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 growth of the yeast Malassezia—a fungus which naturally grows on human skin. This condition causes the skin’s sebaceous (oil) glands to kick into overdrive by producing too much sebum (substance produced by the sebaceous glands) 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, there are a variety of treatment options. Consider talking with a dermatologist about trying out different products to figure out which one(s) work best for you! 

Seborrheic dermatitis is a chronic skin condition that causes areas of your scalp and face with lots of glands to get red and inflamed and be surrounded by white and scaly layers. Though it's common in infants (known as "cradle cap"), risk factors for developing seborrheic dermatitis in adulthood can include some form of immunosuppression, certain neurological and psychiatric conditions, recovery from stressful medical conditions (such as a heart attack), or some medications. Symptoms of dermatitis may include: 

  • 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 
  • Skin flakes (dandruff) on your scalp, eyebrows, beard or mustache 
  • Red or discolored (darker or lighter) skin 

List adapted from Mayo Clinic

As you've noted, this condition may flare up more in the winter. This is because the sun exposure that often happens during other seasons (and is often missing during the colder months) can help to improve the condition. It should be noted, however, that extended sun exposure can also increase skin dryness, so it’s recommended that you wear sunscreen as a preventative measure. Sunscreens containing zinc oxide or titanium dioxide may provide the best protection and the least irritation. Despite how unpleasant and frustrating adult seborrheic dermatitis may be, there’s 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, tar, or salicylic acid 
  • Steroids, such as hydrocortisone creams, can 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) 
  • Antifungal gels that have ketoconazole or one percent ciclopirox 

Lastly, although you have been given the diagnosis of seborrheic dermatitis by your dermatologist, it’s worth mentioning that this condition often co-occurs and is exacerbated by other similar skin conditions including psoriasis, atopic dermatitis (eczema), tinea versicolor, and rosacea. Since these other conditions may also cause red, itchy, dry, or inflamed skin, you may want to ask your dermatologist about these other conditions as well. If you are unhappy with the suport that your current dermatologist has provided you, or you feel that your concerns aren’t being addressed the way you had hoped, consider getting a second opinion with a different dermatologist. 

Here’s to putting your best face forward! 

Last updated Apr 21, 2023
Originally published Jan 19, 1995

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