Seborrheic Dermatitis: Symptoms, Treatments, & Its Impact On Hair Loss

Article Summary

Seborrheic dermatitis is a common cause of dandruff, but what’s really happening to your scalp when it flares up? From excess sebum and yeast overgrowth to genetic factors, this condition has multiple triggers. Wondering what treatments work best and how to manage symptoms long-term? Check out our in-depth guide to explore your options and find the right solution for you.

Full Article

Seborrheic dermatitis is a common, chronic inflammatory skin condition that primarily affects areas with a high concentration of sebaceous (oil-producing) glands, such as the scalp, face, upper back, and chest. It is characterized by red, itchy patches of skin covered with greasy, yellowish scales or flakes.

In the scalp, seborrheic dermatitis is also called dandruff. It can vary widely in symptoms and severity, and a number of treatment options are marketed to treat and prevent dandruff. But what is actually happening to your scalp and hair follicles when seborrheic dermatitis hits, and what are the best treatment combinations? Let’s find out below.

Key Takeaways

• What is it? Seborrheic dermatitis is a chronic inflammatory skin condition that affects areas rich in oil glands, like the scalp, causing red, itchy patches with greasy, yellowish flakes.
• What are the symptoms? Symptoms include visible flakes (dandruff), itchiness, redness, and, in severe cases, crusting and hair shafts around hair follicles.
• What Is The Prevalence of Seborrheic Dermatitis in Patients with AGA? One study found that out of 250 patients with AGA, 56.9% also had seborrheic dermatitis.
• What are the most common treatments? Antifungal topicals are most often used (e.g., ketoconazole and selenium sulfide), topical corticosteroids, and newer options like roflumilast foam to reduce inflammation and yeast overgrowth.
• How else can I improve it? Lifestyle changes, like reducing stress, eating a balanced diet, and avoiding known triggers like harsh hair products or cold weather, can help manage symptoms.
• Final thoughts. Managing seborrheic dermatitis often involves trial and error with different therapies, but with the right combination, most people can achieve long-term symptom control.

What Are the General Features of Seborrheic Dermatitis?

• Appearance: The condition manifests as oily patches with yellow or white scales, which may appear darker or lighter in people of color and redder in those with white skin.
• Common locations: Scalp, face, sides of the nose, eyebrows, ears, eyelids, chest, armpits, and groin area.
• Symptoms: Itching, flaking skin, and sometimes a ring-shaped (annular) rash called petaloid seborrheic dermatitis.

Why Does Seborrheic Dermatitis of the Scalp Happen?

Seborrheic dermatitis of the scalp (also called dandruff) occurs due to a combination of factors, one of which is sebum production. The condition primarily affects areas with a high concentration of sebaceous glands, including the scalp.^[1]Ro, B.I., Dawson, T.L. (2005). The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff. The Journal of Investigative Dermatology. … Continue reading Excess sebum creates a favorable environment for the growth of Malassezia yeasts, which are naturally present on the skin. 

Another factor is the overgrowth of Malassezia yeasts. Malassezia species, particularly M.globosa and M.restricta, are commonly found on the scalps of individuals with seborrheic dermatitis. These yeasts are normally harmless but can trigger an inflammatory response when they overgrow.^[2]Wikramanayake, T.C., Borda, L.J., Miteva, M., Paus, R. (2019). Seborrheic dermatitis-looking beyond Malassezia. Experimental Dermatology. 28(9). 991-1001. Available at: … Continue reading 

Malessezia lipase breaks down human sebum, releasing free fatty acids (FFAs) and other metabolites. These FFAs can penetrate the stratum corneum (the outer layer of the skin), altering skin barrier permeability and leading to inflammation and abnormal keratinization, which are key features of seborrheic dermatitis.^[3]Dawson Jr. (2007). Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis. Journal of … Continue reading

Genetic predisposition is also a contributing factor in the pathogenesis of seborrheic dermatitis.^[4]Karakadze, M.A., Hirt, P.A., Wikramanayake, T.C. (2018). The genetic basis of seborrheic dermatitis: a review. Journal of the European Academy of Dermatology and Venereology. 32(4). 529-536. … Continue reading Several gene mutations and protein deficiencies have been associated with the condition or similar phenotypes. The affected genes are involved in the immune response (e.g., ACT1, C5, IKBG/NEMO) and epidermal maturation (differentiation) (e.g., ZNF750, MPZL3).

