Seborrheic Dermatitis: Aggravators, Remedies, and the Role of Shaving
Shaving facial hair should be done very carefully if you have seborrheic dermatitis, but there is no evidence that removing facial hair improves the condition. 1
Aggravating Factors for Seborrheic Dermatitis
Environmental and Physical Aggravators
- Cold temperatures and winter weather worsen seborrheic dermatitis symptoms 2, 3
- Stress is a known exacerbating factor 2, 3
- Hot water and excessive heat should be avoided; use tepid water instead 1, 3
- Hot blow-drying of hair can aggravate the condition 1
Product-Related Aggravators
- Harsh soaps and detergents remove natural lipids from the skin surface, worsening dryness 1
- Alcohol-containing preparations increase skin dryness and should be avoided on facial seborrheic dermatitis 4
- Greasy or occlusive creams can facilitate folliculitis development 1
- Topical acne medications (especially retinoids) may irritate and worsen the condition due to their drying effects 1
Behavioral Aggravators
- Skin manipulation increases risk of infection 1
- Rubbing skin dry after bathing (should pat dry instead) 1
- Certain medications may exacerbate seborrheic dermatitis 2, 3
Treatment Remedies for Seborrheic Dermatitis
First-Line Topical Treatments
The most effective approach combines topical antifungal medications to reduce Malassezia yeast with topical anti-inflammatory agents to control inflammation and itching. 4
Antifungal Agents
- Ketoconazole 2% cream is FDA-approved and should be applied twice daily for 4 weeks for seborrheic dermatitis 5
- Selenium sulfide 1% shampoo has demonstrated efficacy alongside ketoconazole 4
- Ketoconazole works by reducing Malassezia ovale (Pityrosporum ovale), though the exact mechanism in seborrheic dermatitis is not fully proven 5
Anti-inflammatory Agents
- Topical corticosteroids are effective but should be low-potency for facial use 4, 6
- Prednicarbate cream 0.02% is recommended for significant erythema and inflammation 4
- Avoid long-term corticosteroid use on the face due to risk of skin atrophy, telangiectasia, and tachyphylaxis 4
- Calcineurin inhibitors (tacrolimus, pimecrolimus) are alternative anti-inflammatory options 6, 7, 8
Newer Options
- Roflumilast 0.3% foam (topical phosphodiesterase-4 inhibitor) is a newly approved noncorticosteroid option showing promise as first-line treatment 7, 8
Skin Care Regimen
Cleansing
- Use mild, non-soap cleansers (pH 5 neutral formulations) with tepid water 1, 4
- Dispersible creams as soap substitutes preserve natural skin lipids 1
- Very mild shampoos for hair washing 1
Moisturizing
- Apply emollients after bathing to provide a surface lipid film that retards evaporative water loss 1
- Hypoallergenic moisturizing creams and emollients should be used once daily 1
- Non-greasy moisturizers with urea or glicerina help maintain skin hydration 4
- Pat skin dry with clean, smooth towels rather than rubbing 1
Scalp-Specific Treatments
- Coal tar preparations (1% strength preferred) reduce inflammation and scaling 4
- Keratolytic shampoos and lotions for thick, scaly areas 6
Additional Therapeutic Options
For Resistant Cases
- Narrowband UVB phototherapy has shown efficacy in open studies for recalcitrant cases not responding to topical therapy 4
- Systemic therapies are reserved for severe or resistant cases 7, 8
Adjunctive Treatments
- Topical polidocanol-containing lotions provide additional relief for pruritus 4
- Antihistamines with sedative properties (cetirizine, loratadine, fexofenadina) can be useful as short-term adjuvants during severe flares with intense pruritus 4
Non-Pharmacological Products
- Zinc PCA, piroctone olamine, hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2, and stearyl glycyrrhetinate in topical formulations have shown effectiveness 2, 3
- These antimicrobial and anti-inflammatory ingredients may speed recovery and prevent flare-ups 3
Shaving and Facial Hair Considerations
Shaving must be done very carefully in patients with seborrheic dermatitis to avoid trauma and secondary infection. 1 However, there is no evidence in the provided guidelines or research that shaving off facial hair improves seborrheic dermatitis outcomes. The recommendation is purely about technique—if you choose to shave, do so gently to avoid skin trauma, which increases infection risk 1.
Common Pitfalls to Avoid
- Do not use topical steroids long-term on the face without dermatologic supervision due to risk of perioral dermatitis and skin atrophy 1, 4
- Avoid neomycin in topical preparations due to sensitization risk 4
- Do not apply moisturizers immediately before phototherapy as they create a bolus effect 4
- Distinguish seborrheic dermatitis from psoriasis, atopic dermatitis, and contact dermatitis, which require different treatment approaches 4
- Look for secondary bacterial infection (crusting, weeping) or herpes simplex (grouped, punched-out erosions) which require specific antimicrobial treatment 1, 4