Seborrheic dermatitis on the forehead

What does it look like on the forehead?

Look for thin, flaky patches around the hairline, eyebrows or the space between the eyebrows. The edges can be indistinct rather than sharply outlined. Scale can look white or yellowish and feel dry or greasy. The forehead can look oily and scaly at the same time. Itching varies: some people have little itch, while others find the affected skin itchy, sore or sensitive.123

On lighter skin, the rash often looks red or pink. On darker skin, patches can look pink, slightly purple, lighter or darker than the surrounding skin. Redness is not a requirement. Dandruff, flaky eyebrows or scaling beside the nose can occur alongside the forehead rash, but the appearance alone is not enough to diagnose it.23

Why does seborrheic dermatitis happen?

The cause is not fully understood. Malassezia, a yeast normally present on skin, is thought to contribute through its interaction with skin oils and the skin barrier. Increased sensitivity to fatty acids produced by the yeast can contribute to inflammation. Seborrheic dermatitis is not contagious, and most people who have it do not have an underlying illness.123

Stress, tiredness and cold, dry weather can trigger flares. Some people improve in warm, humid weather. The condition affects babies, teenagers and adults, but infant seborrheic dermatitis is a separate treatment situation. The adult treatment routine below is not suitable for babies.23

Could the forehead rash be something else?

Contact dermatitis, eczema, psoriasis and rosacea can resemble seborrheic dermatitis. Soap or hair dye can cause an irritating rash, while fragrance can trigger an allergic reaction. A reaction can develop even to a product you have used for years. Stopping exposure to the responsible product helps contact dermatitis clear, but identifying that product can be difficult.14

A GP or dermatologist usually diagnoses seborrheic dermatitis by examining the rash. Tests are not usually necessary, although a skin sample can help when the diagnosis is uncertain. You can also have seborrheic dermatitis alongside psoriasis or rosacea. Write down when the rash appears, what symptoms accompany it and whether it comes and goes before your appointment.23

How to care for your forehead during a flare

Gentle washing and a light moisturizer help support the skin barrier, which is a more useful job description than 'miracle cream'. Moisturizer helps with dryness, but treating the underlying dermatitis is also necessary.25

1. 1Wash the affected skin once or twice daily with a gentle soap free cleanser. Use cooler rather than hot water, and do not scrub the flakes.
2. 2Pat the skin dry with a soft touch rather than rubbing it.
3. 3Apply any prescribed treatment as directed. If you use ketoconazole cream, wait 30 minutes before applying other creams, lotions or ointments to the same area.
4. 4Apply a light, fragrance free facial moisturizer. When you are not separating moisturizer from ketoconazole, apply it within five minutes of washing to help retain moisture.
5. 5Protect your skin from sunlight and cold air. A daily moisturizer containing sunscreen is one option for sun protection.

Avoid trying to exfoliate the rash away. Exfoliation can remove more skin than intended and leave dry skin damaged and irritated. Retinol and astringent toners can also worsen dryness. Choose facial products labeled fragrance free rather than relying on 'unscented', which can still contain irritating fragrance chemicals. If you wear makeup, choose products described as noncomedogenic, meaning they do not block pores.25

Which medicines treat forehead seborrheic dermatitis?

Antifungal creams reduce the amount of Malassezia on the skin. Ketoconazole and ciclopirox are common facial treatment options. Facial treatment courses commonly last 2 to 4 weeks. Ketoconazole cream is used once or twice daily, depending on the medicine instructions and your clinician's advice. Follow those directions rather than increasing applications to speed things up.16

For ketoconazole cream, wash and dry the area, then gently rub a small amount into the affected and surrounding skin. Keep it out of your eyes and mouth; rinse with water if contact occurs. Wash your hands afterwards. Skip a missed application and return to your usual schedule. Using too much or applying it too frequently can irritate the skin.6

For an inflamed flare, a clinician can add a mild steroid cream. Hydrocortisone is one option, used up to twice daily for 1 or 2 weeks when directed. Do not extend the course yourself: prolonged steroid use can cause skin reactions, thinning and visible blood vessels. If frequent treatment is needed, prescription pimecrolimus cream or tacrolimus ointment can be alternatives with fewer adverse effects on facial skin during longer use.14

What if the hairline and scalp are flaky too?

Scalp involvement can need a medicated shampoo as well as facial treatment. Ketoconazole shampoo is commonly used twice weekly for 2 to 4 weeks, followed by once every 1 to 2 weeks for maintenance. NHS directions specify leaving ketoconazole shampoo on for 3 to 5 minutes before rinsing. Follow your particular medicine's instructions, and keep shampoo out of your eyes and mouth.6

Review hair products if the scalp is irritated too. Shampoos, conditioners, gels and hairsprays can aggravate scalp eczema. Fragranced products, including essential oils, can be irritating. Sodium lauryl sulphate can also irritate an affected scalp. Reduce styling products, then reintroduce them individually to identify a problem product. Use a low or warm hairdryer setting rather than hot air, which can dry the scalp and worsen itching.7

How long does it take to clear?

Treatment can reduce itching and lessen or clear the rash. Adults often need ongoing maintenance because the condition can recur. Seborrheic dermatitis can return after treatment stops, so 'clear' and 'cured' are not interchangeable, however convenient that would be for the packaging. A treatment break is sometimes possible if your doctor recommends it; repeated flares need a maintenance plan rather than repeated, extended steroid courses.23

When should you see a doctor?

Arrange an assessment if the diagnosis is unclear, facial redness lasts more than two weeks, or the rash is not improving. Seek help if the skin looks wet and red or itching disrupts daily activities. Avoid scratching: untreated scale can thicken, and scratching can lead to infection. Early treatment also helps prevent the dark spots and patches seborrheic dermatitis can leave on darker skin.345