Diagnostic Considerations

Also consider the following:

Xerotic eczema
Chronic granulomatous disease
Exfoliative erythroderma
Facial chapping
Infectious eczematoid dermatitis
Letterer-Siwe disease
Scaling drug eruptions
Sebopsoriasis
Staphylococcal blepharitis
Tinea amiantacea
Tinea versicolor ^[29]
Vitamin B and/or zinc deficiency

Differential Diagnoses

Workup

Zisova LG. Malassezia species and seborrheic dermatitis. Folia Med (Plovdiv). 2009 Jan-Mar. 51(1):23-33. [QxMD MEDLINE Link].
Litt JZ, Powlak WA. Drug Eruption Reference Manual. 5th ed. Cleveland, Ohio: Wal-Zac Enterprises; 1966. 465.
Brodell EE, Smith E, Brodell RT. Exacerbation of seborrheic dermatitis by topical fluorouracil. Arch Dermatol. Feb 2011. 147(2):245-6. [QxMD MEDLINE Link].
Ford GP, Farr PM, Ive FA, Shuster S. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol. 1984 Nov. 111(5):603-7. [QxMD MEDLINE Link].
Green CA, Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with ketoconazole: II. Response of seborrhoeic dermatitis of the face, scalp and trunk to topical ketoconazole. Br J Dermatol. 1987 Feb. 116(2):217-21. [QxMD MEDLINE Link].
Skinner RB Jr, Noah PW, Taylor RM, et al. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol. 1985 May. 12(5 Pt 1):852-6. [QxMD MEDLINE Link].
Tatlican S, Eren C, Eskioglu F. Insight into pimecrolimus experience in seborrheic dermatitis: close follow-up with exact mean cure and remission times and side-effect profile. J Dermatolog Treat. 2009. 20(4):198-202. [QxMD MEDLINE Link].
Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol. 2009. 10(2):103-18. [QxMD MEDLINE Link].
Ozden MG, Tekin NS, Ilter N, Ankarali H. Topical pimecrolimus 1% cream for resistant seborrheic dermatitis of the face: an open-label study. Am J Clin Dermatol. 2010. 11(1):51-4. [QxMD MEDLINE Link].
Cunha PR. Pimecrolimus cream 1% is effective in seborrhoeic dermatitis refractory to treatment with topical corticosteroids. Acta Derm Venereol. 2006. 86(1):69-70. [QxMD MEDLINE Link].
Firooz A, Solhpour A, Gorouhi F, et al. Pimecrolimus cream, 1%, vs hydrocortisone acetate cream, 1%, in the treatment of facial seborrheic dermatitis: a randomized, investigator-blind, clinical trial. Arch Dermatol. 2006 Aug. 142(8):1066-7. [QxMD MEDLINE Link].
High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. 2006 Jun. 54(6):1083-8. [QxMD MEDLINE Link].
Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician. 2006 Jul 1. 74(1):125-30. [QxMD MEDLINE Link].
Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol. 2009. 10(2):103-18. [QxMD MEDLINE Link].
Zisova LG. Fluconazole and its place in the treatment of seborrheic dermatitis--new therapeutic possibilities. Folia Med (Plovdiv). 2006. 48(1):39-45. [QxMD MEDLINE Link].
Kligman AM, Marples RR, Lantis LR, McGinley KJ. Appraisal of efficacy of antidandruff formulations. J Soc Cosmet Chem. 1974. 225:73-91.
Schwartz JR, Rocchetta H, Asawanonda P, Luo F, Thomas JH. Does tachyphylaxis occur in long-term management of scalp seborrheic dermatitis with pyrithione zinc-based treatments?. Int J Dermatol. 2009 Jan. 48(1):79-85. [QxMD MEDLINE Link].
Carr MM, Pryce DM, Ive FA. Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole. Br J Dermatol. 1987 Feb. 116(2):213-6. [QxMD MEDLINE Link].
Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. 2008 Jul. 7(7):699-703. [QxMD MEDLINE Link].
Seite S, Rougier A, Talarico S. Randomized study comparing the efficacy and tolerance of a lipohydroxy acid shampoo to a ciclopiroxolamine shampoo in the treatment of scalp seborrheic dermatitis. J Cosmet Dermatol. 2009 Dec. 8(4):249-53. [QxMD MEDLINE Link].
Groisser D, Bottone EJ, Lebwohl M. Association of Pityrosporum orbiculare (Malassezia furfur) with seborrheic dermatitis in patients with acquired immunodeficiency syndrome (AIDS). J Am Acad Dermatol. 1989 May. 20(5 Pt 1):770-3. [QxMD MEDLINE Link].
Odom RB. Seborrheic dermatitis in AIDS. J Int Postgrad Med. 1990. 2:18-20.
Zani MB, Soares RC, Arruda AC, de Arruda LH, Paulino LC. Ketoconazole does not decrease fungal amount in patients with seborrhoeic dermatitis. Br J Dermatol. 2016 Aug. 175 (2):417-21. [QxMD MEDLINE Link].
Belew PW, Rosenberg EW, Jennings BR. Activation of the alternative pathway of complement by Malassezia ovalis (Pityrosporum ovale). Mycopathologia. 1980 Mar 31. 70(3):187-91. [QxMD MEDLINE Link].
Tajima M, Sugita T, Nishikawa A, Tsuboi R. Molecular analysis of Malassezia microflora in seborrheic dermatitis patients: comparison with other diseases and healthy subjects. J Invest Dermatol. 2008 Feb. 128(2):345-51. [QxMD MEDLINE Link].
