Sebderm Treatments
Understanding Seborrheic Dermatitis
Seborrheic dermatitis is a common inflammatory skin condition characterized by scaly, red, and itchy patches on areas rich in sebaceous (oil) glands—most often the scalp, eyebrows, sides of the nose, beard area in men, and occasionally the chest or back. While the precise cause remains a topic of ongoing research, the current understanding is that sebderm is linked to an overgrowth of Malassezia yeast combined with individual susceptibility, skin oil composition, genetic factors, and possibly immune response irregularities. The condition can wax and wane, often flaring with stress, seasonal changes, and hormonal shifts.
Given that seborrheic dermatitis can be chronic, many patients seek not just quick fixes but sustainable routines and product regimens that keep flare-ups manageable. Over the years, patients have shared their journeys in online forums, where highly detailed personal experiences abound. Coupled with recommendations from dermatologists and cutting-edge skincare research, this collective wisdom has shaped a broad range of treatments—from antifungal shampoos to gentle cleansing routines and lifestyle adjustments.
Key Treatment Approaches
1. Medicated Shampoos and Cleansers
Active Ingredients That Show Results
• Ketoconazole: One of the most clinically supported antifungal agents. Shampoos like Nizoral (brand widely cited on forums) contain ketoconazole 1% or 2%. Many patients report reduced scaling, decreased redness, and relief from itching after several weeks of consistent use.
• Ciclopirox: Another antifungal agent found in shampoos and creams. Ciclopirox formulations like Loprox Shampoo (popular in some dermatology circles) have shown good efficacy in controlling dandruff and associated inflammation.
• Zinc Pyrithione (ZPT): Commonly found in Head & Shoulders (one of the most frequently mentioned mainstream brands on forums), zinc pyrithione shampoos offer a more accessible and often gentler approach. Many with milder sebderm find them effective enough to maintain remission.
• Selenium Sulfide: Shampoos like Selsun Blue are also often cited on forums. They work by reducing Malassezia growth and also have mild anti-inflammatory effects.
• Coal Tar: Less favored in recent years due to smell and potential irritation, but some individuals swear by Neutrogena T/Gel for persistent scalp scaling. Coal tar helps slow down the turnover of skin cells. Coal tar can also help with eczema and psoriasis.
Forum Insights & Tips
• Many forum users alternate between antifungal shampoos (e.g., Nizoral) and gentler ones (e.g., zinc pyrithione) to prevent the scalp from becoming overly dry or irritated.
• Some prefer leaving the shampoo on the scalp for a few minutes (as directed) before rinsing to increase efficacy.
• Frequent mention of using lukewarm water instead of hot water to avoid further irritation. Personally, I find hot water to be highly irritating as it increases dryness dramatically. The colder you can get the water the better.
2. Topical Steroids, Calcineurin Inhibitors, and Other Anti-Inflammatories
Steroid Creams and Lotions
• Low-Potency Steroids: For facial involvement, dermatologists often prescribe low-potency steroids like hydrocortisone cream. However, forum participants are wary of long-term steroid use due to the risk of skin thinning and steroid rosacea. Steroids are not a good solution for chronic sebderm.
• Scalp Steroids: Solutions like fluocinolone acetonide (e.g., Synalar) or clobetasol solutions (for severe cases) can be applied directly to the scalp. But these are usually short-term measures.
Calcineurin Inhibitors
• Pimecrolimus (Elidel) & Tacrolimus (Protopic): These creams and ointments modulate the immune response without the thinning effects of steroids. While not initially approved for sebderm, many dermatologists use them off-label for resistant facial sebderm. Many forum-goers find them helpful, although they can sting initially.
Other Anti-Inflammatory Agents
• Metronidazole Cream or Gel: Sometimes considered if there’s a rosacea overlap, metronidazole products can reduce inflammation. Forums highlight its gentleness and suitability for sensitive facial skin, but for pure sebderm it’s less commonly the first choice.
• Azelaic Acid (e.g., The Ordinary Azelaic Acid Suspension 10% is frequently mentioned): This agent has mild antifungal activity and is anti-inflammatory, making it a popular option in the skincare community. Many find it particularly beneficial when sebderm affects the T-zone.
3. Antifungal Creams
• Ketoconazole Cream: Matches the shampoo in active ingredient, commonly used for more persistent patches on the face or body. The brand Nizoral Cream is sometimes mentioned in forums, though less commonly available than the shampoo.
• Ciclopirox Cream: Often used on the face or chest. Patients like it because it absorbs well and often reduces redness and scale within a week or two.