Other genetic mutations that can affect the complement system, which is part of the immune response, have been associated with an increased risk of seborrheic dermatitis. This dysfunction can lead to an inability to effectively restrict the growth of Malassezia.^[5]Adalsteinsson, J.A., Kaushik, S., Muzumdar, S., Guttman-Yassky, E., Ungar, J. (2020). An update on the microbiology, immunology, and genetics of seborrheic dermatitis. Experimental Dermatology. … Continue reading 

In addition to these, a number of other elements can influence the development of seborrheic dermatitis and its exacerbation. These include immune system abnormalities, such as reduced numbers of helper T cells.^[6]Bergbrant, I.M., Johansson, S., Robbins, D., Scheynius, A., Faergemann, J., Soderstrom, T. (1991). An immunological study in patients with seborrheic dermatitis. Clinical and Experimental … Continue reading Hormonal changes can also aggravate the condition.^[7]Kashiri, A., Maghsoudloo, N. (2024). Exploring the Impact of Vitamin D and Zinc Deficiencies on Sebhorreic Dermatitis: A Comparative Study. Health Science Reports. 7(12). E70283. Available at: … Continue reading Furthermore, cold weather can worsen symptoms, and stress can trigger or exacerbate flare-ups.

What Are the Symptoms of Seborrheic Dermatitis in the Scalp?

We can split the symptoms of seborrheic dermatitis into three levels: cosmetic, symptom, and microscopic levels.

Cosmetic Level

At the cosmetic level, the most noticeable sign of seborrheic dermatitis on the scalp is the presence of visible flakes on the scalp, which may fall onto clothing. These flakes can range from mild dandruff to more severe scaling.^[8]Schwartz, R.A., Janusz, C.A., Janniger, C.K. (2006). Seborrheic dermatitis: an overview. American Family Physician. 74(1). 125-130. Available at: PMID:16848386 The scales often appear greasy and may have a yellow-brown color. In more pronounced cases, you might see white or yellowish scales covering patches of skin on the scalp. These scales can sometimes form crusts, especially in areas where the scalp meets the hairline or behind the ears. The flakiness can be accompanied by noticeable redness (erythema) and bumps or pustules.^[9]Saunte, D.M., Gaitanis, G., Hay, R.J. (2020). Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment. Frontiers in Cellular and Infection Microbiology. 10. 112. Available at: … Continue reading 

Symptom Level

On a symptom level, itchiness (pruritis) is often the most bothersome aspect of seborrheic dermatitis.^[11]Zhang, F., Li, Y., Ren, W., Li, S. (2023). Establishment of clinical evaluation criteria for scalp seborrheic dermatitis. Journal of Cosmetic Dermatology. 22(11). 3042-3046. Available at: … Continue reading The itching can range from mild to intense and may lead to scratching, which can further irritate the scalp and, in some cases, cause hair loss.^[12]National Eczema Associations. (no date). Seborrheic Dermatitis. Available at: https://nationaleczema.org/eczema/types-of-eczema/seborrheic-dermatitis/ (Accessed: February 2025)  Some people may experience soreness or tenderness in the affected areas, especially if the condition is severe and there has been excessive scratching. In the most severe cases, the rash may weep or ooze, leading to the formation of crusts.

Microscopic Level

At the microscopic level, several distinctive factors characterize seborrheic dermatitis. One of the most notable is the presence of dandruff casts, which are accumulations of dead skin cells and sebum around hair shafts.^[13]Franca, K., Villa, R.T., Silva, I.R., de Carvalho, C.A., Bedin, V. (2011). Hair Casts or Pseudonits. International Journal of Trichology. 3(2). 121-122. Available at: … Continue reading These casts are typically white, firm, and tubular in shape and can range from 2 to 7 mm in length.