Prohic A, Kasumagic-Halilovic E. Identification of Malassezia species from immunocompetent and immunocompromised patients with seborrheic dermatitis. Eur Rev Med Pharmacol Science. Dec 2010. 14(12):1019-23. [QxMD MEDLINE Link].
Manuel F, Ranganathan S. A new postulate on two stages of dandruff: a clinical perspective. Int J Trichology. 2011 Jan. 3 (1):3-6. [QxMD MEDLINE Link].
Elish D, Silverberg NB. Infantile seborrheic dermatitis. Cutis. 2006 May. 77(5):297-300. [QxMD MEDLINE Link].
Pontasch MJ, Kyanko ME, Brodell RT. Tinea versicolor of the face in black children in a temperate region. Cutis. 1989 Jan. 43(1):81-4. [QxMD MEDLINE Link].
Gupta AK, Versteeg SG. Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review. Am J Clin Dermatol. 2016 Nov 2. [QxMD MEDLINE Link].
Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol. 2013 Jul-Aug. 31 (4):343-51. [QxMD MEDLINE Link].
Elewski B. An investigator-blind, randomized, 4-week, parallel-group, multicenter pilot study to compare the safety and efficacy of a nonsteroidal cream (Promiseb Topical Cream) and desonide cream 0.05% in the twice-daily treatment of mild to moderate seborrheic dermatitis of the face. Clin Dermatol. 2009 Nov-Dec. 27(6 Suppl):S48-53. [QxMD MEDLINE Link].
Pazyar N, Yaghoobi R, Bagherani N, Kazerouni A. A review of applications of tea tree oil in dermatology. Int J Dermatol. 2013 Jul. 52 (7):784-90. [QxMD MEDLINE Link].
Satchell AC, Saurajen A, Bell C, Barnetson RS. Treatment of dandruff with 5% tea tree oil shampoo. J Am Acad Dermatol. 2002 Dec. 47 (6):852-5. [QxMD MEDLINE Link].
Shin H, Kwon OS, Won CH, et al. Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: a comparative study. J Dermatol. 2009 Mar. 36(3):131-7. [QxMD MEDLINE Link].
de Souza Leão Kamamoto C, Sanudo A, Hassun KM, Bagatin E. Low-dose oral isotretinoin for moderate to severe seborrhea and seborrheic dermatitis: a randomized comparative trial. Int J Dermatol. 2017 Jan. 56 (1):80-85. [QxMD MEDLINE Link].
Siadat AH, Iraji F, Shahmoradi Z, Enshaieh S, Taheri A. The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: a double blind study. Indian J Dermatol Venereol Leprol. 2006 Jul-Aug. 72(4):266-9. [QxMD MEDLINE Link].
Apasrawirote W, Udompataikul M, Rattanamongkolgul S. Topical antifungal agents for seborrheic dermatitis: systematic review and meta-analysis. J Med Assoc Thai. 2011 Jun. 94 (6):756-60. [QxMD MEDLINE Link].
Goldust M, Rezaee E, Raghifar R. Treatment of seborrheic dermatitis: comparison of sertaconazole 2 % cream versus pimecrolimus 1 % cream. Ir J Med Sci. 2013 Dec. 182 (4):703-6. [QxMD MEDLINE Link].
Bikowski J. Facial seborrheic dermatitis: a report on current status and therapeutic horizons. J Drugs Dermatol. 2009 Feb. 8(2):125-33. [QxMD MEDLINE Link].
Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015 Dec. 3 (2):[QxMD MEDLINE Link].

Media Gallery

Seborrheic dermatitis affecting the scalp line and the eyebrows with red skin and scaling. Courtesy of Wilford Hall Medical Center Dermatology slide files.
Seborrheic dermatitis may affect any hair-bearing area, and the chest is frequently involved. Courtesy of Wilford Hall Medical Center Dermatology Teaching slides.
African Americans and persons from other darker-skinned races are susceptible to annular seborrheic dermatitis, also called petaloid seborrheic dermatitis or seborrhea petaloides. Sarcoidosis, secondary syphilis, and even discoid lupus may be in the differential in such cases. Courtesy of Jeffrey J. Meffert, MD.

of 3

Author

Marc Zachary Handler, MD Fellow in Mohs Micrographic Surgery, Skin Laser and Surgery Specialists of NY and NJ

Marc Zachary Handler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, European Society for Pediatric Dermatology, International Society of Dermatology, New York Academy of Medicine, Sigma Xi, The Scientific Research Honor Society, Society for Pediatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Robin Travers, MD Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians

Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Women's Dermatologic Society, Medical Dermatology Society

Disclosure: Nothing to disclose.

Samuel T Selden, MD Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Samuel T Selden, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Geriatric Dermatology

Disclosure: Nothing to disclose.

Seborrheic Dermatitis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?