What is seborrhoeic eczema?
Seborrhoeic eczema (seborrhoeic dermatitis) is a very common scaly and slightly itchy skin condition. The red, scaly patches develop mainly in the folds beside the nose, in the eyebrows and on the scalp. It responds well to treatment.
What causes seborrhoeic eczema?
A yeast plays a central role in the development of seborrhoeic eczema. This yeast (Pityrosporum ovale, also called Malassezia) is very common and is found generally on the skin of people without seborrhoeic eczema or dandruff. Complaints only arise when there is reduced resistance to the yeast. Many people with seborrhoeic eczema report a flare with mental stress, illness and changes of season.
The course is hard to predict. Sometimes it lasts only a few weeks and then disappears again without treatment; but episodes can last many months, when treatment with medicines is desirable. Common sites are:
- beside the nose and in the eyebrows;
- along the hairline of the scalp;
- the eyelids and outer ears;
- the chest and the back between the shoulder blades;
- in the folds: armpits, groin, genital area;
- the scalp — where seborrhoeic eczema is better known as “dandruff”.
How is seborrhoeic eczema treated?
The most important aspect of treatment is reducing the amount of Pityrosporum ovale on the skin. Special anti-yeast creams and shampoos are available for this. Some of these products also have an anti-inflammatory effect, so the eczema complaints disappear sooner. Examples of anti-yeast agents are ketoconazole (cream and shampoo), ciclopirox (cream), miconazole (cream) and sulconazole (cream).
Because the scalp acts as a reservoir for the yeast, it can be wise to include it in the treatment by washing a few times a week with, for example, ketoconazole shampoo or a selenium sulphide shampoo — this also applies of course if there is active seborrhoeic eczema on the scalp.
For severe forms, the doctor may also prescribe a mild corticosteroid cream that can be combined with the anti-yeast medicine. Because the eczema mainly affects delicate areas of skin, the added corticosteroid will almost always be a class 1 (hydrocortisone) or class 2 (triamcinolone) corticosteroid.
What is the outlook?
After stopping treatment the seborrhoeic eczema can return, and the treatment can then be repeated. In many cases seborrhoeic eczema will eventually fade out (unfortunately sometimes only after years).
What looks like seborrhoeic eczema but is not?
- Psoriasis — seborrhoeic eczema along the hairline can resemble psoriasis; in psoriasis the scales are larger.
- Perioral dermatitis — small red spots around the mouth and/or on either side of the eyes, which scales less.
Frequently asked questions
Can tension and stress be the cause of seborrhoeic eczema? Although tension and stress are not the cause, they can worsen scaling and itch if you already have seborrhoeic eczema. The body’s immune system is sensitive to increased stress, and the immune system in turn governs the skin’s reaction to the Pityrosporum yeast. It is a well-known phenomenon that people under stress (for example just before an exam) can develop a huge increase in severity from one day to the next.
Can seborrhoeic eczema be cured? The medicines used against it can suppress the complaints but not cure them. Even so, most people notice that the complaints improve over time, and there are many examples of people in whom, after a (sometimes long) period of complaints, the seborrhoeic eczema faded and did not return.
When to see a doctor
See a doctor if scaly, itchy patches on the face or scalp persist, keep returning, or do not respond to over-the-counter anti-dandruff or anti-yeast products.