Patient information · Dermatology
Seborrhoeic dermatitis
controlled rather than cured — and easily controlled
Seborrhoeic dermatitis causes flaking, redness and itching on the scalp, face and chest. It is a reaction to a yeast that lives normally on everyone's skin, not a sign of poor hygiene or dry skin — which is why moisturising alone never fixes it and antifungal treatment usually does.
Arrange assessment rather than self-treating if there is
- sudden severe or widespread onset, particularly in an adult
- weeping, crusting or spreading redness, suggesting infection
- involvement of the eyelids with a red painful eye
- seborrhoeic dermatitis in someone immunosuppressed or with HIV
- no response to appropriate treatment after six weeks
- scaling with hair loss, or well-defined thick plaques suggesting psoriasis
Severe, sudden or treatment-resistant seborrhoeic dermatitis in an adult is a recognised association with HIV and with Parkinson's disease, and warrants assessment rather than repeated shampoo changes.
Where it appears
- Scalp — from mild dandruff to thick greasy yellow scale and redness
- Face — sides of the nose, eyebrows, between the brows, behind the ears and in the beard area
- Eyelid margins — blepharitis, with crusting and gritty eyes
- Chest and upper back, and skin folds
- It is typically worse in winter, with stress, tiredness and alcohol, and better with sunlight
Treating the scalp
- Use an antifungal shampoo — ketoconazole is the most effective; selenium sulfide, zinc pyrithione and coal tar also work.
- Leave it on for five to ten minutes before rinsing. This is the step almost everyone skips, and it is the one that matters — a shampoo rinsed off immediately has no time to act.
- Use it two or three times a week during a flare, then once a week or fortnight to maintain.
- Rotate between two different active ingredients if it seems to stop working.
- For thick scale, apply a salicylic acid or oil-based preparation first to soften it, then shampoo.
- A scalp steroid lotion may be prescribed for short-term use where inflammation is marked.
Treating the face
- Antifungal cream — ketoconazole or clotrimazole — applied once or twice daily until clear, then a couple of times a week to maintain.
- A mild steroid cream for short courses when inflamed. Do not use steroid creams on the face long term — they cause thinning and a rebound dermatitis.
- Wash with a gentle non-soap cleanser; avoid harsh scrubs and alcohol-based toners.
- A light non-greasy moisturiser afterwards.
- For the eyelids, warm compresses and lid hygiene rather than creams.
Cradle cap in babies
The infant version appears in the first weeks and looks alarming — thick yellow greasy crusts on the scalp, sometimes eyebrows and nappy area. It is harmless, does not itch, and almost always clears by itself within a few months. Soften with baby oil, olive oil or emulsifying ointment, leave for a few hours or overnight, then brush gently with a soft brush and wash out with baby shampoo. Do not pick the crusts. See us if it is weeping, spreading, or your baby seems uncomfortable.
Living with it
- It is a long-term condition that is controlled rather than cured. Stopping treatment when clear is why it returns; ongoing maintenance is the point.
- It is not contagious and not caused by being unclean — if anything, over-washing and harsh products make it worse.
- Flares follow stress, illness, tiredness, cold weather and alcohol.
- It commonly coexists with rosacea and with blepharitis, both of which may need treating alongside.
Why come to us. Seborrhoeic dermatitis is frequently mistaken for dry skin, eczema or psoriasis, and treated with the wrong thing for years. Our dermatology team can confirm what you actually have, prescribe the antifungal and steroid preparations that are not available over the counter, and set up a maintenance routine that keeps it controlled rather than treating each flare from scratch. We can also test for the underlying associations where the picture is unusual. Seven days a week, no referral needed.
The right diagnosis and prescription treatment
Dermatology without a referral, seven days a week on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.