Seborrheic dermatitis is often misdiagnosed as atopic dermatitis, psoriasis and a myriad of other skin diseases. Not only that, many people, even doctors, don’t really know what is seborrheic dermatitis. Is it a fungal infection? Is it an allergic reaction?
Seborrheic dermatitis is a skin condition that occurs in areas high in sebaceous glands, like your face, neck, upper chest and back, and scalp, resulting in redness, itching and flaking skin. Seborrheic dermatitis is neither a fungus nor a fungal infection but is due to an abnormal immune response to the byproducts of a common yeast that lives on our skin, Malassezia.
Let’s take a deep dive:
What is seborrheic dermatitis?
Seborrheic dermatitis is a skin condition that causes a red, itchy, scaly rash on the scalp, face, and body. It’s a common skin condition that affects people of all ages but mostly affects infants with cradle cap, teenagers and adults between ages 30 to 60 years old.
The most common symptoms are scaling, redness, and flaking on the scalp, face, chest, creases of arm and leg, and groin area. Dandruff is a mild form of seborrheic dermatitis on the scalp.
- overproduction of oil by the oil-producing glands in the skin.
- Malassezia yeast
- immunosuppression e.g HIV and Parkinson’s disease
- a genetic predisposition (others in your family have the same problem)
Seborrheic dermatitis comes and goes but often affects people for life. So far, experts agree there is no known cure for it.
Is seborrheic dermatitis a fungal infection?
Malassezia yeast is thought to play a major role in seborrheic dermatitis. Malassezia proliferates and consumes the dead skin and oils on our skin, producing free fatty acids. These byproducts trigger our immune system to react, causing inflammation on the skin.
Malassezia yeast is a genus of fungi that lives in the bodies of nearly all kinds of animals, including humans. Some studies found that there were higher levels of Malassezia on the skin of seborrheic dermatitis sufferers while others showed similar levels compared to other people.
So, even though the fungus Malassezia is implicated in seborrheic dermatitis, it’s not a fungal infection. Instead, seborrheic dermatitis is an exaggerated immune reaction to a common yeast found on our skin. It’s actually an immune disorder.
Is seborrheic dermatitis a fungus?
Seborrheic dermatitis occurs on oily parts of the skin because Malassezia live off the oils on our skin. It’s usually treated with products that can manage yeast infections, such as those containing tea tree oil, antifungal agents or zinc pyrithione.
Further reading: What is the best antifungal cream for seborrheic dermatitis?
Malassezia is a fungus. It plays a part in seborrheic dermatitis. But seborrheic dermatitis itself refers to a skin condition that occurs due to inflammation triggered by Malassezia.
Unlike fungal infections, seborrheic dermatitis is not contagious and is not an infectious disease.
How do people treat or eradicate Malassezia from their skin?
There are a few ways you can treat or eradicate Malassezia from your skin. As Malassezia is a type of fungus, it can be killed by anti-fungal medications:
- Topical antifungals – These are applied directly to the skin and are available over the counter or prescribed by a doctor. Anti-dandruff shampoo is used for scalp SD.
- Prescription oral antifungals – These are taken by mouth and are only prescribed if other treatments haven’t worked.
You can also discourage growth of Malassezia by reducing sebum overproduction and preventing oily skin. Diet plays a major role in this.
Further reading: What foods trigger seborrheic dermatitis?
Moisturizers that mimic our natural skin oils reduce sebum production and as a result, reduces Malassezia growth. I swear by MooGoo Scalp Cream (it’s not just for the scalp) and it’s the only face moisturizer I use during a flare:
The vast majority of people with seborrheic dermatitis (SD) use topical steroids to treat their condition. Steroids don’t kill Malassezia but reduce the inflammatory response to it. If used for a long time, it can actually promote Malassezia growth and cause other complications.
Topical calcineurin inhibitors, including tacrolimus and pimecrolimus, are also used by some patients to treat SD. These agents inhibit fungal calcineurin activity, which is a property that has been well documented for Malassezia species. In addition, these agents exhibit anti-fungal activity for Malassezia species.
While the efficacy of topical agents could be due to cell-penetrating peptides (though harmless), additional studies are needed to test this hypothesis. Clinical trials are currently underway to determine the efficacy of topical agents in treating SD and erasing Malassezia from the skin.
Does antifungal cream work on seborrheic dermatitis?
Yes, antifungal cream is an effective treatment for seborrheic dermatitis. This type of cream works by inhibiting the production of ergosterol, which is necessary for fungal growth and reproduction. Azoles are the main class of drugs used to treat fungal infections, and ketoconazole is one of these azoles that has anti-inflammatory properties. Ketoconazole was found to be successful in randomized controlled trials when used for scalp dermatitis and other parts of the body. It is available in various topical preparations, including foams, gels, and creams.
Other good topical antifungals that are effective for reducing Malassezia are clotrimazole and miconazole, which is also used to treat skin and groin candida infections.
To wrap up
Due to the big focus on Malassezia and is dubious role in seborrheic dermatitis, the disease can easily be mistaken as a fungal infection. It’s not. And putting all your efforts into erradicating Malassezia and suppressing the inflammation with steroid creams doesn’t treat the disease in the long term. We need to think of SD as an auto-immune disease instead and focus on repairing our immune system.