Seborrheic Dermatitis on Face: Treatment, Causes, Symptoms

Seborrheic dermatitis, or eczema, commonly affects the skin on the face, especially on and around the nose. It is also referred to as facial dandruff.

Facial seborrheic dermatitis can lead to a red rash that is covered with thick, yellowish, greasy flakes or scales. Despite the skin feeling oily, it may appear dry. The main causes of seborrheic dermatitis are the fungus Malassezia, oily skin, and skin barrier dysfunction.

Treatment for facial seborrheic dermatitis often includes shampoos and topicals with antifungal ingredients, steroids, and sometimes immunomodulators.

Seborrheic dermatitis is a common skin condition that affects the face. It is characterized by dry flaky skin and redness. Why it happens is still a mystery but there are few theories.

Seborrheic dermatitis is sometimes referred to as facial dandruff, although it isn’t truly dandruff. The term ‘dandruff’ is mainly used for dry, flaky skin on the scalp, while seborrheic dermatitis refers to dry, flaky skin along with inflammation, which can not only involve the scalp but other parts of the body as well.

Causes

There are multiple factors that have been associated with seborrheic dermatitis. However, still, it is not entirely clear what is the root cause of seborrheic dermatitis. It mainly affects areas that are rich in oil glands like the face, scalp, back, and chest.

Various factors associated with causing seborrheic dermatitis are as follows:

1. Malassezia

Multiple research studies show some relationship between Malassezia fungus and seborrheic dermatitis. Malassezia is a fungus that is part of the normal flora of our skin so basically, we all have it on our skin and it doesn’t cause any symptoms.

However, in some people, there is an excess of Malassezia and they develop sensitivity to it and its metabolites.

It is believed that Malassezia can utilize skin oils. After feeding on these oils, it produces free fatty acids such as oleic acid.

Oleic acid can penetrate our skin barrier leading to an inflammatory reaction, hyperproliferation of skin cells, and symptoms of seborrheic dermatitis (like redness, dryness, and buildup of scales).

2. Excessive oiliness

The skin on the face, especially the T-zone involving the nose, is rich in oil glands. Malassezia utilizes these skin oils to grow and flourish. This is probably the reason why it commonly affects the face.

3. Skin barrier dysfunction

Many inflammatory skin conditions have an underlying skin barrier defect. Seborrheic dermatitis is one such skin condition that is thought to be associated with some degree of underlying skin barrier dysfunction.

In fact, some think that this might be the main reason making some people sensitive to Malassezia.

When we look at the factors above, seborrheic dermatitis does not occur due to one factor but rather the interplay of all these factors.

Although the oiliness of the skin is linked to seborrheic dermatitis, people with normal or dry skin can also have seborrheic dermatitis.

4. Other causes

In addition, other factors like sun exposure, certain cosmetics, stress, and dry cold weather can worsen seborrheic dermatitis. It has also been linked to certain medications and neurological diseases.

Symptoms

Facial seborrheic dermatitis often affects the area between the eyebrows and the nose. In some people, seborrheic dermatitis also involves the eyelid skin. One can also see patches of seborrheic eczema inside the ear canals.

The following features are usually seen with facial seborrheic dermatitis:

The skin often feels dry and is rough to the touch – almost like sandpaper. The skin with seborrheic eczema may be covered with thick yellow scales in comparison to the fine white flakes of dry skin. Underlying redness may also be present.
These dry, scaly areas are often present on the nose and nose crease and may extend to the skin on the nasolabial fold (the fold that runs from the side of the nose to the corners of the mouth).
In men, patches can appear in the beard area, which may present as red, inflamed areas covered with thick greasy scales.
The thick yellow flakes can also be seen clinging to eyebrow hair.
In people with darker skin tones, seborrheic dermatitis can present with dark red or brown patches or hypopigmented (white) spots.
Seborrheic dermatitis patches are often associated with itching.
In babies, seborrheic dermatitis is often referred to as cradle cap. It commonly affects the scalp, but seborrheic dermatitis can extend to the forehead and between the eyebrows. The affected area is covered with thick yellow scales.

Diagnosis

The diagnosis of seborrheic dermatitis is usually made clinically by its signs and symptoms. Sometimes your healthcare provider may take a skin biopsy to rule out other skin conditions.

