Seborrheic Dermatitis: Causes, Symptoms, How to Tell It from Psoriasis and Fungal Rashes, and Long-Term Control
Seborrheic dermatitis (Seborrheic dermatitis), or inflammatory skin rash from the oil glands, is a chronic inflammatory skin condition that causes red patches with white to yellow greasy scales in areas rich in oil glands: the scalp, eyebrows, beside the nose, the cheek folds, behind the ears and the middle of the chest. It comes and goes, is not contagious, and can be kept calm with medicated shampoo, antifungal creams and short courses of anti-inflammatory medicine.
It affects about 3–5% of adults, while dandruff, a mild form of the same condition, affects almost half of adults. It is most common at two ages: infants up to 3 months old, and adults aged 30–60, especially men. A problem dermatologists often see is patients who buy steroid cream and apply it to the face themselves for a year, or who have been treated as acne or dry skin for a long time, because they do not know that this same rash needs different treatment depending on where it appears. This article therefore separates seborrheic dermatitis by site and type, with medicine names, strengths and the actual duration of use.
What Does Seborrheic Dermatitis Look Like?
Common features that help you suspect seborrheic dermatitis even before seeing a doctor
Red patches with greasy scales: white to yellow scales that feel oily to the touch, not the dry, rough flakes of dry skin.
Poorly defined edges: the rash fades gradually at the border, unlike psoriasis, which has sharp edges.
Both sides equal: beside both sides of the nose, both eyebrows. Symmetry in oil-rich areas is an important clue.
Mild to moderate itch: some people barely itch, while others itch a lot on the scalp.
Comes and goes: it can improve on its own for a while, then return with stress, lack of sleep or cold, dry weather.
Pus bumps are not the main feature: if there are small, evenly sized itchy bumps on the chest and back, think of yeast folliculitis (Malassezia folliculitis), which can occur together with it.
What Causes Seborrheic Dermatitis?
Seborrheic dermatitis comes from several factors working together, not from a single cause.
Malassezia yeast (Malassezia): it lives on everyone's skin normally. It breaks down skin oils into free fatty acids that irritate the skin.
Oil glands: they explain why the rash appears where oil is abundant, and why it usually starts after adolescence.
Skin immunity: some people react too strongly to the yeast and the substances it produces, which causes inflammation.
Weakened skin barrier: irritants pass through easily, so the rash flares when harsh products are used.
This is why two people with the same yeast can differ, one getting the rash and the other not, and why treatment has to reduce both the yeast and the inflammation at the same time. Seborrheic dermatitis is not caused by poor hygiene.
Is Seborrheic Dermatitis a Fungal Infection? Is It Contagious?
Seborrheic dermatitis is not contagious. Sharing pillows or combs or sleeping together does not give it to another person. Although antifungal medicine helps, seborrheic dermatitis is not an infection from an outside fungus like ringworm. The medicine helps because it reduces the number of resident yeast that trigger inflammation. This differs from tinea versicolor, which comes from the same type of yeast but changes form and causes patchy discoloured circles on the skin.
Seborrheic Dermatitis on the Scalp: From Ordinary Dandruff to Thick Scales
Appearance: it starts as fine flakes falling onto the shoulders. When worse, it becomes plaques of yellow greasy scale stuck to the scalp, red and itchy. It may spread to the hairline, forehead and behind the ears.
Cause: overactive scalp oil glands together with Malassezia yeast. Ordinary dandruff is the mild form without red inflammation.
Severity/urgency: not dangerous, but it disrupts daily life. A dry scalp with flaking, where the flakes are fine, dry and not greasy, is treated differently, and if there is a lot of scalp itching, it should also be told apart from fungal infection and head lice.
When to see a doctor: no improvement after a full 4 weeks of using medicated shampoo correctly, thick tightly packed scale, pus on the scalp, or patchy hair loss.
Seborrheic Dermatitis on the Face: Eyebrows, Beside the Nose, Cheek Folds
Appearance: thin red patches with greasy scale at the inner eyebrows, between the eyebrows, beside the nose and in the cheek folds, usually on both sides. Patients often think it is flaky facial skin from dryness, so they apply heavier cream and the rash gets worse.