Several characteristic vascular patterns can be observed in seborrheic dermatitis under dermoscopy, a noninvasive imaging tool.^[15]Kim, G.W., Jung, H.J., Ko, H-C., Kim, M.B., Lee, W-J., Lee, S-J., Kim, D-W., Kim, B-S. (2011). Dermoscopy can be useful in differentiating scalp psoriasis from seborrheic dermatitis. British Journal … Continue reading These include arborizing red lines (ARL), which appear as branching blood vessels, and twisted red loops (TRL), which are coiled blood vessels specific to seborrheic dermatitis. Comma vessels (CV) and short-curved blood vessels are also indicative of this condition. These vascular patterns help differentiate seborrheic dermatitis from other skin conditions.

In addition to these, other microscopic characteristics include spongiosis (buildup of fluid between skin cells in the epidermis) in acute seborrheic dermatitis lesions, psoriasiform hyperplasia (thickening of the epidermis), swelling, and infiltration of antibodies.^[17]Park, J-H., Park, Y.J., Kim, S.K., Kwon, J.E., Kang, Y.H., Lee, E-S., Choi, J.H., Kim, Y.C. (2016). Histopathological Differential Diagnosis of Psoriasis and Seborrheic Dermatitis of the Scalp. … Continue reading In some cases, the opening of a hair follicle can become blocked with excess skin cells (follicular plugging), and maturation (differentiation) of keratinocytes can become impaired, leading to cells in the stratum corneum retaining nuclei (shoulder parakeratosis). This contributes to the scaling characteristic of seborrheic dermatitis.

As epidermal cells differentiate through the skin layers, they usually lose their nuclei and become filled with keratin. By the time they reach the stratum corneum, they are typically flat, dead cells without nuclei, forming a protective barrier.^[18]Alberts, B., Johnson, A., Lewis J. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Epidermis and Its Renewal by Stem Cells. Available from: … Continue reading

How Common is Seborrheic Dermatitis?

A comprehensive meta-analysis published in JAMA Dermatology in 2024 found that the global pooled prevalence (meaning all body locations, including the scalp) of seborrheic dermatitis is 4.38%, which is higher than previous large-scale global estimates.^[20]Polaskey, M.T., Chang, C.H., Daftary, K., Fakhraie, S., Miller, C.H., Chovatiya, R. (2024). The Global Prevalence of Seborrheic Dermatitis: A Systematic Review and Meta-Analysis. JAMA Dermatology. … Continue reading In the US, the prevalence is 5.86%, which appears to be middle-of-the-road compared to places like South Africa, which has a prevalence of 8.82%, and India, with a prevalence of 2.62%.

Is Seborrheic Dermatitis More Common in People with Pattern Hair Loss?

Recent studies have shown a significant association between seborrheic dermatitis and androgenic alopecia (AGA). 

• One five-year study from 2006 to 2010 found that seborrheic dermatitis was the most commonly associated disease in both men and women with AGA.^[22]Jang, W.S., Son, I.P., Yeo, K.I., Park, K.Y., Li, K., Kim, B.J., Seo, S.J., Kim, M.N., Hong, C.K. (2013). The Annual Changes of Clinical Manifestation of Androgenetic Alopecia Clinic in Korean Males … Continue reading 
• A retrospective study published in 2024 found that out of 250 patients with AGA, 56.9% also had seborrheic dermatitis.^[23]Faghihkhorasani, A., Sadeghzadeh, A., Goodarzi, A., Rohaninasab, M. (2024). The Relationship between Seborrheic Dermatitis and Androgenetic Alopecia in Patients Referred to a Skin Clinic in Tehran, … Continue reading 
  • A significant correlation was found between the pattern of AGA in men and the severity of seborrheic dermatitis.
  • A significant relationship was also observed between dandruff symptoms and AGA patterns. 
  • In men, the highest severity of seborrheic dermatitis (grade 3) was related to the Hamilton Norwood type 2 pattern of hair loss (triangular hair loss on both sides of the frontoparietal line).
  • In women, the highest severity of seborrheic dermatitis (grade 2) was observed in the Ludwig type 2 hair loss pattern (thinning of hair about 1-3 cm behind the hairline).

What Is the Biology Behind This Correlation?

