It’s Seborrheic Dermatitis Season……

That flaky skin on your eyebrows and around your nose, in the crease that runs down the edge of your lips to your chin is probably not dry skin…..SO……
1. Slathering on moisturizer won’t fix it.
2. Using some simple over the counter medicated products can help you control it.

I have simple tricks to control facial seborrhea; this is the advice I give my patients and it’s what I use myself.

Facial seborrheic dermatitis (aka dandruff) is common. Most of us will have it at some point in our lives. Seborrheic dermatitis usually makes its debut in the winter. It often starts as dry white flakes in the eyebrows and then may spread to the skin between your brows. Around the nose you may develop itchy red skin with a greasy scale. This lovely look often progresses down the crease running along the sides of your lips and onto your chin. Your skin may also have a dry scalyness on your nose and cheeks. It’s all seborrheic dermatitis!

Unchecked, facial seborrheic dermatitis will become hard to cover up. It may look better in the morning after you’ve washed your face, but as the day wears on, the scale builds up again. The seborrhea turns redder if you use any irritating skin care products like harsh soaps or antiaging products with glycolic acid, vitamin C or Retin A. Trying to cover up the problem with make-up just makes things look worse because make-up gets stuck in the scales.

Over my years of dermatology practice I’ve found practical remedies for facial seborrheic dermatitis. I’ve helped many patients control their seborrhea and I’ve tried many products on my own skin because I too am bothered by this most anoying rash.

I’ve found simple changes for your skin care regimene that will help you control the scale and redness of seborrheic dermatitis so that your skin looks healthy and clean:

1. I’ll tell you how to pick the right medicated soap for your skin type to help prevent flair ups of your seborrhea.
2. When your skin flairs anyway, I’ll tell you how to treat it with over the counter medicated creams to snuff out the rash.

My next blog entry gives you my specific skin care tips to control your facial seborrhea.

My Seborrheic Dermatitis Series:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp; Tis the Season for Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis-Part 2

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

Itchy, Crusty, Scaly Ears-More on Seborrheic Dermatitis

Dr. Cynthia Bailey’s Tips for Facial Seborrheic Dermatitis Control

If you found this post helpful, you may also want to read:

Chapped Lips: The Remedy Depends on the Cause

Dermatologist’s 3 Simple Steps for Sandal Ready Feet by Spring

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Essential Winter Skin Care; 2 simple tricks to healthy winter skin

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Seborrheic dermatitis (aka dandruff) can involve the ears and is in fact quite common.  My patients with seborrheic dermatitis of the ears often complain mostly about the itching, which can occur on the ear or in the ear canal.  They may also complain about the scaly crust that develops on the front of the ear or behind the crease of the ear.  Lastly, they may actually have such thick crust that they think they have a lesion or growth and come in for me to check it to be certain that it is not a cancer.

Like seborrheic dermatitis on the face and scalp, ear seborrheic dermatitis is treatable but not curable.  That means, you can use medicated soaps, shampoos and creams to control the rash, but it will come back over time.  Scientists don’t know what causes seborrhiec dermatitis and so we don’t know why it flairs up.  I do see much more seborrhea during the winter months and in people who aren’t able to bathe or wash the affected area frequently.  Many of my seborrhea patient’s also note that their rash flairs when they’re under stress, are ill, or when they are eating an unusual amount of fat, carbohydrates or sugar in their diet.

My treatment tips for seborrheic dermatitis of the ears if fairly straight forward.

1. I recommend vigorous and daily washing of the ear skin using a wash cloth and medicated dandruff shampoos or soaps to help prevent a flair up of the rash.
2. If the rash flairs up anyway,  I then recommend using medicated creams until the rash clears.

