cured, because the underlying tendency does not change. Treatment reduces the amount of yeast and the inflammatory reaction, and is symptomatic: redness, flaking and itch are suppressed. Treatment usually consists of shampoo, creams or a combination.
Local treatment: dandruff usually responds well to antidandruff shampoos with selenium sulfide or zinc pyrithione. The dermatologist often prescribes shampoos with ketoconazole or tar. For more pronounced changes, lotions or creams with corticosteroids are added, which inhibit inflammation. To prevent side effects from long-term use, the doctor advises stopping after the eczema clears or reducing use to a few days a week. Occasionally creams with sulfur, tar, salicylic acid or calcineurin inhibitors are used.
Systemic treatment: for severe forms, a course of itraconazole or fluconazole tablets can sometimes be added to the local treatment; these kill the yeast and usually improve the eczema.
What can you do yourself?
Dandruff often improves just by washing the hair regularly and rinsing well. For the folds it is important to dry the skin well after showering. People with frequent complaints can, during quiet periods, use a prescribed antidandruff shampoo preventively once or twice a week. Stress is a recognisable trigger for some people; reduce it where possible.
What is the outlook?
Seborrheic eczema is usually a chronic condition. After stopping treatment it can worsen or return. That does not mean it always persists: the course usually varies strongly, with quiet periods alternating with more active times.
Frequently asked questions about seborrheic eczema
Is seborrheic eczema contagious?
No. It develops from a reaction to a yeast naturally present on the skin and cannot be passed from person to person.
Is dandruff the same as seborrheic eczema?
Dandruff is its mildest form: fine flakes on the scalp, sometimes with itch.
Will it ever go away completely?
It treats well but cannot be permanently cured, because the tendency remains. The course varies, with quiet and more active periods.
What helps against the flakes?
Antidandruff shampoo with selenium sulfide, zinc pyrithione, ketoconazole or tar. For more redness the doctor sometimes prescribes a corticosteroid.
Can I do anything myself?
Wash the hair regularly and rinse well, dry skin folds well, and use an antidandruff shampoo preventively during quiet periods. Reducing stress can also help.