Skin care for seborrheic dermatitis on the face

What does facial seborrheic dermatitis look like?

Seborrheic dermatitis commonly affects the eyebrows, hairline, creases beside the nose, inner cheeks and chin creases. The scalp, ears and skin behind the ears can be affected too. Flakes can be white or yellowish, with patches that look oily, dry or scaly. Eyelid involvement can cause scaly blepharitis, meaning inflammation along the eyelid edges. Redness is less obvious in darker skin, so location and flaking matter as well as colour.14

Malassezia, a yeast normally present on skin, is thought to trigger an inflammatory response in seborrheic dermatitis. Skin oil, called sebum, also plays a role. The inflammation disrupts the skin's protective outer layer, allowing moisture to escape more readily. That helps explain why an oily looking rash can still need care for dryness.25

How should you wash and moisturize your face?

Use these gentle care steps to support dry facial skin alongside your treatment. For excess oil, washing twice daily with a mild soap or soapless cleanser can help. A mild cleanser removes excess oil and keeps the face clean, which is a more useful job description than a bottle full of promises.6

1. 1Wash gently with cooler rather than hot water. Avoid rubbing or scrubbing.
2. 2Pat your face dry rather than dragging a towel across the skin.
3. 3Apply moisturizer within five minutes of washing. Use a soft touch.
4. 4In the morning, protect your face from the sun. A daily moisturizer containing sunscreen is one option.

What should you look for in a moisturizer?

Choose a fragrance free product made for the face. Unscented is not the same as fragrance free; unscented products can still contain irritating chemicals. For facial dryness, ceramides help strengthen the protective barrier, while hyaluronic acid helps replenish moisture. These are moisturizing ingredients, not substitutes for treatment of the rash. Moisturizers with these ingredients are available at the drugstore, without turning the bathroom shelf into a luxury goods department.3

Which treatments help the facial rash?

• Antifungal creams, such as ketoconazole, are the main treatment for facial seborrheic dermatitis. They reduce the Malassezia yeast population and are used for both active episodes and longer term control.
• Corticosteroid creams reduce inflammation. They should be used sparingly and for short periods because of possible adverse effects.
• Calcineurin inhibitors are medicines that reduce inflammation without being corticosteroids. They are effective second choice treatments, but are not approved by the US Food and Drug Administration specifically for seborrheic dermatitis.

A dermatologist can tailor treatment to the affected areas and severity. Before starting, ask which areas to treat, how often to apply the medicine, how long to use it and what to continue once the rash settles. Do not extend hydrocortisone use beyond its directions; prolonged use can itself cause a skin reaction.1

Can you use dandruff shampoo on your face?

Dandruff shampoo can be part of a treatment plan for facial seborrheic dermatitis. Ask your dermatologist which shampoo to use and exactly how to use it on the affected skin, rather than treating scalp directions as facial directions. Antifungal creams are the mainstay of facial treatment, so shampoo is not automatically the best choice just because there are flakes.12

Should you exfoliate the flakes?

Avoid scrubbing dry patches or repeatedly exfoliating them. Exfoliation can remove more skin than intended and leave newly damaged skin needing to heal. For dry facial skin, avoid drying products such as astringent toners; retinol can also worsen dryness. Review makeup and shampoo as well as cleanser and moisturizer, because products beyond your skincare routine can contribute to dryness.3

What should you expect from treatment?

Treatment can clear or lessen the rash, itching and swelling, and help prevent flares. Seborrheic dermatitis is a chronic condition, so maintenance treatment is often necessary. Cold, dry conditions and increased stress can make symptoms more severe. Ask for a plan that distinguishes treatment during a flare from maintenance, including when to return if the rash is not improving.25

When should you see a dermatologist?

Make an appointment if facial redness lasts more than two weeks, or if dryness is not improving or itching interferes with daily life. Wet, red patches also warrant medical assessment. A facial rash is not automatically seborrheic dermatitis: contact dermatitis, psoriasis and rosacea can resemble it. If a product is causing irritation or an allergic reaction, avoiding that product is part of clearing the rash. Get help identifying the cause rather than repeatedly adding treatments for an unconfirmed diagnosis.123