WHAT IS SEBORRHOEIC DERMATITIS?

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​Seborrhoeic dermatitis, also known as seborrhoeic eczema, is a chronic skin condition characterised by inflamed, itchy, scaly and flaky skin. It predominantly affects oily areas of the body, such as the scalp, face, ears, chest, and skin folds. Dandruff, a mild form of seborrhoeic dermatitis, is extremely common and affects many adults.
Seborrhoeic dermatitis is slightly more common in men and can affect people at any age, but it is most frequently seen between the ages of 30-40. It is also a common condition that affects around 3-5% of the population.
In babies, this condition is referred to as cradle cap, especially when it affects the scalp. Cradle cap is temporary and typically clears within a few months. However, seborrhoeic dermatitis in adults is a long-term condition that tends to flare up periodically, sometimes triggered by environmental factors such as stress, fatigue, or cold, dry weather.

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UNIQUE CONSIDERATIONS FOR SKIN OF COLOUR

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Seborrhoeic dermatitis is very common among patients of darker skin types. Studies have shown that it is among the five most common diagnoses observed in black patients. In
individuals with darker skin tones, seborrhoeic dermatitis may present differently compared to lighter skin:

• Discolouration: Affected areas may appear lighter or darker than the surrounding skin rather than the usual redness. This can sometimes make the condition less noticeable and potentially more difficult to diagnose.

• Pigment Changes: Inflammation may lead to postinflammatory hyperpigmentation (darkening) or hypopigmentation (lightening) after the rash subsides. This is particularly important to monitor as the condition evolves.

• The yellow flakes typical of seborrhoeic dermatitis may be more pronounced, creating noticeable contrasts.

• In darker skin types, it can sometimes present in a flower-like (petaloid) shape, especially in areas like the scalp and forehead.

• Treatment recommendations should take into consideration the hairstyling practices and the cultural standards of hair care within certain racial groups. For example, textured hair is inherently drier and more prone to hair breakage, so the frequency of hair washing may

• be limited to once in 1-2 weeks.

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​CAUSES AND CONTRIBUTING FACTORS

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While the exact cause of seborrhoeic dermatitis is not fully understood, several factors are believed to contribute:

• Malassezia Yeast: An overgrowth of this normally harmless yeast on the skin is linked to seborrhoeic

• dermatitis.

• Oil Production: Excess oil production on the skin can exacerbate the condition.

• Skin Barrier Abnormalities: Sensitivity to oleic acid, produced by Malassezia, may cause inflammation.

• Environmental Factors: Heat, tiredness, stress, and cold, dry weather can trigger flare-ups.

• Immunocompromised States: Conditions such as HIV or neurological diseases like Parkinson’s may increase risk.

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WHAT DOES IT LOOK LIKE?

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Seborrhoeic dermatitis varies in appearance and can look different based on skin type:

• Scalp: The scalp may show symptoms ranging from mild dandruff to more greasy inflamed crusting, which can appear lighter or more ashen compared to the surrounding skin. It may weep or ooze.

• Face: Common affected areas include the eyebrows, sides of the nose, and cheeks. On darker skin, affected areas might appear ashy or lighter than the surrounding skin. The eyelids may also become red, swollen, and flaky (called seborrhoeic blepharitis).

• Ears: Scale, crusting, and oozing can occur inside the ear canal and around the outer ear.

• Chest and Back: It might present as yellowish scaling on pale patches

• Skin Folds: In areas like under the breasts, in the groin, or under the arms, the skin may appear darker or ashy in darker skin tones, with a shiny texture and surface cracks.

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DIAGNOSIS

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Diagnosis is usually based on a clinical examination. In some cases, further tests may be required:

• Skin Scrapings: To rule out fungal infections such as ringworm.

• Skin Biopsy: May be performed to differentiate from other conditions, but it is rarely needed.

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TREATMENT OPTIONS

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Currently, there is no cure for seborrhoeic dermatitis, but effective management can significantly improve symptoms:

• Antifungal Treatments: Medicated shampoos and creams containing ketoconazole, zinc pyrithione, or selenium sulfide help reduce yeast levels.

• Anti-Inflammatory Agents: Topical corticosteroids or calcineurin inhibitors can alleviate inflammation. Use as directed by your healthcare provider.

• Keratolytics: Products containing salicylic acid can help remove thick scales, particularly on the scalp.

• Treatments can come in different vehicles such as solutions, foams, oils or ointments, therefore a suitable one can be suggested by your doctor based on your hairstyling practice and hair care routine.

• General Skin Care: Use gentle, soap-free cleansers and non-comedogenic moisturisers to support the skin barrier. Avoid products that irritate the skin or block pores.

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SELF-CARE TIPS

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Here are some self-care measures to help manage seborrhoeic dermatitis:

• Regular Cleansing: Wash affected areas with gentle, antifungal shampoos or cleansers. Leave on for several minutes before rinsing.

• Moisturise: Apply a light, non-comedogenic moisturiser to maintain skin hydration.

• Avoid Heavy Products: Refrain from using heavy oils, gels, or pomades that can create buildup on the scalp and worsen seborrhoeic dermatitis. Opt for lighter products and ensure thorough cleansing.

• Avoid Triggers: Identify and avoid personal triggers such as stress and harsh weather conditions.

• Sun Protection: Use sunscreen to protect against further skin changes.

• Ear Care: Avoid inserting cotton buds into the ears, as this can worsen irritation.

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WHEN TO SEEK MEDICAL ADVICE

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Consult a healthcare provider if:

• Persistent Symptoms: Over-the-counter treatments are ineffective.

• Severe Reactions: Noticeable swelling, significant pain, or severe redness.

• Signs of Infection: Oozing or crusting that may indicate a bacterial infection.

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CONCLUSION

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Seborrhoeic dermatitis is a manageable condition with appropriate treatment and self-care strategies. For individuals with skin of colour, recognising its unique presentation and adhering to a consistent treatment plan can help control symptoms and improve skin health.​​​​​​​​

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