4. Natural and Non-Prescription Approaches
Essential Oils and Botanical Extracts
• Tea Tree Oil: A common suggestion in forums is to add a few drops of tea tree oil to shampoo, or use products containing tea tree oil (like Paul Mitchell Tea Tree Special Shampoo). While some find relief due to tea tree’s antifungal and anti-inflammatory properties, others experience irritation if not properly diluted.
• Aloe Vera Gel: Pure aloe vera gel (brands like Seven Minerals or Nature Republic mentioned in some forums) can soothe irritation and redness. It’s gentle, hydrating, and can be layered under more potent treatments.
Oregano Oil
• Oregano Oil’s Antifungal Potential: Oregano oil (often containing high concentrations of carvacrol and thymol) is sometimes mentioned in forums for its potential antifungal and anti-inflammatory properties. Users might mix a few drops of a quality oregano oil (a popular brand in forums is Gaia Herbs Oregano Oil) with a carrier oil—such as jojoba or sweet almond—and apply it gently to affected areas. Alternatively, oregano oil can be consumed orally in capsule form, a method that many find more convenient, though it may take slightly longer to experience its full effects.
• Application Tips and Cautions: Because oregano oil is highly potent and can be irritating, it must be heavily diluted before use (e.g., 1 drop oregano oil per teaspoon of carrier oil). Users who find success typically apply a thin layer once or twice a week and monitor for irritation. Others prefer adding a drop to their shampoo rather than applying it directly to the skin. While some forum members swear by it, clinical backing is limited.
Propolis & Honey Masks
• Raw Honey Masks: A widely discussed natural remedy involves applying raw honey diluted with a bit of warm water to the affected areas. Some users report significant improvement in itch and scale. Research backs honey’s antifungal and soothing properties. This is a time-intensive approach but frequently mentioned as beneficial. Some forum entries call into question whether the honey should be diluted with warm water instead of cold.
• Propolis Ointments: Propolis, a bee product, is also championed by some in forums. While not mainstream, those who use it claim it helps reduce inflammation and scaling.
Dietary and Lifestyle Factors
• Diet: Although the link is debated, some forum participants notice their sebderm flares after consuming high-sugar or high-yeast foods. Reducing processed sugars, increasing vegetables, and incorporating probiotic-rich foods (like yogurt or kefir) can sometimes help calm inflammation from within. Personally, I do think sugar can have a large impact. I think many people who argue that it does not, do not eliminate it fully enough or long enough to see results. Sometimes there can be foods, which we think to be sugar safe, like certain breads that may actually have extremely high sugar content.
• Stress Management: Stress can exacerbate sebderm. Techniques like yoga, meditation, or regular exercise are commonly advised. A calmer emotional state often leads to fewer and milder flare-ups.
5. Barrier Repair and Supportive Skin Care
Choosing the Right Moisturizer
• Ceramide-rich Moisturizers: Products like CeraVe PM Facial Moisturizing Lotion (a forum favorite) are popular choices. They reinforce the skin barrier and can help reduce dryness, a frequent side effect of medicated washes.
• Non-Comedogenic, Fragrance-Free Lotions: Sebderm-prone skin is often sensitive. Brands like Vanicream or La Roche-Posay Toleriane line are frequently recommended in online communities for their gentle and soothing formulations.
Cleansing Approach
• Gentle Cleansers (e.g., Cetaphil Gentle Skin Cleanser or CeraVe Hydrating Cleanser): Over-cleansing and harsh soaps can worsen inflammation. Forums stress the importance of mild cleansers to avoid stripping the skin.
• Frequency of Cleansing: Twice a day might be best for many, with care taken not to overwash. In severe flare-ups, some reduce cleansing to once daily and rely on gentle rinsing.
6. Phototherapy and Other Advanced Treatments
Light Therapy
• Low-Dose UV Therapy: Some clinics offer UV-B therapy for sebderm flares. Patients in forums note that mild sun exposure (while taking sun protection measures) can sometimes improve symptoms. Dermatologist-supervised phototherapy can be beneficial for stubborn cases.
Oral Medications
• Oral Antifungals (e.g., Fluconazole, Itraconazole): In severe, widespread cases, a short course may be prescribed. Patients in forums who’ve tried them say they quickly calm severe flares, but long-term use is generally avoided due to potential side effects and resistance concerns.
• Biologics and Systemics: Rarely used just for sebderm unless severe and unresponsive. In cases where overlapping conditions like psoriasis occur, biologics might be considered. Some patients note improvements in sebderm when treating their other condition, but this remains a more complex scenario.
Demodex-Targeted Treatments
Although Demodex mite overgrowth (often called demodicosis) is not the same as sebderm, it can produce similar symptoms—redness, itching, and scaly skin in oil-rich areas. Demodex mites also thrive in hair follicles (eyebrows, eyelashes, scalp), leading some individuals to suspect or develop overlapping sebderm and demodicosis.
