Seborrheic Dermatitis

[Guide]

Co-Existence with Rosacea
There are numerous reports that rosacea and Seborrheic Dermatitis can co-exist! Yes, you can have SD and rosacea at the same time. [3]

Misdiagnosed
SD looks so much like rosacea that some rosaceans have reported that their rosacea was misdiagnosed as SD or vice versa! [4]

"In addition, because of the similarities in distribution, seborrheic dermatitis can be easily confused with rosacea." [27]

Photos
Images courtesy of DermNet NZ [8]. Google image search. 

Cause
"The cause of seborrhoeic dermatitis remains unknown, although many factors have been implicated. The widely present yeast, Malassezia furfur (formerly known as Pityrosporum ovale), a fungus, may be involved, as well as genetic, environmental, hormonal, and immune-system factors. A theory that seborrhoeic dermatitis is an inflammatory response to the yeast (fungus) has not been proven. Those afflicted with seborrhoeic dermatitis have an unfavourable epidermic response to the infection, with the skin becoming inflamed and flaking. In children, excessive vitamin A intake can cause seborrhoeic dermatitis. Lack of biotin, pyridoxine (vitamin B6) and riboflavin (vitamin B2) may also be a cause." [1]

In May 2007 it was published, "The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor." [1a]

An article published in 2007 [2] may help you if you have been diagnosed with SD since the real cause may be a fungi called Malassezia Globosa. The article mentions three factors that my be involved with SD; sebum, microbial metabolism (specifically, Malassezia yeasts), and individual susceptibility.

"Pyrithione Zinc (PTZ) is a potent monographed anti-fungal agent against M. globosa. It treats seborrheic dermatitis/dandruff and provides symptomatic relief, reducing the irritation response while inhibiting the causal agent. The particles that comprise this anti-fungal can be engineered into flat platelet shapes to deliver optimized scalp coverage resulting in improved efficacy." [2a] [7a]

"High colonization with Staphylococcus epidermidis, along with impaired skin permeability barrier function, contributes to the occurrence of SD....The results show a predominance of Acinetobacter, Staphylococcus, and Streptococcus on lesional sites. The authors suggest that, in addition to Malassezia, these commensal bacteria might contribute to SD development. Likewise, our preliminary study indicated a greater predominance of these phyla on SD lesional skin as compared to normal controls (unpublished data). Studies on both French and Chinese populations suggested that dandruff scalps, often associated with SD, are associated with a high incidence of M. restricta and Staphylococcus epidermidis." [21]

"Although the causes of SD are not completely understood, it appears to result from a combination of the following three factors: sebaceous gland secretion, presence of Malassezia yeast, and the host immune response." [23]

Dermoscopy
"In conclusion, dermoscopic examination can be useful in the diagnosis of patients with facial inflammatory diseases, especially in patients with rosacea and seborrheic dermatitis, which are common in clinical practice." [28]

Not Contagious
According to several reputable sources, SD is not contagious. [8]

Support Groups
You can use this thread if you have SD and post here and hopefully others with SD will do the same. 

Genetic Marker?
"A new gene associated with a variant of psoriasis and seborrheic dermatitis has been identified by a research group led by Dr. Ohad Birk at the Morris Kahn Laboratory of Human Genetics at Ben Gurion University and Soroka Medical Center. ...Psoriasis and seborrheic dermatitis affect 2-3% of the population worldwide and 85% of AIDS patients...." [5]

Number of SD Sufferers Worldwide
If you take the 2% figure that would mean there are over 150 million Psoriasis/SD sufferers worldwide, less than the number of rosacea sufferers worldwide, which is probably not the case. The NPF says the number for psoriasis is 2 to 3 percent of the worldwide population. The number world wide who suffer from SD is said to be "1 to 5 percent" according this report, so clearly the combined number would be higher. 

Signs and Symptoms
Wikipedia reports, "Seborrhoeic dermatitis' symptoms appear gradually and usually the first signs are flaky skin and scalp. Symptoms occur most commonly anywhere on the skin of the face, behind the ears and in areas where the skin folds. Flakes may be yellow, white or grayish. Redness and flaking may also occur on the skin near the eyelashes, on the forehead, around the sides of the nose, and the chest and upper back.

In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.

Commonly, patients experience mild redness, scaly skin lesions and in some cases hair loss. Other symptoms include patchy scaling or thick crusts on the scalp, red, greasy skin covered with flaky white or yellow scales, itching, soreness and yellow or white scales that may attach to the hair shaft.