Cause: this area is oily and the skin is thin, so heavy greasy creams or scrubbing easily trigger it.
Severity/urgency: not dangerous, but the face is where steroid misuse does the most harm, such as thin skin, tiny visible blood vessels and perioral dermatitis.
When to see a doctor: no improvement within 2–4 weeks, red patches on both cheeks that spare the nasal folds (must be told apart from lupus), or a red face that flares after stopping a steroid used for a long time.
Seborrheic Dermatitis on the Eyelids: Red Lid Margins, Scales at the Eyelash Base
Appearance: red eyelid margins, greasy scales stuck at the base of the eyelashes, stinging or irritated eyes, and sticky eyes on waking. Doctors call this eyelid inflammation (seborrheic blepharitis).
Cause: abnormal activity of the oil glands in the eyelids, often together with seborrheic dermatitis of the eyebrows or scalp.
Severity/urgency: mostly mild and chronic. Care with a warm compress for 5–10 minutes, then gently wiping the lid margin once a day with diluted baby shampoo. Do not use medicated shampoo or antifungal cream near the eyes on your own.
When to see a doctor: very red eyes, eye pain, blurred vision or lost eyelashes. See an eye doctor, because there may be an associated corneal inflammation.
Seborrheic Dermatitis Behind the Ears and in the Ear: Cracked, Itchy Rash
Appearance: greasy scales and red rash in the fold behind the ear, in the outer ear, or at the ear canal opening. Some people have raw, cracked skin in the fold behind the ear.
Cause: the fold behind the ear is damp and oily, and sweat and shampoo that is not rinsed off make it flare. Picking at the ears is a common trigger.
Severity/urgency: mostly not dangerous, but the cracks can become infected with bacteria.
When to see a doctor: ear pain, pus or fluid draining from the ear, muffled hearing, or fever. You should be checked for outer ear infection. Do not put drops or medicine into the ear canal on your own.
Seborrheic Dermatitis in Men with Beards and Moustaches
Appearance: a red itchy rash with scales under the beard, the moustache and around the mouth, often starting when a beard is grown or in cold weather.
Cause: thick hair traps oil and scales, so the yeast multiplies. Many people clearly see the rash improve after shaving the beard.
Severity/urgency: not dangerous. Washing the beard with medicated shampoo 2–3 times a week and trimming it shorter often helps a lot.
When to see a doctor: pus bumps at the hair base, pain or lumps, because it may be bacterial folliculitis or ringworm of the beard.
Seborrheic Dermatitis on the Chest and Back: May Occur with Yeast Folliculitis
Appearance: round red patches with greasy scale in the middle of the chest or back. Some have a petal-like shape with fine scale at the edge.
Cause: the middle of the trunk has many oil glands, and tight clothing and sweat make it flare. If small, evenly sized itchy bumps are present too, yeast folliculitis may be layered on top, since it comes from the same yeast.
Severity/urgency: not dangerous. Medicated shampoo can be used to wash the body the same way as on the scalp, left on for 5 minutes before rinsing.
When to see a doctor: you are not sure whether it is tinea versicolor, ringworm or pityriasis rosea, or the rash is spreading widely and fast, because a skin scraping is easy to do and changes the treatment immediately.
Seborrheic Dermatitis in the Skin Folds: Armpits, Groin, Under the Breasts
Appearance: smooth, shiny red patches with little scale because this area is moist. It is uncommon in ordinary adults and more common in infants and older people.
Cause: dampness together with yeast, and it must be told apart from intertrigo, Candida yeast infection, ringworm of the groin and psoriasis in the folds.
Severity/urgency: not dangerous, but skin here absorbs steroid medicine a lot, so do not apply strong medicine on your own.
When to see a doctor: lasting more than 2 weeks, weeping, painful or smelly. Be examined before using medicine, because the medicine differs by cause.
Seborrheic Dermatitis in Infants (Cradle Cap)
Appearance: thick yellow greasy scales on the top of the head, sometimes spreading to the eyebrows, behind the ears or the skin folds. Babies usually do not itch and eat and sleep normally.
