Dear Alice,

I have always used moisturizer during winter time because of my dry skin. However, something strange happened last spring. Areas of my face turned reddish as if it were flushed and were slightly puffy. It went untreated for a while as I thought it was only a minor irritation or allergic reaction. After 2 months, as it had not gone away yet, and the condition fluctuated between almost about to heal and starting to puff up, I went to a dermatologist who diagnosed this as seborrheic dermatitis. He said it is something I'll always have if I don't wash my face often and keep it clean. He also said moisturizers are off limits as someone my age (19) would not need it.

That was during the summer and I could live without moisturizer. Also, during that time I found that if I used soaps to wash my face, my skin would start to get red again. I stayed away from soaps, cleansers, and moisturizers for the summer and relied on warm water. Now it is winter. HELP! My face feels like a desert without moisturizer, but any moisturizer I have used irritates my skin. I haven't found any cleanser which doesn't give me immediate bad results either. Can you suggest anything for me to use or explain why my skin is reacting the way it is to anything and everything besides water?

— Winter blues

Dear Winter blues,

As you’ve begun to experience, seborrheic dermatitis often makes people feel uncomfortable in their own skin — especially in cold and dry weather. Unfortunately, its exact cause isn’t well understood, resulting in the vast majority of moisturizers being ineffective for treatment. However, some research suggests that seborrheic dermatitis may be partly caused by excessive proliferation of the yeast Malassezia — a fungus which naturally grows on human skin. This condition causes the skin’s sebaceous glands to kick into overdrive by producing too much sebum which can then lead to dry skin (dandruff) or yellow, oily and inflamed skin. While this is a lifelong condition, a consistent regimen may help you prevent future flare-ups and provide needed relief. That said, given the existing variety of treatment options, speaking with your dermatologist will likely help determine which regimen works best for you!

A bit more before jumping into potential treatment options: This chronic skin condition involves sebaceous- and gland-rich areas of the scalp and face, causing red and inflamed patches of skin which are surrounded by white and scaly layers. Though it most commonly affects infants under three months of age, adults between the ages of 30 and 60 years old, and people assigned male at birth, anyone can be diagnosed with seborrheic dermatitis. Some risk factors for adult onset seborrheic dermatitis include oily skin, a genetic predisposition to it, some form of immunosuppression, certain neurological and psychiatric conditions, or experiencing stressful events or sleep deprivation. For these adults, the symptoms of their dermatitis may include:

  • Mild itching
  • A combination of oily and dry skin
  • Pink, red, thin, scaly, and poorly defined plaques in skin folds on both sides of the face, near the nose
  • Ring-shaped flaky patches on the hairline

As you've noted, it may also flare up more in the winter, as the sun exposure that often happens during other seasons can improve the condition. Despite how unpleasant and frustrating adult seborrheic dermatitis may be, here’s some good news: while most moisturizers may exacerbate your symptoms or simply not provide you with desired relief, there are a variety of treatment options to consider. Options for facial and scalp seborrheic dermatitis include:

  • Medicated shampoos, specifically those which contain ketoconazole, ciclopirox, selenium sulfide, zinc pyrithione, coal tar, or salicylic acid
  • Steroids, such as hydrocortisone creams, to reduce itching and redness
  • Non-corticosteroid topical medications, such as tacrolimus or pimecrolimus. It’s helpful to keep in mind that these usually need to be prescribed and may be more costly compared to other treatment options.
  • Other topical gels, such as two percent ketoconazole, or 15 to 20 percent azelaic acid (the latter of which is also effective at treating acne and rosacea)
  • Oral antifungal gels that have ketoconazole, itraconazole, fluconazole, or terbinafine

Lastly, although your diagnosis is seborrheic dermatitis, it’s worth mentioning that this condition often co-occurs and is exacerbated by other similar skin conditions. These conditions include: psoriasis, atopic dermatitis (eczema), tinea versicolor, and rosacea. Since they may also cause red, itchy, dry, or inflamed skin, you may want to ask your dermatologist about these other conditions as well.

Here’s to putting your best face forward!


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