Seborrheic dermatitis can occur in infants younger than three months and it causes a thick, oily, yellowish crust around the hairline and on the scalp. Itching is not common among infants. Frequently, a stubborn diaper rash accompanies the scalp rash.[6] Usually, when it occurs in infants the condition resolves itself within days and with no treatment.[citation needed]

In adults, symptoms of seborrheic dermatitis may last from a few weeks, to years. Many patients experience alternating periods of inflammation. The condition is referred to a specialist when self-care has proven unsuccessful."

Treatments for Seborrheic Dermatitis

AquaVive Lotion

AquaVive Shampoo

Auburn's Raw Honey & Raw Coconut Oil Recommendation

Azeliac Acid [29]

Biom8 [25]

Ciclopiroxolamine 1% cream, twice daily for 28 days followed by once daily for 28 days [23]

Climbazole and Piroctone Olamine [19]

Clotrimazole

Crude (raw) honey [24]

Dermadexin [14]

Eutrosis DS [30]

Hyaluronate acid sodium salt 0.2% (Bionect) cream [31]

Ketoconazole (Extina, Nizoral, Nizoral A-D, and Xolegel)

Miconazole

Nizoral

Nonpathogenic E. coli strain Nissle 1917 [20]

Oral itraconazole given in a dose of 200mg/day for one week, followed by a maintenance dose, resulted in clinical improvement of SD symptoms in two open-label trials. [23]

Ovace

Pimecrolimus

Promiseb Topical Cream for seborrheic dermatitis may be something to consider. "Promiseb®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials)." Promiseb contains Piroctone olamine, is a prescription drug, and averages about $127/30 grams. [17]

Pyrithione Zinc (PTZ) is effective against SD. [7a]

Sea Salt Baths (see post #2)

Sebamed (contains Piroctone Olamine)

Sebclair Shampoo (contains Piroctone Olamine – Anti-fungal action) [19]

"Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis." [7]

Sebuderm

Stellate ganglion block (SGB) [26]

"The therapy consists mainly of antifungal agents, corticosteroids, immunomodulators, and keratolytics." [6]

"Treatment options for nonscalp and scalp seborrheic dermatitis include topical agents and shampoos containing antifungal agents, anti-inflammatory agents, keratolytic agents, and calcineurin inhibitors. Because multiple body sites are usually involved, the physician should examine all commonly affected areas. Patients should be made aware that seborrheic dermatitis is a chronic condition that will probably recur even after successful treatment." [9]

topical 4% Quassia amara gel [18]

Topical ketoconazole [15]

Topical Nicotinamide (NCT) [12]

Topical corticosteroids (short-term) [16]

"topical treatment with tacrolimus, fusidic acid, or moisturizers." [21]

Urea [13]

Uriage Eau Thermale DS Emulsion

Anecdotal Reports

Anecdotal Reports on Using Raw Honey

flurb says, "I am buying Fage brand 2% plain yogurt and I apply a thin layer for 20 minutes a day to my face. I then rinse it off and moisturize with MCT Oil and Cerave PM Moisturizer. I also shampoo my hair with Hegor 150. The yogurt is a mild exfoliator which helps with scaling but isn't irritating. It also helps with the mild acne caused by my rosacea. If you can't find Fage yogurt in your area, just try to find a thicker plain greek yogurt with live cultures in it."

gora recommends Excipial U Lipolotio [13]

Jonu's Definitive Guide to Beat Malassezia Conditions

Rory (post #5) says, "Cyclopirox Olamine 1% cream, Ketoconazole 2 % cream or Climbazole 1% cream may be better options."

Seborrheic Dermatitis and Telangiectasia (dilated blood vessels)

TJM23 recommends eliminating stress (post no 1) 

Tom Busby's SD Treatment Protocol

Washing Clothes to Eliminate Malassezia

Several anecdotal success stories at RF thread started by TJM23

Differences in Treatment
"The topical anti-inflammatory treatments were more effective in achieving total clearance of symptoms than placebo by 1.4-fold to 8.5-fold, but there are no considerable differences in the anti-inflammatory topical treatments or in comparison with azoles for short-term treatment. There is no evidence of treatment effects in long-term, continuous, or intermittent use of these compounds despite the chronic nature of the disease." [10]

"Lithium salts were more effective than azoles in producing total clearance." [11]

Folliculitis or Pityrosporum Folliculitis (PF)

Folliculitis should be ruled out from SD or rosacea. It may be possible that rosacea, SD and folliculitis are all related. 