Cause: common in the first 3 months, related to oil glands that are still very active in infants. It is not caused by poor hygiene.
Severity/urgency: not dangerous and mostly clears by itself within 6–12 months. Care: apply baby oil or petroleum jelly and leave for 15–30 minutes, gently loosen the scales with a soft brush, then wash with baby shampoo. Do not pick the scales, and do not use products containing salicylic acid in infants because it can be absorbed.
When to see a doctor: the rash spreads over the whole body, weeps or has pus, the baby itches so much that they cannot sleep (must be told apart from atopic dermatitis), the rash has not cleared after 1 year of age, there are bleeding spots, or the baby is not growing and has chronic diarrhoea. See other rashes at this age at newborn rashes.
Seborrheic Dermatitis Flares in Winter and During Stress
Appearance: in people who already have it, the rash flares clearly in cold dry weather, in air-conditioned rooms, after heavy workloads or after lack of sleep, usually returning at the same sites as before.
Cause: dry air weakens the skin barrier, there is less sunlight, and stress and short sleep change the immune response. Alcohol is a trigger in some people.
Severity/urgency: not dangerous. At this time, go back to medicated shampoo 2–3 times a week in advance instead of waiting until it flares badly, and avoid washing the face with hot water.
When to see a doctor: flares more often than once a month, or gets worse every winter, to plan long-term control.
Unusually Severe Seborrheic Dermatitis: Parkinson's Disease, HIV and Low Immunity
Appearance: a widespread, fast-spreading, thick rash, or one that starts severely without ever having had it before, and does not respond to usual medicines.
Cause: seborrheic dermatitis is found in about 30–80% of people with HIV infection, depending on immune level, and in about 20–60% of people with Parkinson's disease because facial oil increases. It is also seen in people on immune-suppressing drugs, people with epilepsy, depression, and people taking certain medicines such as lithium or some antipsychotics.
Severity/urgency: the rash itself is not dangerous, but this pattern may be a sign of an underlying condition. Red, peeling skin over almost the whole body (erythroderma) with fever or chills is an emergency.
When to see a doctor: whenever the rash is unusually severe, spreading fast, or does not improve with standard treatment. The doctor may recommend further testing of immunity or an HIV test.
How to Tell Seborrheic Dermatitis from Look-Alike Conditions
This is the point where patients are treated the wrong way most often.
Psoriasis (Psoriasis): thick silvery scale, sharp rash edges, pinpoint bleeding when scraped, found on the elbows, knees and hairline, and the nails may be pitted. Borderline cases are called sebopsoriasis.
Ordinary dandruff: scale but no red inflammation, and limited to the scalp.
Ringworm of the face (Tinea faciei): often on one side only, a ring with a clearly raised edge and a paler centre, and it spreads worse if a steroid is applied.
Tinea versicolor: white or brown discoloured circles on the trunk, rarely red or inflamed.
Rosacea (Rosacea): redness in the middle of the cheeks and nose, with tiny visible blood vessels and bumps, without greasy scale. It can occur together with seborrheic dermatitis. See more at facial redness with visible blood vessels.
Lupus (Lupus): a red rash on the cheeks and bridge of the nose, usually sparing the nasal folds, and sensitive to sunlight. There may be joint pain, tiredness and hair loss.
Contact dermatitis: starts after using a new product, itch is prominent, and the rash matches the area of contact.
Atopic dermatitis: very itchy, dry skin, in the skin folds, often with a family history of allergy.
How Does a Dermatologist Diagnose Seborrheic Dermatitis?
Most cases are diagnosed from the site and look of the rash together with the history. No blood test is needed. Further tests are used when the picture is unclear.
Skin scraping for fungus (KOH): to tell ringworm and tinea versicolor apart. The result is known within minutes.
Skin biopsy: when psoriasis is suspected, or when the rash does not clear and has unusual features that must be told apart from other diseases.
Blood tests only in specific cases: such as ANA when lupus is suspected, or an HIV test when the rash is unusually severe.
