Integrative Dermatology Approaches to Seborrheic Dermatitis: Testing, Diagnosis, and Treatments

Seborrheic dermatitis is a skin condition affecting the skin primarily on the scalp and face, although it can appear all over the body. It’s estimated to affect 5% of people worldwide. However, one form of seborrheic dermatitis, dandruff, affects nearly 50% of the worldwide population. This article will discuss what seborrheic dermatitis is, including its symptoms and causes. We’ll then discuss functional medicine testing that can aid in managing seborrheic dermatitis and integrative dermatology treatments that may help support skin health.

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What is Seborrheic Dermatitis?

Seborrheic dermatitis primarily affects the skin in oily areas of the body and is a chronic inflammatory condition. Seborrheic dermatitis is not contagious and men are more likely to experience seborrheic dermatitis than women. Seborrheic dermatitis can begin at any age, but it is usually found in infants (infantile seborrheic dermatitis) and middle-aged adults (adult seborrheic dermatitis) and presents differently in both groups.

Infantile Seborrheic Dermatitis (Cradle Cap)

Infantile seborrheic dermatitis can be found on the face, scalp, skin creases of the neck, armpit areas, and on the skin covered by diapers. This condition usually appears in the second week of life and lasts until four to six months of age. The rash is generally not bothersome to the child but may look like it is, causing stress for the parents. When infantile seborrheic dermatitis is found on the scalp, it's commonly referred to as “cradle cap,” although if the rash is found anywhere outside of the scalp, we still refer to it as cradle cap. This condition usually resolves on its own.

Adult Seborrheic Dermatitis

Adult seborrheic dermatitis can be found on the scalp, face, and chest, with the face being the most common site of occurrence and the chest the least common. On the face, seborrheic dermatitis is most commonly found in the middle of the face, including the center of the forehead and the inner parts of the eyebrows. It’s also commonly found behind the ear and at the opening of the ear, known as the external ear canal. While this condition may go away on its own, it may become chronic. In those with chronic seborrheic dermatitis, it is common to have periods of flare-ups, especially during the winter and early spring seasons. Fluctuations in hormones are thought to trigger the development of seborrheic dermatitis and can lead to flare-ups.

What is the Difference Between Seborrheic Dermatitis and Eczema?

Eczema is actually a form of Seborrheic dermatitis. In addition to seborrheic dermatitis, there are six other types of eczema, including atopic dermatitis, contact dermatitis, neurodermatitis, dyshidrotic dermatitis, nummular eczema, and status dermatitis. It's also possible that a person can be affected by more than one type of eczema at the same time.

Symptoms of Seborrheic Dermatitis

In adults, symptoms of seborrheic dermatitis can include:

• Rash on the scalp can be dry or oily and will have scales. It will also have pigmentation changes: on darker skin tones, the rash will appear purple, pink, or lighter than the skin color, and white spots can also develop. In those with lighter skin tones, the rash is often red.
• Rash on face can affect a combination of oily and dry areas and some may develop areas of raised patches. The rash can be darker or lighter than their skin color in those with darker skin tones. In lighter skin tones, the rash will be red.
• Blepharitis is inflammation of the oil glands on the eyelids. This may cause itching, and the eyelids can become swollen, discolored, and inflamed.
• Rash around ears that may lead to oozing.
• Rash in the folds of the skin that may become infected
• Flaking skin on the chest, face, or scalp (dandruff)
• Burning
• Itching

In infants, symptoms of seborrheic dermatitis, or cradle cap, can include:

• Rash on the scalp: In lighter skin tones, greasy, scaly patches form that may turn into crusts and can cover the entire scalp and infiltrate the skin on the face. In darker skin tones, the rash will often appear lighter than the natural skin tone or white and will often flake.
• Rash on the body: In lighter skin tones, the rash will appear red and can be dry or greasy. In darker skin tones, the rash can be darker than the natural skin tone, purple or white, and will be flaky.

What Causes Seborrheic Dermatitis?

While we are unsure what exactly causes seborrheic dermatitis, we do know two factors that play a role: yeast and sebum production. Some naturally occurring yeasts live on our skin, and it's thought that seborrheic dermatitis may develop from a reaction to that yeast. Sebum also plays a role as seborrheic dermatitis develops in areas of the body that naturally produce more sebum.

Risk factors associated with the development of seborrheic dermatitis include those with HIV, Downs syndrome, rosacea, psoriasis, lymphoma, anorexia nervosa, depression, other mood disorders, and neurological conditions like Parkinson’s disease and epilepsy. Additionally, those who are recovering from a stroke or heart attack, those with injuries that affect the brain and spinal cord, and those who have received an organ transplant may also be at increased risk of developing seborrheic dermatitis. Lastly, high alcohol consumption will also increase the risk of development of seborrheic dermatitis.

Functional Medicine Labs to Test for Root Cause of Seborrheic Dermatitis and to Help Individualize Treatment Plans

Functional medicine testing for the root cause of seborrheic dermatitis includes hormone testing and comprehensive gut testing.