1. Topical Anti-Demodex Agents
• Topical Ivermectin (Soolantra): FDA-approved for rosacea, but also reduces Demodex mites. Some see improvement in “sebderm-like” facial redness when Demodex is the real culprit.
• Topical Sulfur Creams: Sulfur is both keratolytic and anti-parasitic, used off-label to lower mite populations.
• Tea Tree Oil Formulations: Known to kill Demodex with proper dilution. Many forum users apply tea tree oil–based cleansers around the eyelashes or brows.
2. Cleansing Routines
• Eyelid Hygiene: Using tea tree oil foam or special eyelid cleansers can reduce mite overgrowth around lashes.
• Scalp & Face Cleansing: Gentle but thorough washing can help remove excess mites. However, harsh scrubbing can cause more inflammation.
3. Combining with Sebderm Care
• If both Demodex and sebderm exist, an approach that includes both antifungal (for Malassezia) and anti-mite treatments can bring better relief. For instance, a ketoconazole shampoo for scalp plus topical ivermectin for demodex-prone facial areas.
4. Forum Insights
• Some individuals find that persistent “sebderm” does not improve with antifungal regimens alone but significantly improves once a Demodex-focused treatment is introduced. Conversely, overuse of mite treatments can irritate skin, so balancing both is key.
Psoriasis Treatments (When It’s Not Sebderm)
Psoriasis is an autoimmune condition characterized by thick, scaly plaques that can appear silvery or well-defined. Though scalp psoriasis can mimic “dandruff” or sebderm, the treatments are somewhat different, focusing more on immune modulation and slowing skin turnover.
1. Topical Steroids (Mid to High Potency)
• Clobetasol, Betamethasone, etc.: Used on thicker psoriatic plaques. Stronger than those generally recommended for sebderm. Usually applied short term to avoid skin thinning.
2. Coal Tar
• Also used for sebderm, but more commonly associated with psoriasis. Tar shampoos or creams help slow excessive skin cell production. Some find the smell off-putting, but they can be effective for scalp plaques.
3. Vitamin D Analogs (Calcipotriene)
• Slows down keratinocyte proliferation. Often combined with topical steroids for better efficacy.
4. Phototherapy (UV Light)
• UVB therapy can reduce plaque thickness and inflammation in psoriasis. Similar to sebderm, but more often used for widespread psoriatic patches.
5. Systemic & Biologic Treatments
• Methotrexate, Cyclosporine, Biologics (e.g., TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors): For moderate-to-severe psoriasis. Typically not used for sebderm unless there’s significant overlap.
6. Overlap with Sebderm
• Sebopsoriasis: A hybrid presentation where individuals exhibit aspects of both sebderm (greasy flaking in scalp or T-zone) and psoriasis (thicker scaly plaques). Treatments might blend low-potency antifungals with stronger psoriasis-oriented therapies.
7. Forum Insights
• Many who thought they had stubborn dandruff learn it’s scalp psoriasis requiring potent steroid solutions or tar-based products.
• A simple antifungal shampoo may help the itch but not fully resolve thicker psoriatic scaling.
Additional Considerations for Overlapping Conditions
While the focus is on sebderm, it’s worth noting that some patients have rosacea or psoriasis as well. Such individuals often find that products designed for one condition can have either a positive or negative impact on the other. For example:
• Rosacea Overlap: Those with coexisting rosacea often rely heavily on gentle products and may use metronidazole or azelaic acid, which can also help with sebderm’s inflammation.
• Psoriasis Overlap: Potent treatments like tar shampoos or keratolytic agents used for psoriasis can also reduce sebderm scale. However, caution is advised to avoid irritation.
In any case, it’s important to always patch test and introduce treatments slowly, so as to understand their impact on the entire skin ecosystem.
Putting It All Together: An Example Full-Day Treatment Routine
Morning Routine (e.g., 7:00 AM):
1. Gentle Cleanse: Rinse your face with cool water and use a gentle cleanser like Cetaphil Gentle Skin Cleanser. Gently pat dry with a soft towel.
2. Medicated Cream: Apply a thin layer of ketoconazole or ciclopirox cream to affected areas on the face. Let it absorb fully.
3. Barrier Support: Apply a lightweight, ceramide-rich moisturizer (like CeraVe PM). Let it sink in for a few minutes.
4. Scalp Treatment (If Needed): If a flare is active on the scalp, use a medicated shampoo like Nizoral. Gently massage into the scalp, leave it on for the recommended time (usually around 5 minutes), and rinse. Follow with a gentle conditioner on the ends of your hair only, avoiding the scalp to reduce oil buildup.
