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Seborrheic dermatitis on the face: flaking, redness and what helps

Seborrheic dermatitis causes greasy flakes and redness around the nose, brows and scalp. Why it happens, how it differs from dry skin, and treatments with evidence like ketoconazole.

Small dry flakes beside a swirl of white cream and a sprig of tea tree
Illustrative image

01 · The short version

Seborrheic dermatitis is rising in searches, often from people who think they have stubborn dry skin. It shows up as flaky, sometimes greasy patches with redness, around the sides of the nose, eyebrows, hairline, ears and scalp, where it is better known as dandruff.

02 · How it differs from dry skin

  • Flakes are often yellowish or greasy rather than dry and white.
  • It sits in oily areas: nose folds, brows, beard, scalp.
  • Moisturizer alone doesn’t clear it, and it tends to come back.

03 · Treatments with evidence

It can be controlled but not cured, so most people use a treatment when it flares and a lighter routine to keep it away.

  • Ketoconazole 2% cream or shampoo: the best-studied option.
  • Shampoos with zinc pyrithione, selenium sulfide or ciclopirox, which can also be lathered on the face and rinsed.
  • Short courses of mild prescription anti-inflammatory creams for flares.

04 · Skincare that helps

Use a gentle cleanser, avoid heavy oils on affected areas, and choose a light moisturizer. Stress, cold weather and lack of sleep can trigger flares.

05 · When to see a dermatologist

If it spreads, doesn’t improve with over-the-counter treatment, or you’re not sure of the diagnosis, a dermatologist can confirm it. Psoriasis, rosacea and eczema can look similar.

06 · The science

Seborrheic dermatitis is linked to an inflammatory reaction to Malassezia, a yeast that lives on oily skin. That is why antifungal treatments help. A Cochrane review found ketoconazole and ciclopirox more effective than placebo.

07 · What might help

  • Ketoconazole 2% cream or shampoo.well-supported
  • Ciclopirox.well-supported
  • Zinc pyrithione and selenium sulfide shampoos.limited evidence
  • Tea tree oil.insufficient evidence

08 · Insufficient evidence

  • Coconut or other plant oils on affected skin; oils may feed the yeast.
  • Diet changes as a cure.

The Receipt

  1. 01Greasy flakes around the nose and brows are often seborrheic dermatitis, not dryness.
  2. 02Antifungals like ketoconazole are first line.
  3. 03It comes and goes, so plan for flares.

Education, not a diagnosis. If something changes quickly, hurts, bleeds, or worries you, see a dermatologist.

Questions people ask

What causes seborrheic dermatitis on the face?
An inflammatory reaction to Malassezia yeast on oily skin, made worse by stress, cold weather and some medical conditions.
What is the best treatment for seborrheic dermatitis?
Topical antifungals, especially ketoconazole 2%, are the best-studied option. A dermatologist may add a short anti-inflammatory treatment for flares.
Is seborrheic dermatitis the same as dandruff?
Dandruff is a mild form of seborrheic dermatitis on the scalp.
Sources (6)
  1. Okokon EO, et al. Topical antifungals for seborrhoeic dermatitis. Cochrane Database Syst Rev. 2015;(5):CD008138.
  2. Clark GW, et al. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91(3):185–190.
  3. Borda LJ, et al. Treatment of seborrheic dermatitis: a comprehensive review. J Dermatolog Treat. 2019;30(2):158–169.
  4. American Academy of Dermatology. Seborrheic dermatitis: overview.
  5. American Academy of Dermatology. Seborrheic dermatitis: diagnosis and treatment.
  6. DermNet. Seborrhoeic dermatitis.

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