Although there is no established explanation, there are several factors that could explain the correlation between seborrheic dermatitis and AGA.

1. Androgen sensitivity: Both conditions are influenced by androgens, particularly dihydrotestosterone (DHT). The enzyme 5-alpha reductase (5-AR) converts testosterone to DHT, which affects both sebum production and hair follicle miniaturization.^[24]Kim, B.J., Kim, J.Y., Eun, H.C., Kwon, O.S., Kim, M.N. (2006). Androgenetic alopecia in adolescents: A report of 43 cases. The Journal of Dermatology. 33(10). 696-699. Available at: … Continue reading
2. Sebum production: Increased sebum production is characteristic of both conditions. In AGA, there are increased levels of 5-AR in the follicles of the temporal, frontal, and crown regions.^[25]Kure, K., Isago, T., Hirayama, T. (2015). Changes in the sebaceous gland in patients with male pattern hair loss (androgenic alopecia). Journal of Cosmetic Dermatology. 14(3). 178-184. Available at: … Continue reading This excess sebum creates an environment conducive to the overgrowth of Malassezia yeast.
3. Microbiome imbalance (dysbiosis): Patients with AGA exhibit scalp dysbiosis, with an increased abundance of Cutibacterium and a decreased abundance of Corynebacterium.^[26]Suzuki, K., Inoue, M., Cho, O., Mizutani, R., Shimizu, Y., Nagahama, T., Sugita, T. (2021). Scalp microbiome and sebum composition in Japanese male individuals with and without androgenetic alopecia. … Continue reading This altered microbiome may contribute to inflammation and exacerbate both conditions.
4. Malassezia yeast: Malassezia restricta is more abundant on the scalps of patients with AGA and is also implicated in seborrheic dermatitis, which may exacerbate the condition.

While there is no established causality for AGA and seborrheic dermatitis, these underlying factors mean that seborrheic dermatitis and AGA can exacerbate one another.

So, what can you do to treat seborrheic dermatitis on the scalp?

What Are the Typical Treatments for Seborrheic Dermatitis on the Scalp?

Seborrheic dermatitis of the scalp can be managed through various treatment options. It can be attacked in multiple ways, such as through the use of antifungals, anti-inflammatories, treatments that suppress sebum, corticosteroids, and topical keratolytic agents.

FDA-Approved Options

Among the FDA-approved treatments, Roflumilast foam 0.3% (Zoryve) is a recent addition, approved on December 2023, for treating seborrheic dermatitis in individuals aged 9 and older.^[28]Arcutis Biotherapeutics. (no date). FDA Approves Arcutis’ ZORYVE (roflumilast) Topical Foam, 0.3% for the Treatment of Seborrheic Dermatitis in Individuals Aged 9 Years and Older. Available at: … Continue reading This treatment is a topical non-steroidal phosphodiesterase 4 (PDE4) inhibitor. PDE4 plays a key role in the inflammatory response, so by inhibiting this, it reduces inflammation and associated symptoms like redness, scaling, and itching.^[29]Zirwas, M.J., Draelos, Z.D., DuBois, J., Kircik, L.H., Moore, A.Y., Gold, L.S., Alonso-Llamazares, J., Bukhalo, M., Bruce, S., Eads, K., Green, L.J., Guenthner, S., Ferris, L.K., Forman, S.B., … Continue reading 

Ketoconazole is FDA-approved for patients 12 years of age and older with healthy immune systems. It acts through multiple mechanisms to treat seborrheic dermatitis in the scalp. It inhibits the production of lanosterol, a precursor for ergosterol biosynthesis, which is essential for fungal membrane integrity.^[30]Tynes, B.E., Johnson, C.D., Vaish, M.H., Abbott, B., Vucenovic, J., Varrassi, G., Potharaju, P., Torres, Y.L., Lee, Z., Ahmadzadeh, S., Shekoohi, S., Kaye, A.D. (2024). Ketoconazole Shampoo for … Continue reading 

