Often in clinic, I get patients coming in complaining about red patches on their face, in particular around the nose and around the eyebrows. These might be mildly itchy on occasion, and the skin here might be flaky or scaly, but otherwise cause no major symptoms. After looking at their skin, they are often surprised why I go on asking about ‘dandruff’ on the scalp, especially as usually the answer is yes.
The reason is that there is a very common skin condition called seborrhoeic dermatitis (also known as seborrhoeic eczema), which often affects the face with scaly, salmon-red patches, in particular around the creases of the nose and around the eyebrows, but also affects the scalp with bran-like scaling and sometimes itchiness. In addition to this, it can also affect body areas such as the middle of the chest and/or skin folds such as the armpits.
Seborrhoeic dermatitis is a very common skin condition that tends to come and go. The condition can appear at any age after puberty, but tends to flare in periods of stress, general ill-health and in immune-deficient patients. It is caused by an inflammatory reaction to an overgrowth of a yeast-like fungus called Malassezia. Malassezia is a normal part of our skin flora, but patients with seborrhoeic dermatitis seem to be more sensitive to a skin irritating substance this fungus produces.
The good news is that the condition is harmless and non-contagious. However, it is a chronic skin disease, which is unfortunately likely to persist, in varying degrees of severity. It can be kept under control well though with regular use of antifungal creams and shampoos (aimed to reduce Malassezia growth) and intermittent use of anti-inflammatory creams (aimed to reduce the inflammatory skin reaction) on an as needed basis. The skin should be cleansed with a non-soap cleanser such as Cetaphil cleanser.