Perioral dermatitis is another condition that can lead to dryness around the nose. However, it is usually accompanied by small red papules.

Treatment

In babies, seborrheic dermatitis usually resolves on its own. The thick scales can be loosened by applying mineral oil or other emollients.

However, in adults, facial seborrheic dermatitis is a chronic condition and cannot be cured. Its treatment can help in managing this condition and decreasing its flare episodes.

The main aim of treating facial seborrheic dermatitis is:

Addressing the inflammation.
Decreasing the burden of Malassezia fungus.
Repairing our skin barrier.

Keep in mind, that everyone’s skin is unique and everyone responds differently to different treatments. So, you may have to try and see what works best for your skin.

If you have a severe flare episode of seborrheic dermatitis with extreme redness or pain, it’s best to see a doctor to get a prescription medication. Over-the-counter treatments may not work as efficiently as prescription medications.

Below are some ways to manage this skin condition.

1. Use a face wash with anti-fungal ingredients

In order to get rid of excess Malassezia, we can include a face wash with antifungal ingredients. Some ingredients to look for in the face wash or cleanser are:

Zinc pyrithione
Piroctone olamine
Sulfur

When you use such face wash, make sure to leave the foam on the skin for a few minutes for the ingredients to work. Using these face washes even a few times a week can be beneficial in managing seborrheic dermatitis long-term.

For more details: The 10 Best Face Washes For Seborrheic Dermatitis

2. Occasional use of a face wash with keratolytic or exfoliants

Seborrheic dermatitis leads to the build-up of dead skin cells on the surface. Manual or physical exfoliation can irritate and exacerbate seborrheic dermatitis.

In addition, it can lead to broken capillaries, especially around the root of the nose or sides of the nose. So, it’s best to stay away from any scrubs or washcloths.

Instead, you can occasionally use face wash or a mask with ingredients like sulfur and salicylic acid, to get rid of the dead skin cells.

Removal of dead skin cells can also help in better penetration of other topicals.

Salicylic acid is an exfoliant and can get rid of dead skin cells. Its anti-inflammatory properties can also be beneficial.
Sulfur is a broad-spectrum antimicrobial that can decrease Malassezia. In addition, its keratolytic properties can get rid of dead skin cells.

Both these ingredients can lead to dryness so adjust the frequency according to your needs.

3. Use barrier-repairing and anti-inflammatory ingredients

In order to address the underlying skin barrier dysfunction, it is important to include ingredients that can help in skin barrier repair and decrease inflammation. They can be either part of your serum or your moisturizer.

Some of the ingredients to look for are:

a) Niacinamide

Niacinamide can help in repairing our skin barrier by increasing the production of ceramides in the skin. It can decrease the redness by reducing inflammation.

There’s actually a study that shows it can be beneficial for seborrheic dermatitis. This study used 4% nicotinamide cream.

Some people feel burning and stinging from using high concentrations of niacinamide. If that happens opt for a lower concentration or mix a few drops of your serum with the moisturizer.

b) Urea

Urea can enhance our skin barrier and can also help in getting rid of dead skin cells. It can also hydrate our skin. This makes it a wonderful ingredient for seborrheic dermatitis.

c) Azelaic acid

Are you surprised to see this on the list?

Azelaic acid can benefit seborrheic dermatitis in numerous ways. It can decrease inflammation and redness. It has antimicrobial properties and may suppress Malassezia growth. It may decrease sebum production as well, although the evidence is scarce.

In addition, it can improve seborrheic dermatitis as reported by an article where azelaic acid 15% gel was used in two cases of seborrheic dermatitis.

Having suffered from rosacea and seborrheic dermatitis, azelaic acid has been a game changer for me in improving the rough texture, especially on the nose and nasolabial folds.

Read more: Best Azelaic Acid Products

d) Licorice root extract

This is well known for its skin-soothing and anti-inflammatory properties. The results may not be drastic, however including it in the skincare routine can decrease redness and underlying inflammation.

4. Use a moisturizer to prevent dryness

A lot of people think that since oily skin is linked to seborrheic dermatitis, they should not moisturize the face. This results in a cycle of excessive inflammation and dryness.

A lot of skincare products that are used to manage seborrheic dermatitis can lead to dryness.

If we do not supplement our skin with a moisturizer, the cycle of dryness and inflammation keeps going on.