"Pityrosporum is part of the normal skin flora, but overgrows in certain conditions. Overgrowth is associated with oily skin, humidity or other pre-existing dermatologic conditions such as seborrheic dermatitis and severe dandruff." [22] Just remember, "Malassezia (formerly known as Pityrosporum) is a genus of fungi." Wikipedia

So you might want to rule out PF from SD. 

Reply to this Topic

There is a reply to this topic button somewhere on the device you are reading this post. If you never heard about this topic and you learned about it here first, wouldn't it be a gracious act on your part to show your appreciation for this topic by registering with just your email address and show your appreciation with a post?  And if registering is too much to ask, could you post your appreciation for this topic by finding the START NEW TOPIC button in our guest forum where you don't have to register?  We know how many have viewed this topic because our forum software shows the number of views. However, most rosaceans don't engage or show their appreciation for our website and the RRDi would simply ask that you show your appreciation, please, simply by a post.  

End Notes

[1] Wikipedia

[1a] Adult Seborrheic Dermatitis
A Status Report on Practical Topical Management
James Q. Del Rosso, DO

[2] J Investig Dermatol Symp Proc. 2007 Dec;12(2):15-9.
Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis.
Dawson TL Jr.

[2a] Real cause of seborrhea discovered!
by Artist » Thu Jan 31, 2008 5:17 pm

[3] "Rosacea and seborrheic dermatitis are both inflammatory skin disorders that cause redness, lesions, and itching, and they frequently occur together."
The Rosacea-Seborrheic Dermatitis Link, by Diana Rodriguez, Medically Reviewed by Lindsey Marcellin, MD, MPH, everyday Health

[4] Misdiagnosed Rosacea

[5] Psoriasis gene ID'd by Israeli researchers
Posted by Randall, Google Groups, 6/14/2006

U-M scientists ID major psoriasis susceptibility gene
By Sally Pobojewski
Medical School Communications, University of Michigan

[6] Seborrheic Dermatitis
Aschoff R, Kempter W, Meurer M.
Hautarzt. 2011 Mar 24.

[7] Am Fam Physician. 2015 Feb 1;91(3):185-90.
Diagnosis and treatment of seborrheic dermatitis.
Clark GW, Pope SM, Jaboori KA.

[7a] Pyrithione Zinc, Wikipedia

DermaHarmony Zinc Therapy Soap (2% Pyrithione Zinc)

Noble Formula 2% Pyrithione Zinc

Noble Formula Cream (.25% pyrithione zinc)

Noble Formula Zinc Spray (.25% pyrithione zinc)

[8] DermNet NZ • Mayo Clinic • CNN Health

[9] J Clin Aesthet Dermatol. 2013 Feb;6(2):44-9.
Optimizing treatment approaches in seborrheic dermatitis.
Gary G.

[10] JAMA Dermatol. 2015 Feb;151(2):221-2. doi: 10.1001/jamadermatol.2014.3186.
Topical anti-inflammatory agents for seborrheic dermatitis of the face or scalp: summary of a Cochrane Review.
Kastarinen H, Okokon EO, Verbeek JH.

[11] Cochrane Database Syst Rev. 2014 May 19;(5):CD009446. doi: 10.1002/14651858.CD009446.pub2.
Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp.
Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkkä J, Oravilahti T, Rannanheimo PK, Verbeek JH.

[12] J Dermatolog Treat. 2014 Jun;25(3):241-5. doi: 10.3109/09546634.2013.814754. Epub 2013 Jul 5.
Topical nicotinamide for seborrheic dermatitis: an open randomized study.
Fabbrocini G1, Cantelli M, Monfrecola G.

[13] Urea is mentioned as a treatment for SD in an article by Dermnet New Zealand
Excipial Urea
Excipial Urea Hydrating Healing Lotion
EXCIPIAL U Lipolotion

[14] Dermadexin™
A New Treatment for Dermatitis, Astion Pharma A/S
"Cipher Pharmaceuticals announced it has acquired three products from Astion Pharma that are focused on inflammatory dermatological diseases. he products include Dermadexin, a topical barrier-repair cream containing the pharmacologically active ingredient P3GCM. Dermadexin was approved in the European Union (EU) in 2014 as a Class III medical device for treating seborrheic dermatitis." 
Cipher acquires three dermatology products from Astion Pharma, Healio Dermatology

Cipher Pharmaceuticals has announced that "Dermadexin™ is a patent-protected topical barrier-repair cream containing P3GCM. It received approval in the European Union (EU) in 2014 as a Class III medical device for the alleviation of symptoms of facial dermatitis such as redness, scaling and itching." Source  

