Seborrhoeic Dermatitis on the Face: Flaky Red Patches by the Nose and Eyebrows

Flakes in the eyebrows. A red, slightly greasy patch in the fold beside the nose that peels no matter how much moisturiser you use. Dandruff in the beard. If these come and go, especially in winter or during a stressful month, the likely cause is seborrhoeic dermatitis.

It’s one of the most common rashes a dermatologist sees. It isn’t dangerous and it isn’t about hygiene, but it is persistent, and the wrong creams can make it worse.

What it looks like

• Flaky, scaly patches that may look slightly greasy or yellowish.
• Redness on lighter skin; on brown skin the patches are often paler than the surrounding skin, or pink-brown, with fine scale.
• Mild itch or burning, sometimes none.
• Usually on both sides of the face, in the oil-rich areas:
  • the folds beside the nose and around the nostrils;
  • the eyebrows and the skin between them;
  • the beard and moustache;
  • the hairline, in and behind the ears;
  • the eyelid margins, with crusting at the lashes.
• Often dandruff on the scalp at the same time; sometimes patches on the chest or between the shoulder blades.

Why it happens

The exact cause isn’t fully understood. A yeast called Malassezia, which lives on everyone’s skin and feeds on skin oil, plays a part: in some people, the skin reacts to it with inflammation and faster shedding of the outer layer, which shows as red, flaky patches.

It’s more likely and tends to flare with:

• stress and lack of sleep;
• cold, dry weather (many people are better in summer);
• harsh soaps, hot water and alcohol-based products;
• sweat left on the skin;
• illness, and some conditions that affect the immune or nervous system.

It isn’t caused by dirt, diet or an infection you catch from someone.

What helps at home

Based on the American Academy of Dermatology’s self-care advice:

1. Wash gently, twice a day, with lukewarm water and a fragrance-free, non-soap cleanser. A cleanser with zinc pyrithione suits some people. Rinse well; leftover cleanser can trigger a flare.
2. Moisturise with a light, fragrance-free moisturiser after washing.
3. Choose alcohol-free, fragrance-free products, including sunscreen and makeup. A mineral sunscreen (zinc oxide or titanium dioxide) is often well tolerated.
4. Beard and moustache: wash the area with an anti-dandruff shampoo (for example one with ketoconazole) a few times a week, leave it on for a few minutes, then rinse. Some men find shaving the area keeps it clear.
5. Treat the scalp too. Dandruff and facial patches go together; see our oily scalp and dandruff guide.
6. Don’t scrub or pick the flakes. It irritates the skin and, on brown skin, can leave darker or lighter marks.
7. Start early. Treat a flare as soon as it begins, rather than waiting for it to spread.

What to avoid

• Steroid creams without a prescription, and “three-in-one” combination creams. They calm the redness for a few days, then thin the skin and cause rebound flares and bumps. See steroid creams on the face.
• Home remedies such as lemon, raw onion or vinegar, which irritate inflamed skin.
• Heavy oils on the face: the yeast feeds on oil, so they may make patches worse for some people.

Is it seborrhoeic dermatitis or something else?

• Psoriasis gives thicker, sharply edged, silvery patches and often affects the elbows, knees or nails too. See psoriasis and eczema.
• Perioral dermatitis is a rash of small red bumps around the mouth and nose, often after steroid creams; see perioral dermatitis.
• Rosacea causes flushing, redness and bumps on the central face, usually without flakes in the eyebrows.
• Contact dermatitis follows a new cream, hair dye or cosmetic and is often itchier.
• Fungal infection (tinea) spreads in a ring with a raised edge and needs a different antifungal plan; see monsoon skincare.
• Pale patches on children’s faces can also be pityriasis alba, a mild, dry eczema.

When to see a dermatologist

See a dermatologist if:

• the patches don’t settle after a few weeks of gentle care;
• they’re spreading, very itchy or weeping;
• the eyelids are involved;
• you’ve been using steroid creams and the skin flares when you stop;
• you aren’t sure what the rash is, or it looks different from the usual pattern;
• it suddenly becomes severe, which is worth a general health check.

How a dermatologist treats it

At the consultation, the doctor confirms the diagnosis by examining the skin, often with a dermatoscope, and rules out look-alikes. Treatment usually combines:

• Antifungal creams (such as ketoconazole) applied daily for a few weeks.
• A mild anti-inflammatory cream for short flares, or a non-steroid cream (a calcineurin inhibitor) where the skin is thin or flares often.
• Medicated shampoos for the scalp and beard, then once or twice a week to keep flares away.
• Tablets occasionally, for widespread or stubborn cases.
• A maintenance plan: what to use when the skin is clear, and what to restart at the first sign of a flare.

Seborrhoeic dermatitis is one of many everyday conditions we see in skin specialist consultations in Rajkot.

The short version

Seborrhoeic dermatitis gives flaky, red or paler patches in oily areas: beside the nose, in the eyebrows, beard, hairline and behind the ears, often with dandruff. It isn’t contagious or about hygiene; a skin yeast and the skin’s reaction to it are involved, and it flares with stress and dry weather. Wash gently, use light fragrance-free products, treat the scalp and beard with an anti-dandruff shampoo, and avoid steroid creams you haven’t been prescribed. A dermatologist can confirm it and set up a simple plan that keeps it under control.