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Treatment for Seborrheic Dermatitis (Dandruff)

By Cynthia Bailey MD.

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Treatment for seborrheic dermatitis is a topic I find myself discussing every day in my dermatology practice. It's common! I see a lot of patients who think their scaly, red skin is just dry skin, but it is actually dandruff. When I tell them, they are shocked to learn that they have a rash and not just "dry skin."

The medical name for dandruff is seborrheic dermatitis.

Dandruff (seborrheic dermatitis) is so common that almost everyone will suffer from it at some point in their lifetime.

Seborrhea is a frustrating skin problem that is often difficult to hide. My dad had it, I have it and if you have it there is information here that might help. I take seborrhea seriously!  

The absolute necessity and turn-key treatments that I use to form the basis of every seborrheic dermatitis skin care routine I create to treat seborrheic dermatitis are:

  1. the Facial Flaking and Redness Solution Kit for facial seborrhea, and
  2. Foaming Zinc for scalp dandruff and body dandruff (usually seen as excessively dry flaking and itch on the chest and upper back). 
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Signs that you may have seborrheic dermatitis include,

  • best face wash for seborrheic dermatitis
    Red, greasy, scaly skin in the nose crease or between the eyebrows in your teens
  • ‘Dry’ and itchy scalp starting in your teen years and going on throughout your life
  • ‘Dry’, red, scaly skin in the T-zone of your face at any time in life
  • Crusty skin on, in, and behind your ears
  • Flaking of your eyebrows
  • Beardruff in your facial hair
  • Crusty scale and itching of your eyelashes (blepharitis), especially in the morning when you wake from sleep
  • Greasy, red scaly skin on your chest and upper back

What causes seborrheic dermatitis (dandruff)?

We don't entirely know! We do know that a yeast called Malassezia ovalis (also called Pityrosporum ovale) plays a role. The rash of seborrhea is worse when there are more of these yeast on the skin and pyrithione zinc helps to reduce the amount of yeast on the skin.

The good news is that with the right skin care routine you can control your seborrhea; use targeted skin care products to keep your facial skin and scalp healthy and attractive (instead of red and flaky). - Dr. Bailey

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Remember, you always get the best results with Complete Skin Care that allows fights seborrheic dermatitis and dandruff so your skin can heal. A Complete Skin Care Routine always involves 4 skin care steps:

  1. CLEANSE
  2. CORRECT
  3. HYDRATE
  4. PROTECT

Dermatologist recommended Complete Skin Care routine to control seborrhea.

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Step 1: CLEANSE

Use Calming Zinc™ Soap for facial seborrhea. Fortified with a full 2% pyrithione zinc, this soap is tough on seborrhea. It can be used on the trunk and ears, too.

This has helped my severe seborrheic rash around my nose better than many previous prescription cleansers and topicals. And it isn’t harsh! Hurray Lynn Daly

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For hairy areas like the scalp or thick facial hair use Foaming Zinc. This foaming cleanser acts as a shampoo and is also medicated with a full 2% of pyrithione zinc in a foaming cleanser base.

My skin was flaring up multiple times a week. After using this three days straight, my SD was gone!! Nijah

 A Facial Exfoliating Sponge or Salux Cloth  can help to remove scale on the face and body. On the scalp, use a Scalp Scrubber. 

It's important not to be too rough with exfoliation, because seborrhea is a form of eczema. This means that the skin barrier is compromised and the skin is easily irritated. Also, because the skin barrier is more sensitive, all facial skin cleansers need to be gentle and non-drying. If you have sensitive skin, you may find the daily use of medicated pyrithione zinc drying. When that is the case, try alternating the medicated product with a gentle pH balanced non-medicated product to cleanse affected skin such as my Extremely Gentle Facial Cleanser. 

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Step 2: CORRECT 

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When you cleanse with a pyrithione zinc cleanser, you have already started to correct seborrheic dermatitis. You can do more than this to control facial dandruff. Facial seborrhea responds really well to my Green Tea Antioxidant Skin Therapy applied twice a day right after washing.

This amazing product saved my skin. I was at my wits end with my rosacea and seborrheic dermatitis because nothing was helping my red, dry flakey skin...until this! Within days I started to see a decrease in the flakes and within 2 weeks I had happier, healthier, supple looking skin again. THANK YOU, Dr. Bailey, for this miracle product. It’s truly worth the price for the results. Tierney

For years I have used this unique product in my practice to control facial redness from seborrhea. I use it myself twice daily. When I run out of Green Tea Therapy my seborrhea invariably flares up. The ultra-concentrated green tea polyphenol antioxidants calm and soothe facial redness from many causes, including seborrhea.   

