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Seborrheic Dermatitis Severity: When To See a Doctor

Medically reviewed by Raj Chovatiya, MD, PhD, MSCI
Written by Joan Grossman
Posted on June 10, 2024

People with seborrheic dermatitis know it can be challenging to control symptoms. And when symptoms persist, it’s hard to gauge your condition’s severity, which means it’s not always clear when it’s time to see a doctor.

Doctors and researchers use certain tools to determine seborrheic dermatitis severity. So far, these tools are mainly used in medical research and clinical trials. If your seborrheic dermatitis is affecting your quality of life or your current treatments aren’t working, it may be time to make an appointment with a doctor. If you want a more specialized opinion, you may want to see a dermatologist.

“I’m having a terrible flare, waiting for a dermatologist visit. Prior meds are no longer having any effect,” a MySebDermTeam member wrote.

Another member said, “Diagnosed with seborrheic dermatitis years ago, but it stayed dormant until just a few weeks ago. Scalp is totally pink, and I have been controlling the itch with a combo of Scalpicin and prescription clobetasol. Have never gone to a dermatologist for this, but I think it’s time.”

Someone else shared, “I have had inflamed skin/lymph nodes on the scalp for around four months now — along with this, severe itching, sores, and redness all over the scalp, along with flaky scalp and dry skin on ears, etc. I also experience flare-ups on the face, too. I have been to the doctor multiple times, and I am waiting on a dermatology appointment.”

Read on to learn more about how seborrheic dermatitis severity is assessed and how you should decide whether to see a doctor.

How Is Severity of Seborrheic Dermatitis Measured?

Seborrheic dermatitis is a common skin condition in adolescents and adults that occurs in areas of the body that have sebaceous glands, which produce oil in the skin. The exact cause of seborrheic dermatitis isn’t fully understood, but it’s believed to be at least partly caused by an immune system reaction to Malassezia yeast. This type of yeast occurs naturally in skin but is overproduced in people with seborrheic dermatitis.

Other health conditions such as HIV and Parkinson’s disease are also believed to be risk factors for developing seborrheic dermatitis. In infants, seborrheic dermatitis is known as cradle cap, which is usually mild and can be treated with baby shampoo and topical oils.

Symptoms of seborrheic dermatitis such as itchiness, stinging, flaking, and discoloration — which varies among skin tones — can be hard to measure. For one, people with seborrheic dermatitis may experience their symptoms in different ways. Itchy skin, pain, and discomfort can be subjective, meaning they are based on personal experience, and no two cases of seborrheic dermatitis are exactly the same.

To measure severity, medical researchers have developed tools to look at symptoms of seborrheic dermatitis that can be seen on the skin and determine how serious they are. Currently, these methods are used mostly in research and in clinical trials. A health care provider might not use them during your medical visits. Similar tools have been developed for other skin conditions, such as atopic dermatitis (the most common type of eczema) and psoriasis.

Seborrheic Dermatitis Area Severity Index

The seborrheic dermatitis area severity index (SDASI) is a relatively new tool for assessing disease severity, mainly in research settings. It’s designed to evaluate lesions, or inflammation on affected areas of the body.

SDASI is an evaluation tool that looks at these three skin symptoms:

  • Erythema — Discoloration (either purplish or lighter than surrounding skin for darker skin tones and reddish for lighter skin tones)
  • Papules — Raised areas that may look like pimples
  • Scales — Flaking

Each symptom is rated on a scale of 1 to 5, with 5 being the most severe, based on the percentage of skin affected by the symptom. The higher the score, the higher the level of severity.

Based on the total score, a case of seborrheic dermatitis would be assessed as one of the following stages:

  • Absent
  • Mild
  • Moderate
  • Severe

Symptoms that affect more than 70 percent of an area would be considered severe.

