Seborrheic dermatitis

Overview

Seborrheic dermatitis is a common, flare-prone rash that appears in oily areas like the scalp, eyebrows, sides of the nose, ears, and chest. It happens when a normal skin yeast (Malassezia) feeds on your skin's oils and your skin reacts to the byproducts with inflammation. It looks like red patches topped with greasy, yellowish flakes. Everyday dandruff is the mildest version of the same thing.

Evidence anchors

• systematic review

  Okokon EO, Verbeek JH, Ruotsalainen JH, Ojo OA, Bakhoya VN. Topical antifungals for seborrhoeic dermatitis. Cochrane Database of Systematic Reviews 2015, Issue 5. Art. No.: CD008138.

  PMID:25933684View source ↗
• systematic review

  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.

  PMID:21696088View source ↗
• narrative review

  Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015 Dec;3(2):10.

  PMC4852869View source ↗
• review

  Berk T, Scheinfeld N. Seborrheic Dermatitis. P T. 2010 Jun;35(6):348–352.

  PMC2888552View source ↗
• guideline

  Naldi L, Diphoorn J. Seborrhoeic dermatitis of the scalp. BMJ Clin Evid. 2015 May 27;2015:1713.

  PMID:26016669View source ↗
• consensus guideline

  Cheong WK, Yeung CK, Torsekar RG, et al. Treatment of seborrhoeic dermatitis in Asia: a consensus guide. Skin Appendage Disord. 2016 May;1(4):187–96.

  PMC4908450View source ↗
• rct

  Piérard-Franchimont C, Goffin V, Decroix J, Piérard GE. A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis. Skin Pharmacol Appl Skin Physiol. 2002 Nov–Dec;15(6):434–41.

  PMID:12476017View source ↗

Ingredients that help

• Zinc Pyrithionestrong

  Kills the yeast (Malassezia) that drives seborrheic dermatitis, so there is less of it on your skin to feed the flaking and redness. It is an FDA-approved over-the-counter dandruff active at 1 to 2 percent. In a large trial of 331 people (Piérard-Franchimont 2002), a 1 percent zinc pyrithione shampoo cleared severe dandruff and scalp seborrheic dermatitis well, just slightly behind ketoconazole 2 percent.

  PMID:12476017
• Salicylic Acidmoderate

  Softens and loosens thick, stuck-on flakes so they lift away and the antifungal can reach the yeast underneath. It dissolves the bonds holding dead skin together (this is called a keratolytic). In a trial comparing a ciclopirox 1.5 percent plus salicylic acid 3 percent shampoo with ketoconazole 2 percent (Squire and Goode 2002), both clearly improved dandruff and scalp seborrheic dermatitis.

  PMID:12060502
• Niacinamidemoderate

  Calms redness and cuts back on the oil that feeds the yeast. It quiets the skin's inflammation signals and lowers oil output. In a study of 48 people with facial seborrheic dermatitis (Fabbrocini 2014), a 4 percent niacinamide cream cut the combined redness, scaling, and thickening score by 75 percent over 12 weeks, versus 35 percent for the plain cream.

  PMID:23763270
• Tea Tree Oilmoderate

  Its main active compound (terpinen-4-ol) kills the yeast behind seborrheic dermatitis. In a trial of 126 people (Satchell 2002), a 5 percent tea tree oil shampoo used daily for 4 weeks improved scalp severity by 41 percent, versus 11 percent for placebo. One caution: tea tree oil that has aged and reacted with air is a known cause of allergic skin reactions (PMID:27173437). Use it in rinse-off scalp products. Do not leave it on your face, especially if you also have eczema or react to fragrance.

  PMID:12451368
• Honeymoderate

  Helps clear the yeast and calm the patches. Its high sugar content and the small amount of hydrogen peroxide it makes work against the yeast and soothe inflammation. In a small study of 30 people (Al-Waili 2001), diluted raw honey rubbed onto patches every other day for 4 weeks fully cleared the itching and scaling. Applying it weekly after that kept the rash from coming back over 6 months; 12 of 15 people who stopped saw it return.

  PMID:11485891
• Colloidal Oatmealmoderate

  Calms redness and eases itch on inflamed patches. Its natural compounds (avenanthramides) quiet inflammation and dial down the itch signal. It is an FDA-recognized skin protectant. This is a soothing choice you can leave on between antifungal washes. It does not kill the yeast itself, and its strongest proof is in eczema rather than seborrheic dermatitis.

  PMID:25607907
• Ureamoderate

  Softens thick, crusty flakes so they lift off (on the scalp, cradle cap, or behind the ears). At 10 percent and above it loosens stuck-on scale; at lower strengths it just hydrates and helps hold water in the skin. It is often used with salicylic acid before an antifungal shampoo.

  PMID:23320611
• Bisabololmoderate

  Calms the redness and inflammation in facial patches. It comes from chamomile and turns down the skin's inflammation signals. It is used in facial creams that pair it with an antifungal (piroctone olamine), and those creams have beaten plain cream in trials for mild to moderate facial seborrheic dermatitis.