This halts the growth of Malassezia yeasts associated with seborrheic dermatitis. It also strongly binds to the cytochrome p450 mono-oxygenase complex, hindering the fungal biosynthesis of triglycerides and phospholipids and shifting sebum secretion in the stratum corneum, addressing the hypersecretion of sebum characteristic of the condition.^[31]Borgers, M., Degreed, H. (2007). The Role of Ketoconazole in Seborrheic Dermatitis. Therapeutics for the Clinician. 80. 359-363. Available at: … Continue reading

Ketoconazole also exhibits anti-inflammatory properties and antiproliferative effects and may favor biotin-producing bacteria, which could improve the skin microbiome.^[32]Goularte-Silva, V., Paulino, C.L. (2021). Ketoconazole beyond antifungal activity: Bioinformatics-based hypothesis on lipid metabolism in dandruff and seborrheic dermatitis. Experimental Dermatology. … Continue reading 

Ciclopirox shampoo is approved for people 16 years of age and older with seborrheic dermatitis on the scalp. It works differently from other common antifungals. It acts like a magnet for certain metals, especially iron and aluminum, which are important for fungal survival.^[34]LOPROX® (cicloporox) Shampoo 1%. (2006). MEDICIS Pharmaceutical Corp. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021159s009lbl.pdf (Accessed: February 2025) By grabbing these metals, ciclopirox prevents important fungal enzymes from working properly, leading to peroxide build-up and cellular damage.

Other Treatments

Some over-the-counter treatments are used to treat seborrheic dermatitis. These are often antifungal shampoos containing ingredients such as:

• Selenium sulfide: A treatment with antifungal, cytostatic, keratolytic, anti-inflammatory, and sebum regulatory properties. In clinical studies, 2.5% selenium sulfide shampoo improved dandruff scores by 78.3% after 4 weeks.^[35]Godse, G., Godse, K. (2024). Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study. Cureus. 16(3). E57148. Available at: … Continue reading 
• Coal tar: This helps to reduce inflammation and redness associated with seborrheic dermatitis and has antifungal and keratolytic properties. It also slows the rate of skin cell production, helping to minimize the buildup of scales and dry patches. However, it has been found to be less effective than ciclopirox and ketoconazole.^[36]Davies, D.B., Boorman, G.C., Shuttleworth, D. (1999). Comparative efficacy of shampoos containing coal tar (4.0% w/w; Tarmed), coal tar (4.0% w/w) plus ciclopirox olamine (1.0% w/w Tarmed AF), and … Continue reading 
• Salicylic acid: Salicylic acid helps to slough off dead skin cells and remove flakes from the scalp, which can be beneficial for those with seborrheic dermatitis. It also has keratolytic, oil-controlling, anti-inflammatory, and anti-fungal effects.^[37]Ge, L., Liu, Z., Xu, S., Li, C., Jin, M., Luo, Y., Kong, Y., Meng, J., Zheng, G., Gao, J., Wang, P., Bai, W., Na, H., Zhou, X., Jin, Z., Pi, L. (2025). A Cohort Clinical Study on the Efficacy of … Continue reading 
• Zinc pyrithione: Zinc pyrithione increases cellular copper levels, which damages iron-sulfur clusters of proteins essential for fungal metabolism. This, alongside its antifungal, antibacterial, anti-inflammatory, and sebum-regulatory properties, contributes to its effectiveness in treating seborrheic dermatitis. One study found that a shampoo containing 1% zinc pyrithione was effective in controlling dandruff when used on half of the scalp.^[38]Marks, R., Pearse, A.D., Walker, A.P. (1985). The effects of a shampoo containing zinc pyrithione on the control of dandruff. British Journal of Dermatology. 112(4). 415-422. Available at: … Continue reading 
• Piroctone olamine: A number of clinical studies have used piroctone olamine alongside other treatments to improve seborrheic dermatitis, with one study showing a clinical improvement of 80%.^[39]Ge, L., Liu, Z., Xu, S., Li, C., Jin, M., Luo, Y., Kong, Y., Meng, J., Zheng, G., Gao, J., Wang, P., Bai, W., Na, H., Zhou, X., Jin, Z., Pi, L. (2025). A Cohort Clinical Study on the Efficacy of … Continue reading 