How Is Seborrheic Dermatitis Treated? The 3-Step Approach
Treatment is chosen by site and severity, with these principles:
Reduce the yeast: medicated shampoo or antifungal cream. This is the main medicine and can be used on every site except around the eyes.
Reduce inflammation in the short term: a mild steroid or an immune-modulating medicine, only during flares.
Long-term control: use the antifungal once a week after the rash has calmed. This is the step most people skip, and it is why the rash comes back.
The medicines and doses below are given so that you understand the approach. Choosing and prescribing medicine is the job of the doctor who examines the actual rash.
Medicines for Scalp Seborrheic Dermatitis: How to Use Each Medicated Shampoo
Ketoconazole 2%: the main one with the most evidence. Use 2–3 times a week for 4 weeks, then reduce to once a week for control. It may make hair dry.
Ciclopirox 1%: another antifungal option. Use 2–3 times a week for 4 weeks, then once a week for control.
Selenium sulfide 1–2.5%: twice a week for 2–4 weeks. It has an odour and may change hair colour, so take care in people with light or dyed hair.
Zinc pyrithione 1–2%: suitable for mild cases or for long-term control. It can be used several times a week.
Salicylic acid 2–3%: it does not reduce yeast directly, but helps dissolve thick scale so other medicines can reach the scalp. Use as an add-on while the scale is thick.
Coal tar: used in some people with very thick scale. It has an odour and may stain fabric or light-coloured hair.
What makes it work or not work: lather onto a wet scalp, massage down to the skin, not just the hair, leave for 5–10 minutes, then rinse off. If you rinse immediately, the medicine has no time to work. In a study of scalp patients, using ketoconazole shampoo once a week after the rash cleared reduced recurrence over 6 months from about 47% to about 19% compared with shampoo without the active ingredient.
Thick scale that will not come off: apply mineral oil or baby oil and leave for 1–2 hours before washing with medicated shampoo. In adults, avoid olive oil and vegetable oils because they feed the yeast.
Medicines for Facial Seborrheic Dermatitis: Which Cream to Use
Ketoconazole 2% cream: apply 1–2 times a day for 2–4 weeks. It is the most commonly used starting treatment. Then apply 1–2 times a week for control.
Ciclopirox 1% cream: apply twice a day for 4 weeks. It is an alternative when ketoconazole irritates or does not work.
Medicated shampoo can be used on the face: some people do well dabbing the shampoo lather on the face, leaving it briefly, then rinsing, for rashes on the eyebrows and moustache area. Take care not to get it in the eyes.
Metronidazole 0.75–1%: used in some people, especially when rosacea is present too.
Steroid Medicine for Seborrheic Dermatitis: How Far Can It Be Used?
Steroids reduce inflammation quickly, but they are not a long-term control medicine for this condition.
Hydrocortisone 1%: on the face, 1–2 times a day, no more than 1–2 weeks per course.
Desonide 0.05%: another mild steroid, also used for no more than 1–2 weeks.
On the scalp: the doctor may use a stronger liquid or foam steroid for 1–2 weeks during a severe flare.
Warning from a dermatologist: buying a strong steroid cream and applying it to your own face continuously for months causes thin skin, dilated tiny blood vessels, permanent facial redness and perioral dermatitis. When the medicine is stopped, the rash rebounds worse than before. Whitening creams or creams with no label may also contain steroid.
Tacrolimus and Pimecrolimus: Options for the Face and Around the Eyes
Topical immune-modulating medicines (topical calcineurin inhibitors) reduce inflammation without thinning the skin, so they suit the face and around the eyes where long-term control is needed.
Tacrolimus 0.1% ointment: apply twice a day during a flare for 2–4 weeks, then reduce to twice a week when the doctor thinks it is suitable.
Pimecrolimus 1% cream: apply twice a day. It is slightly less irritating and suits around the eyes and thin skin.
Common side effects are burning in the first 3–5 days, and facial flushing when drinking alcohol. Apply sunscreen during use, and do not use on skin that is infected. Using these for seborrheic dermatitis is off-label use, so it should be under a doctor's care. Roflumilast 0.3% foam is a newer topical approved for seborrheic dermatitis in the United States, but it may not yet be widely available in Thailand.
