Ask the Pharmacist
by Ron & Marla Chapleau

September 15, 2016


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Q) I have developed these red scaly areas on my scalp and forehead that are super itchy. What do you think this could be and what can I do about it?

A) Judging from the description, this sounds a lot like seborrheic dermatitis (SD), a very common chronic inflammatory skin condition. SD affects somewhere between 1 to 5 per cent of the adult population across both sexes (although it more commonly presents in males) and across all ethnicities.

There is a transient infantile form of SD that tends to both present and resolve within the first 3 to 4 months of life. The most recognizable name from the infant form of this is cradle cap.

For the purposes of this article, we’ll focus on the adult version of the disease. While SD is more commonly seen in those over the age of 50, it may initially show up around the time of puberty.

The course of SD, like so many other diseases is extremely variable. For many, there are only occasional periods when the symptoms flare followed by long periods when the disease appears to have gone away. Other adults unfortunately find their form of the disease to be more chronic with greater and perhaps more severe recurrences.

SD is most often found on various regions of the face and/ or the scalp although it may also show up in the ears, the chest and the genital region. SD appears as ill defined (i.e. not distinct borders such as a hive might have) red patches covered with a fine scale. More often than not these areas are quite itchy.

 The scaling that occurs on the scalp will shed and can often be visibly apparent on darker clothing much like dandruff. In fact, recent evidence seems to indicate that dandruff may in fact be a mild form of SD.

Although why some people get SD is not known, there are 3 factors that seem to play a major role.

The first is increased activity from the sebaceous glands, the small glands in the skin which secrete an oily substance (sebum) in order to lubricate the skin and hair shafts.

The second factor appears to be (this is still a contentious issue amongst researchers) an increase in the numbers of the species of yeast known as Malassezia spp, probably as a result of the increased sebum production which is a food source for these yeast. The yeast feed on the sebum and the resulting by-products created penetrate the skin and result in inflammation.

The last factor is related to the individual’s immune system. Those with impaired ones appear to be more likely to be plagued by SD (for example, patients with AIDS more commonly have severe cases of SD than is found in the general population).

The condition seems to worsen with stress and fatigue and is more likely to flare in cold weather rather than warm. Traditionally diet has not been thought to play a role although some suggest trying a low carbohydrate diet and reducing your use of vegetable oils such as corn oil.

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There is at present no permanent cure for SD so the goal of therapy is to clear the visible signs of the disease, control the itch (if any) and reduce the frequency of flare-ups.

There are a number of therapies that have been proven both effective and safe but the two I tend to suggest for the scalp are the anti-fungal shampoo Nizoral (non-prescription) or Loprox cream (prescription required). Either should be applied twice weekly for a period of 4 weeks to control the condition and then reduced to once weekly in order to prevent relapses. If the scalp is really itchy or the SD is more severe in nature, the use at bedtime of a corticosteroid scalp lotion (such as betamethasone) for the first 1-2 weeks can greatly speed the resolution of symptoms.

For areas on the skin, the Nizoral also comes in the form of a cream (although requiring a prescription) and when applied twice daily will within 1-4 weeks often show significant improvement in the symptoms. Another effective option is Elidel cream but I prefer the first two I mentioned if this is to be used continually as there are concerns about malignancy based upon animal data with Elidel.

Once again, if the course of the SD is severe or rapid resolution is greatly desired the addition of a steroid cream once or twice a day for the first 1-2 weeks can be beneficial. Longer term use of the steroid creams are discouraged due to their potential for numerous adverse effects.


For more information about this or any other health related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and Port Elgin.

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