Midday (e.g., Lunch Break):
• If you’re feeling any discomfort or dryness, lightly mist with thermal spring water spray (like La Roche-Posay Thermal Spring Water) or dab on a thin layer of aloe vera gel.
• Some patients carry small travel-sized gentle moisturizers. If you feel tightness or mild itch, a dab of moisturizer can help.
Evening (e.g., After Work, 6:00 PM):
1. Cleansing: Use a mild cleanser again to remove sunscreen and daily grime.
2. Honey Mask (Optional, Once or Twice a Week): If it’s a “treatment day,” mix raw honey with a small amount of warm water until slightly runny and apply gently to affected areas. Leave on for 20-30 minutes. Rinse gently. This can be done 1-2 times per week as a soothing, natural antifungal treat. On non-honey-mask days, skip this step.
3. Active Treatments: If prescribed a calcineurin inhibitor (like Elidel) for stubborn patches, apply it now. Alternatively, if not using prescription topicals, you might apply a pea-sized amount of azelaic acid suspension to any red, scaly areas.
4. Moisturize: Re-apply your ceramide-rich moisturizer to lock in hydration.
5. Lifestyle Support: If you plan to do a short yoga session or stress-reduction technique, now is a good time. Maybe sip on chamomile tea, as stress reduction can indirectly help your skin.
Before Bed (e.g., 10:00 PM):
• If scalp is very itchy, apply a few drops of a gentle antifungal lotion. Massage in gently.
• Ensure pillowcases are clean and changed regularly, as cleanliness of bedding can impact skin health.
Discussion of Emerging and Less Common Approaches
In forums, some individuals discuss less conventional treatments. While these may lack robust clinical evidence, they’re worth mentioning for completeness:
• Probiotics, Oral and Topical: Some suggest that taking oral probiotics, or using probiotic skincare products, can help balance skin flora. There is limited clinical evidence, but anecdotal reports often mention mild improvements.
• CBD-Infused Topicals: Cannabidiol (CBD) has anti-inflammatory properties. Some patients experimenting with CBD-infused creams or oils report soothing effects. Still, this is more niche and requires more research.
• Changing Haircare Habits: Those with scalp-dominant sebderm sometimes switch to sulfite-free and fragrance-free shampoos on non-medicated days. They might also avoid heavy hair styling products that can trap yeast and irritate the scalp.
The Treatment Cycle
The journey of treating sebderm often involves managing acute flares and aiming for longer remissions. Learning to identify triggers is key whether stress, weather changes, certain foods, or skincare ingredients. Over time, many patients develop a personal treatment regime.
Treatment Cycle:
There are three major parts to the treatment cycle of Sebderm:
Trigger avoidance: identifying any triggers is key in treating sebderm. Treatment can become almost impossible when engaging in activities that trigger flares, such as late night gaming sessions that result in poor sleep.
Treatment of active flare ups: Daily regimens for treating active flare ups should have 3 parts:
An antifungal product to kill the fungus causing the flare up, such as Gaia Herbs Oregano Oil.
A product to help the skin recover from the antifungal treatments such as Bulletproof C8 MCT oil.
An “emergence kit” with product/s that can quickly provide relief on bad days or nights while waiting for the antifungal treatment to start taking effect.
Remission maintenance: After defeating a flare up, it is tempting to continue using the same products on the same cycle. However, after several days of clear skin, aggressive antifungals should be swapped out with gentler products that are easier on the skin. For example, ketoconazol shampoo can be swapped with a tea tree shampoo.
Adjusting and Personalizing Treatment
What works best varies widely among individuals. A product hailed in forums by some might trigger irritation in others. The collective wisdom suggests a process of trial and error, combined with dermatologist guidance, to find the perfect balance. Some tips to consider:
• Patch Test New Products: Test behind the ear or on the forearm before applying widely. This precaution helps prevent major flare-ups.
• One Change at a Time: Introduce new treatments or products gradually, so you can identify what’s helping and what’s not.
• Consistency Over Perfection: A consistent routine, even if simple, often trumps sporadic use of aggressive treatments.
Conclusion
Seborrheic dermatitis treatments run the gamut from medicated shampoos and creams to gentle, supportive skincare and lifestyle modifications. Insights from forums and personal anecdotes complement clinical guidelines, helping patients navigate a multitude of options. By carefully selecting appropriate treatments—be they antifungal shampoos like Nizoral, soothing moisturizers like CeraVe, or natural remedies like honey masks—most individuals can find a regimen that reduces flares, controls symptoms, and improves overall skin comfort.
After finding a personal treatment regime that works for you, It will be important to incorporate the right maintenance protocols and lifestyle changes to prevent flare ups in the future. The less often treatment products are used to combat flare ups, the less likely your sebderm will grow resistant to those products. Given the importance of long term sebderm care, we have a separate article on it.