Oral Medicines for Seborrheic Dermatitis: When They Are Used
Oral medicines are not the starting treatment. A doctor will consider them when the rash is widespread, flares often, or has not improved with topical medicine used correctly.
Itraconazole: 200 mg a day after food for about 7 days. Some people repeat it for 2 days a month for control. Other medicines you take must be checked because it interacts with many.
Fluconazole: 50 mg a day for 2 weeks, or 200–300 mg once a week for 2–4 weeks.
Terbinafine: 250 mg a day for about 4 weeks. It is another option.
Low-dose isotretinoin: used only in severe cases resistant to treatment. It must never be used in pregnancy.
Oral ketoconazole should not be used for this skin condition because of liver risk, and you should not use oral antifungal medicine on your own without seeing a doctor. In some resistant cases the doctor may also consider narrow-band ultraviolet B light therapy (NB-UVB).
How Many Days Until It Works? What Shows It Is Working or Not
First 1–2 weeks: itch and redness should reduce first. The scale will gradually become less.
4 weeks: most rashes should be calm. This is the point to switch from treatment to control.
Long term: seborrheic dermatitis can come back when all medicine is stopped, so the focus is on once-a-week control medicine and knowing your own triggers.
Common reasons treatment does not work: rinsing shampoo off too early, applying it only to the hair and not reaching the scalp, stopping the medicine as soon as it improves, putting heavy greasy cream over the rash, the wrong diagnosis, or an added infection. If there is no improvement after 4 weeks, go back to be re-examined instead of changing medicine on your own.
Seborrheic Dermatitis in Pregnancy, Breastfeeding and Children
Pregnancy and breastfeeding: topical antifungals and medicated shampoo over a limited area are absorbed little. A mild steroid can be used short term on a doctor's advice, but oral antifungals should be avoided and isotretinoin must not be used. Always tell your doctor.
Older children and teenagers: the approach is similar to adults, starting with a milder medicated shampoo and using anti-inflammatory medicine only as needed.
Infants: start with the care in the infant section above. If a topical medicine is needed, the doctor should choose the type and duration. Do not use a strong steroid or medicine containing salicylic acid.
Self-Care for Seborrheic Dermatitis
Wash the face with a gentle formula: 1–2 times a day with lukewarm water, without scrubbing, and without strongly alcoholic toners.
Choose a light moisturiser: apply thinly, avoid heavy greasy creams, facial oils and olive oil.
Do not pick the scales: picking triggers inflammation and risks infection.
Get enough sleep and manage stress: these are the triggers patients notice most clearly.
Use a light sunscreen: mild sunlight helps some people, but strong sun and sunburn make the rash worse.
Keep a record of your own triggers: such as new products, alcohol and sleepless periods, then start control medicine ahead of time.
Seborrheic Dermatitis: What Should You Not Eat?
At present no food has been proven to be a direct cause, so there is no need to cut out foods to the point of missing nutrients. Some observational studies found that a Western-style diet may be slightly linked to seborrheic dermatitis, and that eating a lot of fruit may be linked to lower risk, but cause and effect cannot yet be concluded. Alcohol is a trigger that some patients notice, so cut down if you notice it is related. The reasonable advice is to eat a varied diet and not to believe lists of forbidden foods that have no evidence.
Does Seborrheic Dermatitis Cause Hair Loss? Can It Be Cured?
Hair may shed more for a while from the inflammation and scratching, but seborrheic dermatitis does not permanently destroy the hair roots. When the inflammation is controlled, hair grows back. If hair is thin in patches or all over the scalp for several months, other causes should be looked for as well.
As for treatment, seborrheic dermatitis is a chronic condition with no way yet to cure it permanently, but most patients can control it until the skin looks almost normal most of the time, and it flares less when control medicine is used continuously and you know your own triggers. Treatment results vary from person to person.
When Should You See a Dermatologist?