A More Detailed Tool for the Face

Dermatology researchers have proposed a more detailed version of SDASI for seborrheic dermatitis on the face. This index evaluates four facial areas, which each make up about 25 percent of the face:

  • Nose and nasolabial folds, which are creases that run from the nose to the corners of the mouth (sometimes called smile lines)
  • Forehead, including eyebrows and upper eyelids
  • Left cheek, including ear, chin, and lower eyelids
  • Right cheek, including ear, chin, and lower eyelids

Each facial region is evaluated by scoring that indicates the severity of these four factors:

  • Percentage of area covered by seborrheic dermatitis, from no visible lesions (mild) to lesions covering 90 percent of an area (very severe)
  • Characteristics of lesions, such as small and scattered (mild) or large and blending together (very severe)
  • Discoloration, from pink (mild) to intense red or purple (very severe), depending on skin tone
  • Scaly skin, from tiny scales (mild) to large, thick, or crusty scales (very severe)

With this index, grading would indicate mild, moderate, severe, or very severe seborrheic dermatitis.

A Scale for Seborrheic Dermatitis on the Scalp

Medical scientists are also testing a severity scale for seborrheic dermatitis on the scalp that would evaluate scalp flaking, total area of discoloration, and itch. With this scale, total points would determine mild (such as dandruff), moderate, or severe seborrheic dermatitis.

In more severe cases, symptoms may include discolored patches or crusting and greasy scales, which may stick tightly to hair.

When Should You See a Doctor?

Of course, you’re not able to personally use these tools to determine the severity of your condition. If your symptoms don’t respond to over-the-counter (OTC) treatments, including topical therapies (medications applied to skin), such as creams, ointments, gels, or medicated shampoos, it may be time to talk with your doctor about other treatment options. If you’re using a prescription medication and it’s not working, you may want to see your doctor to discuss switching treatments.

Depending on the severity of your seborrheic dermatitis, your doctor may recommend a treatment plan that includes OTC or prescription seborrheic dermatitis treatments including:

  • Topical antifungals, such as ketoconazole
  • Topical corticosteroids (steroid), such as fluocinolone (Synalar), alclometasone, and higher-strength hydrocortisone
  • Calcineurin inhibitors such as pimecrolimus (Eidel) and tacrolimus (Protopic), which are immunosuppressive drugs (medications that lower the body’s immune response)
  • Oral antifungal medication in severe cases

With any drug there’s a risk of side effects, which you can discuss in detail with your health care provider.

Home skin care with gentle cleansers, moisturizing lotions, and dandruff shampoo is usually recommended along with medical treatment of seborrheic dermatitis. Your doctor may advise you to look for skin care products and shampoos with ingredients such as:

  • Salicylic acid
  • Coal tar
  • Zinc pyrithione
  • Selenium sulfide

Always get medical advice before using an OTC product for self care for seborrheic dermatitis, and let your doctor know if you have a history of allergic reactions to any substances.

Symptoms May Be From Another Condition

Other skin conditions can look like seborrheic dermatitis and may need another type of medical treatment. Skin diseases such as rosacea and psoriasis can be confused for seborrheic dermatitis.

“My scalp is almost completely covered for three months now. I finally got to the dermatologist yesterday. She told me that I have an overlap of seborrheic dermatitis and psoriasis,” a MySebDermTeam member shared.

Seeing a doctor can help ensure you have an accurate diagnosis. In some cases, your doctor may want to conduct tests such as a skin biopsy to determine the cause of your skin inflammation. With the right diagnosis, you’re much more likely to get the best treatment plan for keeping your seborrheic dermatitis symptoms under control.

Talk With Others Who Understand

MySebDermTeam is the social network for people with seborrheic dermatitis. On MySebDermTeam, more than 12,000 members come together to ask questions, give advice, and share their stories with others who understand life with seborrheic dermatitis.

Do you have questions about when to see a doctor for your seborrheic dermatitis? When do you consider your seborrheic dermatitis severe enough to go to the doctor? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on June 10, 2024
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Raj Chovatiya, MD, PhD, MSCI is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Learn more about him here.
Joan Grossman is a freelance writer, filmmaker, and consultant based in Brooklyn, NY. Learn more about her here.

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