Prescription medications such as topical corticosteroids and calcineurin inhibitors may also be used off-label.^[40]Paula Ludmann. (2024). Seborrheic Dermatitis: Diagnosis and Treatment. American Academy of Dermatology Association. Available at: … Continue reading UVB light therapy can be used for widespread rash and scales. Other treatments include fluconazole 2%, naftifine hydrochloride 1% gel, and climbazole.^[41]Dall’Oglio, F., Nasca, M.R., Gerbino, C., Micali, G. (2022). An Overview of the Diagnosis and Management of Seborrheic Dermatitis. Clinical, Cosmetic and Investigational Dermatology. 6(15). … Continue reading 

Lifestyle and Dietary Modifications

In addition to these medical treatments, dietary and lifestyle changes can help manage seborrheic dermatitis. 

One case-control study involving 257 participants found associations between white bread, carbonated drinks, and daily fast food, with a higher percentage of seborrheic dermatitis compared to those without the condition.^[42]Alshaebi, M., Zahed, L., Osalyan, M., Sulaimani, S., Albahlool, A., Abduljabbar, M.H., Hariri, J. (2023). Association Between Diet and Seborrheic Dermatitis: A Case-Control Study. Cureus. 15(11). … Continue reading The same study reported that increased fruit consumption was associated with a lower risk of seborrheic dermatitis. Furthermore, adherence to a Western diet has been associated with a higher risk of seborrheic dermatitis in female patients.^[43]Woolhiser, E., Keime, N., Patel, A., Weber, I., Adelman, M., Dellavalle, R.P. (2024). Nutrition, Obesity, and Seborrheic Dermatitis: Systematic Review. JMIR Dermatology. E50143. Available at: … Continue reading 

It is recommended to increase the intake of high-fiber carbohydrates and lean protein foods, as well as foods rich in monounsaturated and omega-3 fatty acids.

Should You Avoid Certain Hair Loss Treatments if You Have Seborrheic Dermatitis?

In our experience, those with seborrheic dermatitis may have problems if they use:

• Topicals containing retinoic acid
• Microneedling
• Scalp massaging
• PRP
• Mesotherapy

These may actually lead to more inflammation, so we would recommend avoiding these until you get your seborrheic dermatitis under control.

Which Treatments Are Best Used for Which Disease Severity?

Management of seborrheic dermatitis of the scalp often involves rotating or combining a number of therapies to target multiple aspects of the disease.

Mild to Moderate Severity

For patients with mild to moderate seborrheic dermatitis, first-line treatments typically include over-the-counter antifungals combined with topical anti-inflammatory agents. 

This can include:

• Anti-dandruff shampoos containing 2.5% selenium sulfide or 1-2% zinc pyrithione, used daily or every other day.^[44]Paula Ludmann. (2024). Seborrheic Dermatitis: Diagnosis and Treatment. American Academy of Dermatology Association. Available at: … Continue reading 
• Ketoconazole shampoo (1-2%) applied for 5-10 minutes before rinsing, used daily initially, then twice weekly for maintenance. 
• Topical corticosteroids, like hydrocortisone 1% cream, applied once or twice daily until inflammation clears, then as needed.
• One clinical trial found that the usage of traditional Chinese medicine can also show significant efficacy in treating mild to moderate seborrheic dermatitis without relapse, especially for those with moderate severity.^[45]Zhang, F., Li, Y-H., Ren, W., Li, S-R., Chen, Y-C. (2023). Clinical efficacy of a combination treatment of traditional Chinese medicine for scalp seborrheic dermatitis. Journal of Cosmetic … Continue reading 

Moderate to Severe

For more severe or persistent cases, treatment may include:

• Oral antifungal medications like itraconazole (200 mg/day for one week, followed by a maintenance dose).^[46]Goldenberg, G. (2013). Optimizing Treatment Approaches in Seborrheic Dermatitis. Journal of Clinical and Aesthetic Dermatology. 6(2). 44-49. Available at: PMID: 23441240 
• UVB light therapy, with 3 treatment sessions per week for up to 8 weeks. However, some studies have shown relapse within 1 month.^[47]Jaalouk, D., Pulumati, A., Algarin, Y.A., Kircik, L., Issa, N.T. (2024). Dermatologic Procedures for the Treatment of Seborrheic Dermatitis. Journal of Drugs in Dermatology. 23(10). 819-824. … Continue reading 
• Combination therapy of clobetasol propionate shampoo (0.05%) and ketoconazole (2%) twice weekly has been shown to provide greater efficacy than ketoconazole alone, with a more sustained effect in the treatment of moderate to severe seborrheic dermatitis.^[48]Ortonne, J-P., Nikkels, A.F., Reich, K., Oliver, R.M.P., Lee., J.H., Kerrouche, N., Sidou, F., Faergemann, J. (2011). Efficacious and safe management of moderate to severe scalp seborrheic dermatitis … Continue reading 
• A recent study conducted on 20 patients with moderate to severe seborrheic dermatitis combined salicylic acid, piroctone olamine, zinc PCA gel, and a cleansing lotion, finding that the combination significantly reduced dandruff, itchiness, redness, and greasiness scores over 4 weeks. Patients with moderate and those with severe seborrheic dermatitis improved to mild with an overall clinical improvement of 80%.^[49]Ge, L., Liu, Z., Xu, S., Li, C., Jin, M., Luo, Y., Kong, Y., Meng, J., Zheng, G., Gao, J., Wang, P., Bai, W., Na, H., Zhou, X., Jin, Z., Pi, L. (2025). A Cohort Clinical Study on the Efficacy of … Continue reading 

Shampoo Rotations

For people dealing with treatment-resistant seborrheic dermatitis, rotating shampoos may be beneficial. Some of our members have consulted with Dr. Donovan, a leading hair specialist and have experienced success with his approach.

The key to this method is using different active ingredients rather than specific brands. If certain additives in a product don’t suit you, you can opt for alternative with the same active ingredients and concentrations.

• 2% Ketoconazole
• Selenium sulfide
• Coal tar
• Zinc pyrithione

Finding the most effective treatment often requires a trial-and-error approach.^[50]University of Utah Health. (no date). Seborrheic Dermatitis. Available at: https://healthcare.utah.edu/dermatology/conditions/seborrheic-dermatitis (Accessed: February 2025) You might be advised by your doctor to start with a basic regimen and assess response after 2-4 weeks. If no improvement has been observed, then your doctor might increase the strength, change the treatment, or add complementary therapies. Once control has been achieved, you can gradually reduce treatment frequency to find the minimal effective maintenance regimen.

When Should You See a Healthcare Professional?

While mild seborrheic dermatitis can be effectively treated with over-the-counter or off-the-shelf treatments, you should see a healthcare professional if any of the following occur:

1. Symptoms persist or worsen: If your symptoms don’t improve after using over-the-counter dandruff shampoos for at least two weeks or if they suddenly get worse.^[51]Cleveland Clinic. (2020). Seborrheic Dermatitis. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/14403-seborrheic-dermatitis (Accessed: February 2025)
2. Severity interferes with daily life: When the condition causes anxiety, embarrassment, or disrupts your daily routine.
3. Signs of severe disease appear: If you develop yellow-red scaling papules along the hairline, behind the ears, on the eyebrows, or in the others of the face and body.^[52]National Eczema Association. (2025). Seborrheic Dermatitis. National Eczema Association. Available at: … Continue reading
4. Suspected complications: If you notice signs of skin infection.
5. Difficulty in diagnosis: If you are unsure if it is seborrheic dermatitis or another skin condition.
6. Presence of other skin conditions: If you suspect you might have seborrheic dermatitis along with other skin conditions, this can complicate diagnosis and treatment.

Final Thoughts

Seborrheic dermatitis of the scalp is a complex condition influenced by factors such as sebum production, Malassezia overgrowth, genetics, and immune responses. While a range of treatments, from over-the-counter antifungal shampoos to prescription medications like roflumilast and ketoconazole, are available, their effectiveness varies depending on the individual and the severity of the condition. Finding the right approach often involves trial and error, with combination therapies frequently offering the best results. Ultimately, consistent management, lifestyle adjustments, and working closely with healthcare providers are key to keeping symptoms under control. If one treatment isn’t working, don’t get discouraged; there are plenty of options to explore.