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Step 2: HYDRATE

Balance skin hydration to help broken skin barrier heal by applying a good moisturizer. Inflamed skin can't heal without hydrating skin care! Use a non-irritating and therapeutic moisturizer such as one of my two Daily Face Creams (Dry to Normal Skin or Oily to Normal) applied to involved non-hairy facial skin twice daily after washing and applying Green Tea. 

I put my Redness Relief Kit together with the right face moisturizing cream in my Facial Flaking and Redness Kit because the combination of these 3 products is key to soothing facial seborrhea. 

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Beardruff responds nicely to hydration of skin and facial hair with my Omega Enriched Booster Oil.  

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Step 4: PROTECT

I recommend one of my mineral zinc sunscreens be applied daily. Zinc oxide is the best type of sunscreen because it does not irritate inflamed skin. My Sheer Strength Pure Physical Sunscreens are my top choice. Pick your pure zinc oxide sunscreen based on your skin type.

Dermatologist's 8 tips to heal and control seborrheic dermatitis.

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Tip #1: Avoid harsh products on areas of actively inflamed seborrhea.

Harsh products will add irritation on top of the seborrhea – and irritation looks red and scaly! This applies to cleansers, acne products, anti-aging products, exfoliating products, and sunscreens.

Tip #2: Use medicated cleansers and shampoos to control seborrhea.

These are really helpful for discouraging Pityrosporum yeast and skin flaking. Pick the right cleanser for the skin area you are treating. Pyrithione zinc is my favorite medicated cleanser and shampoo ingredient. 
treatment for seborrheic dermatitis of the face

Tip #3: Pharmaceutical-grade green tea helps to calm facial seborrhea.

Over my 30+ years of practicing dermatology, I’ve found this to be the most important skin care product along with medicated pyrithione zinc. I created my Facial Flaking and Redness Solution Kit  to take the guess-work out of a facial seborrhea skin care routine. 

Tip #4: Always moisturize non-scalp areas of seborrhea to help the skin heal.

Seborrheic dermatitis leaves skin barrier compromised. Help your skin's barrier heal with a good moisturizer that has NO irritating ingredient. I take the guess-work out by including my Daily Moisturizing Face Cream in my Facial Flaking Kit. 

Tip #5: Use only non-irritating mineral zinc oxide sunscreens to protect facial skin prone to seborrheic dermatitis.

Chemical sunscreens are irritating. My Sheer Strength Pure Physical Sunscreens are designed specifically for barrier compromised skin such as that sufferings from seborrheic dermatitis. 

Tip #6: Beardruff is dandruff of the beard so use the right skin care routine to fight it.

Fight beardruff with my Foaming Zinc Cleanser and apply my Omega Enriched Face Oil to the skin under your beard and on your facial hair to conditions hair into soft and luxuriant beard you can be proud of.

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Tip #7: Crusty and itchy ears are usually due to seborrheic dermatitis so use the right skin care routine to relieve the problem.

For thick crusty scale on scalp and ears, pre-treating skin with coconut oil for 30 minutes before cleansing or shampooing really helps. Wet the skin, towel dry, apply the coconut oil, then wait 30 minutes or more. Use the Foaming Zinc Medicated Cleanser to remove the oil and treat the skin. Leave the cleanser on the skin for 5 minutes then rinse well. 

Tip #8: Stubborn seborrhea may benefit from medicated creams.

For stubborn seborrhea, I use clotrimazole cream twice a day after the Green Tea until the rash is clear for a month or so. This non-prescription anti-yeast cream provides additional control against the Pityrosporum yeast that plays a role in seborrhea. This medicated cream can also be applied to ear and trunk involvement, too. The cream base is too thick to use on hairy areas like the scalp. One-percent hydrocortisone cream on top of the clotrimazole is helpful if the rash won’t budge, but this medicine has side effects that include skin thinning of the application site and, if applied near the eyes, can cause eye damage. It should only be used under a doctor’s supervision.

    For more information on facial seborrhea, and to focus on the products that I use for my Facial Seborrhea Complete Skin Care Routines click here.

    For more information on scalp and body seborrhea, and to focus on the products that I use for my  Scalp Seborrhea Skin Care click here. 

    References:

    Luis J. Borda and Tongyu C. Wikramanayake, Seborrheic Dermatitis and Dandruff: A Comprehensive Review, J Clin Investig Dermatol., 2015 Dec; 3(2): 10.13188/2373-1044.1000019.

    Gary G. Optimizing treatment approaches in seborrheic dermatitis. J Clin Aesthet Dermatol. 2013;6(2):44–49.