Complaints & connections · borters.ch
Dermatitis seborrhoica
Yellowish greasy scales on slightly reddened skin at the oil-rich places — nose, brows, ears, middle of the chest, spine. Better in summer, worse in winter.
Also known as: seborrhoeic eczema · seborrheic dermatitis · Malassezia dermatitis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
On every skin lives a yeast called Malassezia that feeds on oil. In some people the skin reacts to its breakdown products with a mild, chronic inflammation — and out of that comes this picture. It sits exactly where the oil glands are dense: on the sides of the nose and the fold to the corner of the mouth, between the eyebrows, on the eyebrows themselves, behind and in the ears, at the hairline, in the middle of the chest and — often overlooked — along the spine from the lower back up between the shoulder blades. Typical are yellowish greasy scales on slightly reddened skin, blurred at the edges, often with a fine redness in the folds. It usually itches little or not at all, and many notice it only because the skin scales or feels tight. The course is the clearest pointer: worse in winter, with stress, with lack of sleep and after alcohol, better in summer and in the sun. It is not catching and has nothing to do with a lack of hygiene — on the contrary, washing too often and too harshly makes it worse. It is treated neither with antibiotics nor with cortisone long term, but with preparations that keep the yeast in check; it often returns after stopping, and so a maintenance treatment once or twice a week is usual. A suddenly very widespread, stubborn picture in a younger adult is a reason to think once about weakened defences.
Active substances like ketoconazole, ciclopirox, selenium disulfide or zinc pyrithione are the basis — the shampoo can be used on chest and back too: lather, leave on for three to five minutes, rinse off.
Once or twice a week as maintenance keeps it down. Stopping altogether is the most common reason it comes back after four to six weeks — and is then experienced as the treatment failing.
A weak cortisone cream takes redness and burning away within days. Used for weeks on the face the skin gets thinner and the redness comes back stronger as soon as one stops.
Harsh cleansing removes the oil and the skin makes more of it in return. Lukewarm, mild, and do not soap the affected places every day.
The improvement in summer is real and comes from the light. In moderation and without burning that is a lever; a sunbed is not, because there the risk comes without the benefit.
Antifungal creams and shampoos lower the amount of a yeast that lives on every skin — they do not remove it, which is why it returns after stopping. That is not failure but the nature of the thing: it is treated in bouts and then at wider intervals to hold it. Cortisone works quickly on the face, but belongs there for days only. In winter and under stress it gets worse, in summer better for many.
About three to five in a hundred adults are affected, men more often; in babies as cradle cap in the first months and then over by itself. Treatment works in two to four weeks and is then continued to hold it, usually once or twice a week. After stopping it returns within two to six weeks. In winter and under stress it gets worse, in summer better for many — the sun damps the yeast.
In the evening dab a little olive or almond oil onto the scales and leave it one to two hours.
Unlike the dry, white scales of dryness or the silvery ones of psoriasis they are yellowish and stick greasily. The base is slightly reddened and blurred at the edges.
Sides of the nose and the fold to the corner of the mouth, between and on the eyebrows, behind and in the ears, hairline, middle of the chest — and along the spine. Anyone who knows this distribution recognises the picture at a glance.
This up and down over the year is so reliable that it contributes to the classification. Stress, lack of sleep and alcohol also worsen it within days.
Many notice it only because the skin scales or feels tight — not because of itching. That is exactly why it is carried along for years without anyone naming it.
Cradle cap in the first months of life belongs to the same picture but runs harmlessly and disappears by itself. It is not an early stage of atopic eczema and needs no diet.
Sharply bordered, thickly silvery scaling patches on elbows, knees, navel and buttock cleft, with nail changes: then it is more likely psoriasis. The transitions are fluid, and the two can exist side by side.
A suddenly very widespread, treatment-resistant seborrhoeic dermatitis in a younger adult is among the pictures in which this test is offered — not out of suspicion, but because the answer can be treated.
A lack causes a picture very like seborrhoeic dermatitis at nose, mouth and in the folds — and it can be put right. With an unusual distribution or a poor response the value is worthwhile.
A marked lack of these vitamins causes similar scaling patches around nose and mouth. That is rare today and concerns mainly a very one-sided diet, alcohol and certain medicines.
That it gets better in summer is mainly down to the light itself. A low vitamin D level is the rule in winter; direct proof of a connection with this eczema is missing.
Zinc pyrithione acts on the skin against the yeast. To be distinguished from a zinc deficiency in the body, which can make a very similar picture — both are worthwhile, but they are two different things.
A marked lack causes similar patches around nose and mouth. With ordinary eating it is rare — with alcohol, a very one-sided diet and certain medicines a look is worthwhile.
They change the make-up of the skin oil and how readily the skin inflames. On a direct effect on this picture there are no studies.
It worsens the picture within days — through the vessels, the sleep and the oil production. That is one of the few points where something is noticed at once.
Zinc pyrithione in shampoo is the studied form — from outside, not swallowed. Zinc taken by mouth is not supported for this eczema as long as there is no deficiency.
Many notice less scaling in summer. Whether that is vitamin D or the UV light itself is not separated — the value can be measured, the light cannot be put in a capsule.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
The yeast involved here lives on sebum — and the sebaceous glands work under androgens. This is why it affects men more often and often begins at puberty, when sebum production starts.
In a baby cradle cap disappears by itself once the mother’s hormones are broken down — mostly by the end of the first year. That is why here one waits rather than treats.
With a proven zinc deficiency correction improves the skin. Without deficiency no effect is shown — oysters, beef, pumpkin seeds and oats are the densest sources.
Acts against the Malassezia yeast involved. Small studies with 5 % shampoo show an effect on dandruff; undiluted it irritates the skin and can cause contact allergy.
Zinc pyrithione in shampoo is a recognised treatment. Zinc as a tablet works only with a proven deficiency — the two routes are not the same.