Seborrheic Dermatitis (Oily Eczema): Symptoms and Treatment

What is Seborrheic Dermatitis?

Seborrheic dermatitis is a chronic and recurrent inflammatory skin disease characterized by redness and scaling, particularly affecting areas with a high concentration of sebaceous glands such as the scalp, eyebrows, sides of the nose, ears, and the midline of the chest.

It is sometimes referred to as "oily eczema" among the public.

Briefly, what you need to know

It is not contagious.

It doesn't occur simply because "the skin is oily".

Dandruff can be associated with mild scalp appearance of seborrheic dermatitis.

It can flare up and then calm down.

The goal of treatment is to control the disease and reduce relapses.

Not all dandruff is seborrheic dermatitis.

What does seborrheic dermatitis look like?

Most frequent:

redness,

Fine or oily-looking scaling,

dandruff,

itching,

sometimes burning or sensitivity

It is seen.

In darker skin types, redness may be less noticeable; pigment changes and scaling may be more apparent.

Where is it most commonly seen?

scalp

Muscles

Sides of the nose

Around the ear

beard area

Midline of the chest

The clinical presentation may differ in infants; it should not be considered exactly the same as adult seborrheic dermatitis.

What causes seborrheic dermatitis?

There isn't just one reason.

In the current understanding:

skin barrier,

sebum/lipid environment,

immune response,

skin microbiome,

especially Malassezia species

They play a role together. However, it is not accurate to describe the disease simply as a "fungal infection".

Because:

“"Seborrheic dermatitis = scalp fungus"”

Are dandruff and seborrheic dermatitis the same thing?

Not exactly.

Dandruff can manifest as flaking, often without significant inflammation of the scalp.

In seborrheic dermatitis, redness, itching, or inflammation may be more pronounced along with scaling.

However, the two conditions can be considered within the same spectrum and may overlap. The 2024 international consensus also considers scalp seborrheic dermatitis and dandruff together.

Can seborrheic dermatitis and psoriasis be confused?

Yes.

Psoriasis and seborrheic dermatitis can look very similar, especially on the scalp.

In psoriasis, plaques are usually more sharply defined and thicker; in seborrheic dermatitis, the scaling may be finer and have an oily appearance.

However, the true clinical distinction is not always that simple.

Sometimes, sebopsoriasis can present with features of both conditions simultaneously.

Can seborrheic dermatitis and rosacea be confused?

Yes.

Especially in the central part of the face:

redness,

sensibility,

flaking

If present, the two diseases can become confused and may coexist in some individuals.

Therefore, we shouldn't assume every facial redness is rosacea, or every flaky rash is seborrheic dermatitis.

How is seborrheic dermatitis diagnosed?

Diagnosis in most patients:

typical settlement,

clinical appearance,

recurrent course of the disease

The diagnosis is made through evaluation and dermatological examination.

Routine biopsy or laboratory tests are not required.

In atypical or treatment-resistant cases, differential diagnosis may be necessary for psoriasis, contact dermatitis, tinea, and other diseases.

How is seborrheic dermatitis treated?

The treatment has two main goals:

To control microbial load/related factors + reduce inflammation.

The 2024 international consensus and current reviews define topical antifungals and anti-inflammatory therapies as the basic approach.

Antifungal treatments

Especially in seborrheic dermatitis of the scalp:

ketoconazole,

ciclopirox

Antifungal agents such as these are commonly used options.

The choice of shampoo or topical preparation may vary depending on the area and the severity of the condition.

Topical corticosteroids

It can be used for a short period if there is significant inflammation and itching.

However, this is especially true for prolonged and uncontrolled steroid use in the face:

skin thinning,

telangiectasia,

perioral dermatitis,

steroid rosacea

This can lead to problems such as these.

Therefore, the "you have eczema, apply cortisone" approach is not a sustainable treatment plan.

Calcineurin inhibitors

Nonsteroidal anti-inflammatory agents such as tacrolimus or pimecrolim may be considered in some patients, particularly in sensitive areas such as the face.

Are there any new treatments?

New topical options are also being developed in the treatment of seborrheic dermatitis, and current 2025 reviews are evaluating even newer treatments.

However, we will not list every new molecule on the patient page.

Key point:

Treatment is chosen based on the location, severity, and frequency of flare-ups of the disease.

Should dandruff shampoo be used continuously?

Not every patient needs the same frequency of use.

More frequent use during the active phase and less frequent use for maintenance purposes after control is achieved may be considered.

Because seborrheic dermatitis is prone to recurrence, some patients may require a maintenance approach aimed at reducing relapses, not just during flare-ups. The 2024 consensus also specifically emphasizes this chronic-relapsing nature.

Does it increase stress?

Some patients describe flare-ups during periods of stress.

However, stress is not the only cause of illness.

Season, climate, skincare habits, and individual factors can also play a role.

Does it cause hair loss?

Seborrheic dermatitis does not directly lead to permanent follicle miniaturization like classic androgenetic alopecia.

However, significant inflammation, scratching, and scalp irritation can increase the sensation of temporary hair loss.

In cases of persistent, significant hair loss, it's necessary to evaluate other causes of hair loss instead of simply dismissing it as "dandruff.".

What precautions should be taken at home?

Avoid excessively aggressive scraping of the scalp.

Avoid using very hot water.

Reduce irritating products.

Using the treatment shampoo for the correct duration and frequency.

Avoid using cortisone uncontrollably on the face.

It is important.

In seborrheic dermatitis, the goal is not to "completely dry up the oil.".

Excessive drying and irritation can disrupt the skin barrier.

When should you consult a dermatologist?

Especially:

if it happens frequently,

If both the face and scalp are noticeably affected,

If the itching/burning is intense,

If it doesn't improve despite using dandruff shampoos,

if accompanied by hair loss,

if it is confused with psoriasis or another disease

Dermatological evaluation is appropriate.

Frequently Asked Questions

Is seborrheic dermatitis contagious? No.

Is seborrheic dermatitis a fungal infection? No. Malassezia species play a role in the pathogenesis, but the disease itself is not a fungal infection.

Is dandruff seborrheic dermatitis? Dandruff can be considered a milder form of scalp condition within the spectrum associated with seborrheic dermatitis; however, not all cases of dandruff involve significant inflammation.

Will it completely disappear? It can be chronic and recurrent. It can be controlled with appropriate treatment.

Is washing your hair every day bad? It's not accurate to say that daily washing alone worsens the condition. The product used, scalp characteristics, and treatment plan are more important factors.

Does applying oil help? Not for every patient. Some oily/occlusive products can worsen symptoms. Giving a single, one-size-fits-all home remedy is not correct.

Clinical Note by Dr. Utkan Kızıltaç

One of the most common problems I see in seborrheic dermatitis is that patients try to solve the problem for years simply by changing their "anti-dandruff shampoo." However, it's necessary to evaluate whether the scaling on the scalp is truly seborrheic dermatitis, along with accompanying findings on the face or other areas, and differential diagnoses such as psoriasis. Instead of trying to completely eliminate the disease, a more realistic goal is to control flare-ups and reduce the frequency of relapses with the right treatment.

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