Why do we have seborrheic dermatitis?

Seborrheic dermatitis is an inflammatory skin condition characterized by redness, scaling and sometimes itching in areas of increased sebum production, typically the scalp, around the nose, eyebrow area, ears, chest and upper back. Dandruff” is the name given to seborrheic dermatitis affecting the scalp.

The overgrowth of certain fungi normally present on the skin induces an inflammatory response leading to the formation of eczema, with scaling and itching. It is not an infection as such, since we are not talking about pathogenic fungi but fungi that are part of the normal flora, but when the balance between this flora and our immune system is lost, eczema appears. All conditions that increase seborrhea and affect the immune system make the condition appear or worsen. Thus, stress, which increases sebum production and also alters immunity, is a common trigger. Disordered lifestyles, poor nutrition, etc. are forms of stress. Genetics, as in almost all chronic diseases, plays a fundamental role.

Treatment will depend on the severity. In mild cases, the use of cleansing gel for the face and shampoo for the scalp with active ingredients such as zinc pyritone or piroctone olamine and moisturizing with specific creams also containing these compounds and seboregulators and soothing agents. When this is not sufficient, the use of low or medium potency corticosteroids for flare-ups and/or calcineurin inhibitors for maintenance will be the most appropriate treatment.

We must not forget that managing underlying diseases that worsen seborrheic dermatitis is as important, if not more important, than topical treatment and a healthy lifestyle.

We should not use cleansing gels and shampoos that are very detergent because although they eliminate sebum, they irritate the skin more and this favors inflammation. In this regard, it is increasingly common for patients to use homemade soap because they consider it more “natural”, when in reality they are nothing more than artificial products – made by humans – very rudimentary, with a pH usually too alkaline for the skin, and without the refinement of decades of research and refinement that a pharmaceutical laboratory can provide.

Federico Feltes, dermatologist specializing in dermo-aesthetics and laser. HM Sanchinarro Hospital.