No improvement after a full 4 weeks of medicated shampoo or topical medicine
You are not sure whether it is seborrheic dermatitis, psoriasis, ringworm or lupus
The rash appears fast, is severe, or is unusually widespread
You have used steroids for a long time and your face is thin, red or flares when you stop
There is weeping, pus, pain or fever
Red eyes, eye pain or ear pain along with the rash
An infant's rash spreads over the whole body, or the baby itches so much they cannot sleep
Quick Summary
Seborrheic dermatitis (Seborrheic dermatitis) is a red, greasy, scaly rash in oil-rich areas. It comes and goes and is not contagious.
It comes from the skin's reaction to Malassezia yeast together with oil, stress and cold, dry weather.
It is told from psoriasis by yellow greasy scale and indistinct edges, and from ringworm by being symmetrical on both sides.
The main medicine is ketoconazole 2%, left on for 5–10 minutes, 2–3 times a week for 4 weeks, then once a week for control.
Steroids are used short term, no more than 1–2 weeks on the face, while tacrolimus or pimecrolimus suit control on the face and around the eyes.
If the rash is unusually severe or has not improved in 4 weeks, see a dermatologist to be re-examined.
Frequently Asked Questions About Seborrheic Dermatitis
What is seborrheic dermatitis?
Seborrheic dermatitis is a chronic inflammatory skin condition of the oil glands that causes red patches with white to yellow greasy scales on the scalp, eyebrows, beside the nose, cheek folds, behind the ears and the middle of the chest. It comes and goes, is not contagious, and is not caused by poor hygiene. Dandruff is the mild form of the same condition. Most patients can keep it calm with medicated shampoo, antifungal creams and continued care.
What causes seborrheic dermatitis?
It comes from the skin reacting too strongly to Malassezia yeast, which lives normally on everyone's skin, together with overactive oil glands and a weakened skin barrier. Common triggers are stress, lack of sleep, cold dry weather and irritating products. People with low immunity or Parkinson's disease often have a more severe rash than others. Seborrheic dermatitis is not caught from other people.
How is seborrheic dermatitis treated? Which medicine is used on the face?
On the face, treatment usually starts with ketoconazole 2% cream 1–2 times a day for 2–4 weeks. If it is very red, the doctor may add hydrocortisone 1% for no more than 1–2 weeks, or use tacrolimus 0.1% or pimecrolimus 1%, which do not thin the skin. When the rash is calm, a control medicine is used 1–2 times a week. The doctor should choose the medicine according to the severity in each person.
Which shampoo is used for scalp seborrheic dermatitis?
Shampoos with clear evidence are ketoconazole 2%, ciclopirox 1%, selenium sulfide 1–2.5% and zinc pyrithione 1–2%. Use 2–3 times a week, massage down to the scalp, leave for 5–10 minutes, then rinse. When improved, reduce to once a week. If the scale is thick, salicylic acid 2–3% can be added, and if there is no improvement after a full 4 weeks of correct use, see a doctor.
Seborrheic dermatitis: what should you not eat?
No food has been proven to directly cause seborrheic dermatitis, so there is no need to cut out whole food groups. Some observational studies found a slight link with a Western-style diet, but it cannot be concluded that it is a cause. Alcohol is a trigger in some people, so cut down if you notice it is related. Enough sleep and less stress often help more clearly than avoiding foods.
Does seborrheic dermatitis go away on its own?
Sometimes the rash calms by itself, but because the condition is chronic it often returns, especially with stress, lack of sleep or in winter. Treatment helps it calm faster within 2–4 weeks, and using a control medicine once a week reduces recurrence. The exception is infants, in whom cradle cap mostly clears by itself within 6–12 months. If the rash is frequent or getting worse, see a doctor.
Related reading: tell scalp flakes apart with what causes dandruff and dry scalp with flaking · if very itchy see what causes an itchy scalp · if the rash has sharp edges and thick scale see what causes psoriasis · for itchy bumps on the chest and back see yeast folliculitis (fungal acne) · for flaking rash on the face see what causes flaky facial skin · all skin conditions at skin conditions guide from dermatologists
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed November 3, 2026
The information in this article is general knowledge, not a diagnosis or an individual treatment order. Results vary from person to person. Consult a doctor before using any medicine.
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