Dermadexin is a patent-protected topical barrier-repair cream containing the pharmacologically active ingredient P3GCM. The product was approved in the European Union (EU) in 2014 as a Class III medical device for the treatment of seborrheic dermatitis, an inflammatory skin disorder affecting the scalp, face, and torso. Dermadexin SD Cream has been tested in two placebo-controlled, multi center clinical trials (436 patients) where it displayed a marked and statistically significant effect on the symptoms of facial seborrhoeic dermatitis with a fast onset of action and an increasing effect over time. Source

Also known as Helioclin® Dermatitis SD Cream in Europe. Source

Cipher Pharmaceuticals announces acceptance of 510(k) submission for Dermadexin™ by FDA

DermadexinTMa new treatment for dermatitis (pdf)

FDA Accepts Dermadexin 510(K) Submission

Company Overview of Astion Pharma, Worldwide Rights to Dermadexin, Pruridexin And ASF-1096 (Bloomberg)

Cipher Pharmaceuticals Pipeline

Dermadexin, A New Treatment for Dermatitis, Astion

[15] "Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body."
See end note [7]

[16] "Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis."
See end note [7]

[17] Am J Clin Dermatol. 2017 Apr;18(2):193-213. doi: 10.1007/s40257-016-0232-2.
Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review.
Gupta AK,, Versteeg SG.

What is the active ingredient in Promiseb Topical Cream?
"Promiseb Topical Cream is a prescription-only, nonsteroidal FDA-cleared medical device and has no active ingredient. However, Promiseb Topical Cream has demonstrated both anti-inflammatory and antifungal properties."  Source

Promiseb Product Insert

Prescribing Information

[18] J Drugs Dermatol. 2013 Mar;12(3):312-5.
Efficacy of topical 4% Quassia amara gel in facial seborrheic dermatitis:a randomized, double-blind, comparative study.
Diehl C, Ferrari A.

[19] "confirms the science for my positive experience using climbazole and piroctone olamine against malassezia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125955/

Ann Dermatol. 2016 Dec; 28(6): 733–739.
Efficacy and Safety of Cream Containing Climbazole/Piroctone Olamine for Facial Seborrheic Dermatitis: A Single-Center, Open-Label Split-Face Clinical Study
Hae Jeong Youn, Soo Young Kim, Minji Park, Won Hee Jung, Yang Won Lee, Yong Beom Choe, and Kyu Joong Ahn

Begin Tom Busby comment about climbazole and piroctone olamine:

"To convert µg/ml to percentage, move the decimal place 4 places to the left -- you can see in the Korean study (linked above) that very tiny percentages of climbazole and piroctone olamine are effective against malassezia. 

However, I make a true oil-in-water emulsion of dissolved climbazole and piroctone olamine, and it's not clear how the test-product was made (how climbazole and piroctone olamine powders were dissolved and then emulsified) -- this makes all the difference for effectiveness, in my opinion. 

Second, the Korean study refers to Sensibio DS+ cream as a "crude mixture," twice, which makes me think that the powders (climbazole and piroctone olamine) are not dissolved properly.

Third, the test-culture medium used in the Korean study is capable of dissolving climbazole and pirocotone olamine powder, and so, the cosmetic itself, Sensibio DS+ cream, could be much less effective on the human skin.

Finally, no one should buy or use the tested product, Sensibio DS+ cream, because the primary oil in it is coconut oil, which feeds malassezia. This is a terrible idea, and this product is not going to work, except in the manner of one step forward, two steps back. It's expensive too, about $24 for 40 ml."
Tom Busby post #4

[20] Nonpathogenic E. coli strain Nissle 1917

[21] Chin Med J (Engl). 2017 Jul 20; 130(14): 1662–1669.
High Staphylococcus epidermidis Colonization and Impaired Permeability Barrier in Facial Seborrheic Dermatitis
Qian An, Meng Sun, Rui-Qun Qi, Li Zhang, Jin-Long Zhai, Yu-Xiao Hong, Bing Song, Hong-Duo Chen, and Xing-Hua Gao

[22] "Pityrosporum is part of the normal skin flora, but overgrows in certain conditions. Overgrowth is associated with oily skin, humidity or other pre-existing dermatologic conditions such as seborrheic dermatitis and severe dandruff." Wikipedia

More Info on Pityrosporum Folliculitis [PF]

[23] J Clin Aesthet Dermatol. 2013 Feb; 6(2): 44–49. PMCID: PMC3579488
Optimizing Treatment Approaches in Seborrheic Dermatitis
Goldenberg Gary, MD

[24] Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff.
Al-Waili NS.
Eur J Med Res. 2001 Jul 30;6(7):306-8.

