Dandruff can cause you to have an itchy red, crusty flaky eyelashes and lash line. Dandruff of the lash line is called seborrheic blepharitis. It's part of the spectrum of eczema called seborrheic dermatitis.
Seborrheic blepharitis usually happens when you have really severe dandruff in the more usual areas like your scalp and face, but it can also happen by itself. Also, just as with the other manifestations of dandruff, this lash line form tends to be chronic; if you're prone to it, the rash will come and go but your propensity for it persists indefinitely. That means you need a strategy to control it that also includes an intervention to treat flare ups.
How do I treat flaky eyelashes due to seborrhea in my dermatology practice?
I like to recommend preventative skin care that uses the medicated zinc pyrithione soap for facial washing (this will bathe the lash line in the medicated ingredient). Another great treatment is to do special lash line care using a diluted solution of baby shampoo (which thoroughly cleans and degreases the lash line) to treat flare ups and prevent flaky eyelashes.
I have my patients wash their face with Calming Zinc Soap. They tightly close their eyes to keep the soap from entering the eyes, but the lathering of the soap on their face and eyelids will allow the active ingredient to reach the lash line. They then rinse well.
Pyrithione zinc will sting and irritate the eye if it actually gets into it so it's important that none does. I tell my patients to use this soap once or twice a day. Calming Zinc Soap contains the strongest level of the medicine pyrithione zinc, which helps to counter the yeast germs that may contribute to dandruff. There are other products with this active ingredient, including some dandruff shampoos. Many people find them more drying and irritating to their sensitive, dandruff prone skin than Calming Zinc.
What is the best treatment for when seborrheic blepharitis flares up and you again have flaky eyelashes?
I typically start a degreasing and debridement treatment with dilute baby shampoo. It sounds too simple to work for the inflammation of eyelid dandruff but it's highly effective.
After showering, or soaking the eyelids with a warm and wet wash cloth for 5 minutes, I have patients treat the lash line with a cotton tipped applicator dipped in a dilute baby shampoo solution. The solution is made with a small squirt of baby shampoo in about a cup of warm water. The solution is mixed up well and then the cotton tipped applicator is dipped in it. The eyelid's lash line is held taught with a finger and the applicator is gently run along the lash line to help remove built up oil, dead skin cells and microorganisms that clog the lash line pores (oil glands).
This simple treatment is done several times with a clean cotton tipped applicator. Both the upper and lower lash line need to be cleaned in this way. The eyelids are finally rinsed with warm water to remove the baby shampoo residue. This process is repeated once or twice a day as needed.
Clogged glands and crust build up seem to fuel the inflammation of eye lash line dandruff. Curiously, the Pityrosporium yeast germ, and possibly even demodex mites (these are normal and we all have some in our facial pores), may also play a role. This lash line cleaning helps to remove all of these potential contributing factors.
Beyond these two interventions, eyelash line dandruff is tricky to treat because of the proximity of the lash line to the delicate eye itself. If this treatment method is not working then it's time to ask for a doctor's help.
I find that for some of my patients, I need to prescribe oral antibiotics to jump start things. Also, there are medicated eye drops and ointments that can be used, but as a dermatologist, I always refer patients who need those treatments to an ophthalmologist since the medicines will enter the eyes and I want an ophthalmologist supervising the status of the precious eyes.
What causes seborrheic blepharitis?
We don't know. But scientists have found that demodex mites play a role in a blepharitis from rosacea. Many people with seborrhea also have rosacea. I suspect scientists will find that demodex mites play a role in eyelid dandruff. These little insects are normal inhabitants of everyone's pores. They are now known to contribute to blepharitis caused by rosacea. Since many rosacea patients also have facial dandruff, I'll bet these 'charming' little creatures may be part of the inflammation from dandruff too. At present, there is no direct way that I know of to treat them on the lash line. The pyrithione zinc and a good cleaning with the baby shampoo solution probably helps though because the mites can be washed off and out of the pores.
I see a lot of patients with flaky eyelashes. You can find more of my treatment and skin care recommendations in my Advice Pages for Understanding and Treating Seborrheic Dermatitis. I share my favorite tips for dandruff of the scalp, face, ears and more.
For more information on seborrheic dermatitis please see the other posts in this series:
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