  PMID:21607191
• Centella Asiaticaemerging

  Calms redness and helps the skin heal. Its plant compounds (madecassoside and asiaticoside) quiet inflammation signals and speed up repair of the skin surface. There is no direct trial in seborrheic dermatitis yet. It works as a soothing leave-on between antifungal washes, and the calming effect carries over cleanly from trials in eczema and sensitive skin.

  PMID:24683698
• Sea Buckthorn Oilemerging

  Calms inflammation and is less likely to feed the yeast than most plant oils. Its main fat is palmitoleic acid (an omega-7), not the oleic acid found in olive, argan, and coconut oils. The yeast (Malassezia) feeds on oleic acid, so this oil is a poorer food source for it. There are no direct trials in seborrheic dermatitis. If you want a plant oil for dryness, this is a more tolerable choice. One caveat: during an active flare, many dermatologists suggest keeping plant oils off the affected areas entirely.

  PMID:28218803

Suggested routine

Watch out for these on labels

Specific irritants from our watchlist that the research pack identifies as aggravating for seborrheic dermatitis.

Products from our catalog

• CeraVe · Foaming Facial CleanserCleanser

  A gentle foaming cleanser with niacinamide and ceramides that does not strip the skin. It is mild enough for daily use on calm areas while still washing away the surface oil that feeds the yeast. From a line that carries the National Eczema Association Seal of Acceptance.

  View retailer ↗
• La Roche-Posay · Toleriane Hydrating Gentle CleanserCleanser

  A fragrance-free cleanser with ceramides, niacinamide, and glycerin and very little harsh detergent. Gentle enough for inflamed patches, where a stronger sulfate cleanser would make things worse.

  View retailer ↗
• The Ordinary · Niacinamide 10% + Zinc 1%Serum

  Niacinamide 10 percent plus zinc. Niacinamide has direct trial support for seborrheic dermatitis (Fabbrocini 2014: 75 percent improvement versus 35 percent for the plain cream), and the zinc adds to the effect against the yeast. An affordable leave-on for keeping flares away.

  View retailer ↗
• Naturium · Azelaic Topical Acid 10%Serum

  Azelaic acid 10 percent. It fights the microbes in pores, calms inflammation, and fades the leftover redness after a patch clears. A pregnancy-safe option for redness around the nose.

  View retailer ↗
• CeraVe · PM Facial Moisturizing LotionMoisturizer

  A fragrance-free moisturizer built around ceramides and niacinamide that will not clog pores. It has no plant oils to feed the yeast. A solid everyday moisturizer to repair the skin over treated areas.

  View retailer ↗
• KraveBeauty · Great Barrier ReliefMoisturizer

  Squalane plus niacinamide and ceramides. Squalane feels like your skin's own oil but does not feed the yeast the way oleic-rich plant oils do. A reasonable pick for dry, flare-prone skin between flares.

  View retailer ↗

Ingredients to consider adding

Not yet in our catalog. Surfaced here as editorial backlog.

• Ketoconazole

  The first thing most people reach for, available over the counter worldwide for both scalp and facial seborrheic dermatitis. The 2 percent shampoo and 2 percent cream are the most studied options in the Cochrane review.

• Ciclopirox Olamine

  An antifungal that kills the yeast (Malassezia) and also calms inflammation. The 1 to 1.5 percent shampoo and 0.77 percent gel or cream work about as well as ketoconazole in trials.

• Selenium Sulfide

  An FDA-approved over-the-counter dandruff active (1 percent over the counter, 2.25 to 2.5 percent by prescription). It kills the yeast and slows the fast skin growth that makes scalp flakes. Found in Selsun Blue and Head & Shoulders Clinical Strength.

• Piroctone Olamine

  An antifungal closely related to zinc pyrithione (it just swaps out the zinc). It starves the yeast by locking up the iron it needs to survive. Common in European over-the-counter products, and often paired with climbazole or salicylic acid in face creams.

• Climbazole

  An antifungal often paired with piroctone olamine in facial creams. In a study that treated one side of the face, the treated side had less redness and less oil.

• Coal Tar

  An FDA-approved over-the-counter dandruff active. It slows fast skin growth and cuts down scaling, so it helps with thick scalp patches. Best for adults. The smell and staining make it harder to stick with.

• Hydrocortisone (low-potency topical corticosteroid)

  A mild steroid cream, available over the counter in the US at 1 percent. Guidelines suggest it for short bursts (1 to 2 weeks) during an inflamed facial flare. It clears redness fast, but it stops working as well with repeated use and the flare can bounce back, so do not use it long term. Pair it with an antifungal.

• PimecrolimusRx only

  A non-steroid prescription cream that calms inflammation. It is a good option for ongoing facial seborrheic dermatitis when you want to avoid steroids, especially around the eyes and in skin folds. Several trials show it works as well as ketoconazole or hydrocortisone.

• TacrolimusRx only

  A non-steroid prescription ointment (0.1 percent) used off-label for facial seborrheic dermatitis. It plays the same role as pimecrolimus.

• RoflumilastRx only

  A prescription anti-inflammatory foam (Zoryve, 0.3 percent), approved by the FDA in December 2023 for seborrheic dermatitis in people aged 9 and up. It is the first new type of treatment in decades. In its main trial (STRATUM), about 80 percent of people had clear or nearly clear skin by week 8.