To heal the skin barrier include a good moisturizer with humectants (like hyaluronic acid), emollients (like panthenol, shea butter), and occlusives (shea butter, petrolatum).

Do not be afraid of using every oil in your skincare routine. Oils rich in linolenic acid have anti-inflammatory properties which can benefit our skin in addition to providing hydration.

However, oleic acid-rich oils like olive oil may worsen seborrheic dermatitis in some especially when they are present high in the ingredient list. So, these are the types of oils to consider avoiding.

In addition, several moisturizers have anti-fungal ingredients like piroctone olamine, which can benefit seborrheic dermatitis.

For more details: The Best Seborrheic Dermatitis Moisturizers

5. Natural remedies to try

MCT oil: MCT aka medium-chain triglycerides are found in palm and coconut oil. These have antifungal properties and can be beneficial for seborrheic dermatitis. BIOM8 – Skin Conditioning Oil is a product based on MCTs – caprylic/Capric Triglyceride and tricaprylin (Caprylic Triglyceride).
Honey: Honey can be beneficial for seborrheic dermatitis due to its antimicrobial and anti-inflammatory properties. Many people get results from using honey as a face mask. Some people prefer to use manuka honey.

Note: Do not use honey if you are allergic to bee-related products.

6. Use sunscreen every day

The prominence of the nose on the face makes it susceptible to sun damage. UV rays can also impair our skin barrier, So, it’s important to not miss any spots on the face.

Use a broad-spectrum sunscreen at least SPF 30 which protects from both UVA and UVB rays. If a chemical sunscreen stings, burns, or causes irritation, try a physical sunscreen with zinc oxide or titanium dioxide.

7. Lifestyle changes

Stress management: Seborrheic dermatitis has been linked to excessive stress. We often see outbreaks during stressful times like a big event or during exams. So try to use relaxation techniques like walking, meditation, exercise, or listening to music during these times.
Diet: Foods with high glycemic index can result in the release of insulin and insulin-like growth factor-1 which in turn can increase sebum production. Excessive oiliness is often linked to seborrheic dermatitis. So, you can opt for a healthy diet rich in antioxidants, fresh fruits and vegetables, and omega fatty acids.

8. Prescription medications

Severe episodes of seborrheic dermatitis need medical attention. There are several prescription medications that can be helpful for seborrheic dermatitis: topical steroids, antifungal cream or lotion, immunomodulators like tacrolimus and pimecrolimus, and oral antifungals.

These medications should be used only under the guidance of your healthcare provider.

Summary

Facial seborrheic dermatitis is a skin rash with oily red patches that are covered with thick, greasy, yellow scales. It commonly affects the area around the nose and in between the eyebrows.

Overgrowth of Malassezia, excessive oiliness of the skin of the nose, and skin barrier dysfunction are common associated factors leading to seborrheic dermatitis.

Facial seborrheic dermatitis can usually be treated with a gentle skincare regimen with products containing antifungal and barrier-repairing ingredients. Prescription medications may be needed in some cases.

Seborrheic dermatitis is a chronic skin condition that cannot be cured.

Read more:

References

Wikramanayake TC, Borda LJ, Miteva M, Paus R. Seborrheic dermatitis-Looking beyond Malassezia. Exp Dermatol. 2019 Sep;28(9):991-1001. doi: 10.1111/exd.14006. Epub 2019 Aug 19. PMID: 31310695.
McGinley KJ, Leyden JJ, Marples RR, Kligman AM. Quantitative microbiology of the scalp in non-dandruff, dandruff, and seborrheic dermatitis. J Invest Dermatol. 1975 Jun;64(6):401-5. doi: 10.1111/1523-1747.ep12512335. PMID: 237965.
Berk T, Scheinfeld N. Seborrheic dermatitis. P T. 2010 Jun;35(6):348-52. PMID: 20592880; PMCID: PMC2888552.
Fabbrocini G, Cantelli M, Monfrecola G. Topical nicotinamide for seborrheic dermatitis: an open randomized study. J Dermatolog Treat. 2014 Jun;25(3):241-5. doi: 10.3109/09546634.2013.814754. Epub 2013 Jul 5. PMID: 23763270.

Disclaimer: This blog post is for information purposes only and does not replace medical advice.