My detailed treatment instructions are as follows………

Dermatologist Dr. Cynthia Bailey’s Treatment for Seborrheic Dermatitis of the Ears

Maintenance Care to Help Prevent Itching, Crusting and Scaling Ear Skin

1. Wash your ears often (ideally every day) with a thin fiber wash cloth that you can press into the folds of the ear skin and into the crease behind the ear.  Wet the ear first to help soften the skin crust and scale.  Removing the crust and skin scale is important because they further irritate the rash, so scrub vigorously when you wash with the wash cloth.  Thick wash cloths are usually too bulky to get a good scrubbing of the fine ear folds.
2. Use a medicated soap or shampoo to wash your ear skin.  I particularly like the zinc pyrithione products.  My Noble Zinc Soap is the most gentle medicated cleanser that I know of for sensitive skin and it delivers the maximum level of zinc pyrithione to the rash.  For oily skin, OTB Medicated Cleanser #2 cleans and lifts oil while also delivering the maximal level of zinc pyrithione. You could also use one of the other dandruff shampoo or soap products that I recommended in my Nov. 5th blog post on Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis.   For really stubborn ear seborrhea, rotate at least 3 active medicated ingredients just as I recommend for scalp seborrhea.
3. You can expect periods of remission from your seborrhea, and you can quit treating your ears during these times.  The minute you notice any itching, scale or crust on your ears, get your medicated products out and start washing your ears as I outlined above to help snuff out the seborrhea fast.  Treat the ears until they clear up plus at least a month.  It’s also a good idea to start this treatment when you expect the rash to flair up, like during the holidays, when seborrhea seems to be at its worst.

Treatment of Itching, Crusting and Scaling Ear Skin

If washing your ears with the wash cloth and medicated products that I mentioned above doesn’t entirely control your ear seborrhea, then you can try to clear the scale, crust and itching with medicated creams.

1. First try Lotrimin cream (the generic name is clotrimazole cream) applied twice a day to the involved ear skin.  You can gently apply a thin layer to the entrance of the ear canal with a Q-tip type cotton applicator, but do not put the cotton applicator down into the ear canal.
2. If the Lotrimin does not begin to work within a few weeks, you can add 1% hydrocortisone cream after the Lotrimin application.  Apply a thin coat of one then the other twice a day. The cortisone cream should not be use for extended periods of time because it can thin the skin, so if the rash doesn’t clear up within a month you should see your doctor.

Important health precautions for your ears:

1. Your ear canal may contain germs that are different than the rest of your skin.  These germs can cause unusual and hard to treat infections of the ear skin.  Because of this, it’s important not to damage the skin by vigorously scratching, even though the skin itches.  I’ve seen desperate people try to scratch the itch inside the ear canal by putting pointed objects into the ear canal (like ink pens), damaging the skin and getting a roaring infection.  Of course….. DON’T STICK SHARP OBJECTS IN YOUR EAR CANAL TO SCRATCH THE ITCH!
2. Ears get skin cancer and other unusual cancerous and noncancerous tumors.  If you think you have crusting and scale from seborrhea, but the problem persists despite the over the counter treatment that I recommended above, you need to see your doctor, a dermatologist or ear/nose/throat specialist and have the problem evaluated.

My Seborrheic Dermatitis Series:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp; Tis the Season for Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis-Part 2

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

Dermatologist’s Tips for Treating Facial Seborrheic Dermatitis: It Looks Like Dry Skin, But It’s a Rash!

Dr. Cynthia Bailey’s Tips for Facial Seborrheic Dermatitis Control

If you found this post helpful, you may also want to read:

Chapped Lips: The Remedy Depends on the Cause

Dermatologist’s 3 Simple Steps for Sandal Ready Feet by Spring

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Essential Winter Skin Care; 2 simple tricks to healthy winter skin

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Photo Attribution: > / <a rel=”license” href=”http://creativecommons.org/licenses/by/2.0/”>CC BY 2.0</a></div>

Sometimes medicated shampoos alone aren’t strong enough to clear stubborn  scalp dandruff.  If your scalp just doesn’t clear after you’ve diligently rotated through the medicated shampoos as I described in my last post, then it’s time for more intensive scalp treatments and medicated leave-on products.

Topical Leave-on Medicated Products for Scalp Dandruff

For stubborn dandruff, or faster relief than using medicated shampoos alone you can apply leave on products to the affected areas.  Non prescription medicated options include hydrocortisone and salicylic acid liquids.  Typically you use these products twice a day until your scalp clears.  Remember to follow the directions on the product labels.  Product options:

1. Scalpicin Maximum Strength with 1% Hydrocortisone
2. Scalpicin with 3% Salicylic Acid

Your doctor can prescribe stronger cortisone products if your scalp seborrhea won’t clear with these non prescription options.