There are a number of threads at RF discussing the merits of raw honey, particularly Manuka honey, in treating SD. Try this one. There are others in a search if youtake the time.

[25] Biom8 Official Web Site • Biom8 Review at RF • Biom8 are products by Michael Anders who runs Skindrone

[26] Korean J Anesthesiol. 2016 Apr; 69(2): 171–174.
Seborrheic dermatitis treatment with stellate ganglion block: a case report
Gun Woo Kim, Ki Ho Mun, Jeong Yun Song, Byung Gun Kim, Jong Kwon Jung, Choon Soo Lee, Young Deog Cha, and Jang Ho 

[27] P T. 2010 Jun; 35(6): 348–352.
Seborrheic Dermatitis
Thomas Berk, MD and Noah Scheinfeld, MD

[28] Indian J Dermatol. 2020 Jul-Aug;65(4):316-318
Useful Dermoscopic Findings for Differentiating Rosacea from Seborrheic Dermatitis.
Kang IH, Seo JK, Shin MK

[29] "A recent exploratory study supports the efficacy and safety of azelaic acid 15% gel in seborrheic dermatitis. Azelaic acid may be especially valuable in this application because of its efficacy in treating concomitant rosacea and acne."

J Drugs Dermatol. 2009 Feb;8(2):125-33.
Facial seborrheic dermatitis: a report on current status and therapeutic horizons
Joseph Bikowski 

[30] Eutrosis DS, Difa Cooper, Calabria labs, Italy

Efficacy of a Corticosteroid-Free, 5% Hyaluronic-Based Facial Cream in the Treatment of Seborrheic Dermatitis. A Proof-of-Concept Study
January 2017
DOI: 10.4172/2155-9554.1000426

[31] "Dr Allen: For patients who have some seborrheic dermatitis associated with their rosacea (which is fairly common), I am starting to use hyaluronate acid sodium salt 0.2% (Bionect) cream, which attracts and binds water and plays a role in inflammation and tissue repair, as well as Promiseb cream, an antiseborrheic cream that helps to repair the skin barrier. These are alternatives to topical steroids, which can be good for rosacea flares but should not be used for more than a few weeks." 
Rosacea: The Patients Pay the Price
Interview with Jennifer H. Allen, MD
AHDB

Other Articles

Treatment of Seborrheic Dermatitis
BETTY ANNE JOHNSON, M.D., PH.D., and
JULIA R. NUNLEY, M.D.
Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia

[Guide]

The RRDi is an Amazon Affiliate. By clicking below on the link and purchasing the item, the RRDi receives a small fee. Thanks. Please post your experience using any of the products in this thread. 

Clotrimazole Antifungal Cream 1% USP

Dermoscribe Seborrheic Dermatitis Cream

Ducray Elution Rebalancing Shampoo

Nizoral

pHat 5.5 Seborrheic Dermatitis Shampoo and Conditioner Set

Sebamed Scalp Balancing Shampoo

Sebclair Shampoo

Yes To Tea Tree Soothing Scalp Treatment

 

[Guide]

Two Steps for SD Newbies

(1) Read Tom Busby's SD Treatment Protocol

(2) Read this thread

 

[Guide]

If you look at the photos of the "erythematous scaly plaques on the eyelids, cheeks, nose, nasolabial folds, and chin" of this 16 year old male suffering from Netherton syndrome who was successfully treated with secukinumab, it looks a bit like SD. It would be interesting to see if this treatment works on SD or rosacea?  Who would sponsor such a research clinical paper? Could 10K members of the RRDi be united enough to each donate one dollar so we could sponsor such a research investigation? Wouldn't you like to know if secukinumab would treat your skin issue? Ask you physician. Post in this thread your results. Why not be a RRDi volunteer and post your comment about this? Find the green reply button. It is not that difficult to register an account with just your email address. Of course, volunteering is not for sissies. 

"At his most recent follow-up after almost 3 years of treatment with secukinumab, he had complete clearance of his facial erythema and only 1 mild flare of the polycyclic plaques on his trunk and extremities several months before."
JAAD Case Rep. 2020 Jun; 6(6): 577–578.
Successful use of secukinumab in Netherton syndrome
Sarah K. Blanchard, MD and Neil S. Prose, MD

[Guide]

A rare condition involving SD is eyebrow hairloss. Sickening started an interesting thread on this subject if you are suffering from this disorder. A similar thread was started by angelstar. Sometimes it can be confused with Frontal Fibrosis Alopecia.