Hormone Testing

As discussed above, hormone fluctuations can cause or lead to flare-ups of seborrheic dermatitis. Hormones referred to as “androgens” include DHEA, testosterone, and dihydrotestosterone (DHT) and can induce increased sebum production and, thus, may play a role in seborrheic dermatitis. The DUTCH Complete is a dried urine hormone test that evaluates how hormones are metabolized and can tell you if an increase in sex hormones is influencing sebum production or contributing to flare-ups.

Comprehensive Gut Testing

Within the gastrointestinal tract is the microbiome: a collective group of bacteria, fungi, and yeasts that live within the large intestine. The microbiome assists in the digestion and absorption of food, modulates the immune system and inflammatory response, and plays a role in hormone metabolism. Microbiomes exist in other areas of the body, too, including the skin, and it’s thought that these microbes interact. In fact, evidence suggests the gut microbiome can affect the skin microbiome and alter the immune and inflammatory response. Because of this, comprehensive stool testing such as the GI 360 test by Doctors Data is warranted in cases of seborrheic dermatitis. This test provides a complete look at the gut microbiome, showing levels of numerous bacteria, viruses, and fungi found within it.

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Conventional Treatment for Seborrheic Dermatitis

Conventional treatment for adult seborrheic dermatitis can include corticosteroids and antifungals, including dandruff shampoos. These treatments may be over-the-counter or prescription, depending on the severity of symptoms. Antibiotics may also be needed if infections are present.

Complementary and Integrative Medicine Treatment for Seborrheic Dermatitis

Complementary and integrative medicine treatments for seborrheic dermatitis include a balanced, nutrient-rich diet, supplements, and herbs.

Integrative Nutrition for Seborrheic Dermatitis

A study with over 4,000 participants showed that seborrheic dermatitis was inversely associated with fruit intake, meaning that people with high fruit intake had fewer rates of seborrheic dermatitis. Additionally, a “Western diet” characterized by a high intake of potatoes, meat, and alcohol, was associated with higher rates of seborrheic dermatitis in women. Since inflammation plays a role in seborrheic dermatitis, a low-inflammatory diet, such as the Mediterranean diet, may be a good option. This diet emphasizes fresh fruits and vegetables, legumes, minimally processed whole grains, and healthy fats such as olive oil, nuts, seeds, and fatty fish. Eating a diet focused on whole-foods can lead to an increase in immune function and decrease inflammation within the body.

Supplements and Herbs That May Support Seborrheic Dermatitis

There are many supplements that integrative practitioners can use in the management of seborrheic dermatitis.

Myo-Inositol for Seborrheic Dermatitis

Inositols are found in nuts, grains, and fruits and can play a role in regulating hormones. Supplementation with myoinositol specifically has been shown to reduce sebum-promoting androgens, including DHEA and testosterone which may help to decrease sebum production.

Probiotics for Seborrheic Dermatitis

Probiotics are supplements that contain various strains of microbes commonly found in and beneficial to the microbiome. Probiotics are used in gastrointestinal tract diseases, and due to the interaction between the gut and skin microbiomes, they may also be beneficial in dermatological conditions, including seborrheic dermatitis. A study done in the Journal of Beneficial Microbes had 60 adult men with moderate to severe dandruff take either a daily probiotic or placebo for 56 days. Results showed significant improvements in dandruff in the probiotic group as compared to the placebo.

Prebiotics for Seborrheic Dermatitis

Prebiotics are substances that function as food for the microbes in the microbiome. Triphala is a traditional Ayurvedic remedy that consists of a blend of three dried fruits. Triphala is considered a prebiotic, and a study in the Journal of Dermatological Treatment assessed its effectiveness in seborrheic dermatitis, specifically in reducing oil production on the scalp. The study was conducted on 80 participants who were split into two groups. One group received one gram of Triphala twice daily, while the other received a placebo. After eight weeks, the Triphala group showed statistically significant reductions in scalp sebum production as compared to placebo.

Solanum Chryotrichum for Seborrheic Dermatitis

Solanum chryotrichum is a plant belonging to the Solanaceae family. Plants from the Solanaceae family have been used medicinally in Mexico for a variety of dermatological conditions. A study done on over 100 participants assessed the effectiveness of a shampoo containing an extract of Solanum chryotrichum against a standard antifungal shampoo for the treatment of dandruff. Results showed no significant difference in the treatment groups, meaning both had similar success rates, making Solanum chryotrichum extract an option to consider for supporting skin health.

Tea Tree Oil for Seborrheic Dermatitis

Melaleuca alternifolia is more commonly known as “tea tree.” The leaves from the tea tree are the active part of the tree that is used to create tea tree oil. This species is native to the southeast coast of Australia and has been historically used medicinally by the Australian aboriginal people. The Journal of the American Academy of Dermatology published a study that assessed the effectiveness of a shampoo containing tea tree oil against a placebo in the treatment of dandruff. The study included 160 people and was four weeks long. Results showed statistically significant improvements in the tea tree group compared to placebo, with no adverse effects reported, making it a safe option to consider.

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Summary

Seborrheic dermatitis is an inflammatory type of eczema that is relatively common across the lifespan. Infants experience seborrheic dermatitis as cradle cap, a painless condition. For adults, however, seborrheic dermatitis can be bothersome in both appearance and symptoms. Functional medicine labs can help get to the root of seborrheic dermatitis, and integrative treatments may help support symptom management.