Intensive Scalp Treatments for Thick Scale and Stubborn Dandruff

If you have stubborn plaques of really thick scale you can loosen them with oil treatments or P&S liquid.

1. Oil Treatment:  Slightly warm mineral oil in the microwave (of course be careful not to heat it to the point that it burns your skin!).  Apply the warmed oil to the scalp plaques for 30 minutes under a towel.  Comb the plaque to loosen the scale then shampoo your scalp to remove the oil.  Use your medicated shampoo as your last lather as directed above.
2. P&S Liquid: Apply the liquid to the scalp plaques and cover with a shower cap for 8 hours.  Then shampoo your scalp as I describe above.

Please remember that if your scalp does not improve you should see your doctor to be certain that you don’t have some other more unusual reason for an itchy and scaly scalp.

My Seborrheic Dermatitis Series:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp; Tis the Season for Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis-Part 2

Itchy Crusty Scaly Ears; More on Seborrheic Dermatitis

Dermatologist’s Tips for Treating Facial Seborrheic Dermatitis: It Looks Like Dry Skin, But It’s a Rash!

Dr. Cynthia Bailey’s Tips for Facial Seborrheic Dermatitis Control

If you found this post helpful, you may also want to read:

Chapped Lips: The Remedy Depends on the Cause

Dermatologist’s 3 Simple Steps for Sandal Ready Feet by Spring

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Essential Winter Skin Care; 2 simple tricks to healthy winter skin

Making Sense Of The Vitamin D Dilemma And Sun Exposure

There are tricks to getting the best results from your dandruff products. As I mentioned in my last post, scalp dandruff is common and most people misinterpret the scale and itch as ‘dry scalp’. The scalp isn’t dry, it has a rash and medicated shampoos deliver the medicine necessary to treat the problem.

Here are the instructions that I give my seborrheic dermatitis patients in my dermatology office:

Dr. Cynthia Bailey’s instructions for using medicated dandruff shampoos:

Shampoo Instructions

1. Try to shampoo as often as possible. Initially, you may want to shampoo every day until your scalp is controlled. Remember, shampooing delivers medicine to the scalp skin and it also helps to remove the oils and scale that contribute to seborrheic dermatitis.
2. Lather and rinse your hair twice with each washing.
   1. Each lathering needs to reach down to the skin of your scalp. Evenly cover the skin with suds and rub or scruff them into the scalp using your finger tips or a scalp scrubber (little plastic brush-like things that are inexpensive and available at drug stores)
   2. Use a non-medicated shampoo for your first lather to clean dirt, oil and hair care products from your scalp and hair.
   3. Use your medicated shampoo for your second lather and allow the shampoo to stay on your scalp for about 5 minutes before rinsing.
3. You can follow up with conditioners or the other hair care products that you like to use.
4. Rotate your medicated dandruff shampoo active ingredients. Use a different type of medicated ingredient each time that you shampoo. Your scalp gets used to one ingredient and you need to keep rotating through at least 3 different ones. This phenomenon is called tachyphylaxis and it’s why medicines sometimes quit working.
5. Continue using your medicated shampoos until your scalp is controlled plus at least a month. If you stop too soon, the dandruff comes back faster than if you really chase it away with persistent treatment.

Many medicated shampoos are harsh to your actual hair shafts. If you have fine or fragile hair then take care to only apply the shampoo to your scalp skin. There’s no need to lather up the full length of your hair shafts because you cleaned them with your first, non-medicated shampoo product.

Medicated ingredients in dandruff shampoos

Over the counter medicated shampoos basically boil down to 5 different ingredients. When your staring at the shelf of dandruff products in your drug store, realize that there are really only 5 choices. Pick the ones with the highest concentration of active ingredients (noted below in parentheses). You should pick at least 3 different active ingredients and rotate the products.  The product ingredients are:

1. Zinc Pyrithione: I really like this ingredient. I find it to be gentler on my fine hair than the other dandruff medicines. My OTB Medicated Cleanser #2 for Back Acne (with 2% Zinc Pyrithione) works beautifully as a shampoo and it’s what I use. Another of my favorite product is DHS Zinc Shampoo (2% ). Other zinc pyrithione options include the many Head and Sholders products (1% ), Zincon (1%), Herbal Essences No Flakin’ Way Pyrithione Zinc Anti-Dandruff Shampoo (1% ), Neutrogena T-Gel Daily Control Dandruff Shampoo (1% ) and ZNP soap (2% ) which lathers nicely on the scalp in spite of being a bar soap.
2. Salicylic Acid with or without Sulfur. These medicines are also fairly gentle on fine or treated hair. Products include Denorex Extra Strength (3% sal. acid), Selsun Blue Naturals (3% sal. acid), DHS Sal Shampoo (3% sal. acid), Neutrogena T/Sal Therapeutic Shampoo (3% sal. acid), P&S Shampoo (2% sal. acid), Sebulex (2% sulfur, 2% sal. acid).
3. Ketoconazole. This is an antifungal product that used to be a prescription but is now available in half strength over the counter. It’s reasonably gentle on fine hair. The brand name product is Nizoril (1% ketoconazole)
4. Selenium Sulfide: This very effective ingredient has been around for years. It’s a little harsh on fine hair. Products include Selsun Blue (1% ), Head and Shoulders Intensive Treatment (1%)
5. Tar: This ingredients work really well but will yellow light colored hair. It also smells like tar and no amount of perfume can mask that smell in your hair. The tar concentration can be described with different terms. I give the coal tar concentration in parentheses. (Tar is my favorite ingredient for scalp psoriasis, which can look like seborrhea but is much more severe.) Products include Denorex (2.5%), T/Gel Therapeutic Shampoo (0.5%), T/Gel Extra Strength (1%), DHS Tar (0.5%), MG 217 Medicated Tar Shampoo (3%), Tarsum Shampoo/Gel (2%)

Please remember that if your scalp does not improve you should see your doctor to be sure that you don’t have a more unusual reason for having an itchy scalp!

My Seborrheic Dermatitis Series:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp; Tis the Season for Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

Itchy Crusty Scaly Ears; More on Seborrheic Dermatitis

Dermatologist’s Tips for Treating Facial Seborrheic Dermatitis: It Looks Like Dry Skin, But It’s a Rash!

Dr. Cynthia Bailey’s Tips for Facial Seborrheic Dermatitis Control

If you found this post helpful, you may also want to read:

Chapped Lips: The Remedy Depends on the Cause

Dermatologist’s 3 Simple Steps for Sandal Ready Feet by Spring

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Essential Winter Skin Care; 2 simple tricks to healthy winter skin

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Normally your scalp shouldn’t itch!

The most common cause of an itchy scalp is seborrheic dermatitis, also called dandruff.  Dandruff may or may not be accompanied by scaly skin and a red rash.

You can have seborrheic dermatitis any time of year, but I see a lot more seborrhea when the weather turns cold.  It’s early fall and I’m just starting to notice more patients with active scalp seborrhea.  The holiday season really gets seborrhea going so now is the time to start working to prevent a big flair up.

Patients with seborrheic dermatitis usually think that they have ‘dry scalp’ and start changing shampoos or shampoo less often.  This doesn’t work because seborrhea is not due to dry scalp, it’s actually a rash, and the more often you shampoo the better your dandruff is controlled.

Treatment for seborrhea of the scalp is aimed at delivering medicated ingredients to the involved scalp skin by using medicated shampoos. These products leave a layer of medicine on the skin after you rinse off the lather.  It’s important to know how to properly use medicated shampoos in order to get the best results.  In my next post I’ll teach you how to pick  really effective medicated dandruff shampoos and I’ll give you the detailed instructions that I give my patients with scalp seborrheic dermatitis.

My Seborrheic Dermatitis Series:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp; Tis the Season for Seborrheic Dermatitis

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis-Part 2

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

Itchy Crusty Scaly Ears; More on Seborrheic Dermatitis

Dermatologist’s Tips for Treating Facial Seborrheic Dermatitis: It Looks Like Dry Skin, But It’s a Rash!

Dr. Cynthia Bailey’s Tips for Facial Seborrheic Dermatitis Control

If you found this post helpful, you may also want to read:

Chapped Lips: The Remedy Depends on the Cause

Dermatologist’s 3 Simple Steps for Sandal Ready Feet by Spring

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Essential Winter Skin Care; 2 simple tricks to healthy winter skin

Making Sense Of The Vitamin D Dilemma And Sun Exposure