Reviewed: 11 Seborrheic Dermatitis Treatments. Which Ones Actually Worked

I tried them so you don't have to.

Michelle Veras - Aug 20, 2020

Update (Jan 18, 2022):

This blog post has now helped THOUSANDS of people since it was written almost 2 years ago. I have updated the guide and added new scientific studies that have been published over the years. 

I will continue to update this guide in hopes that continues to help others who are also suffering from seb derm. Please read the whole post before leaving a comment, there’s a good chance your question has already been answered. Thank you for your support and now without further ado…

First and foremost, my sincerest apologies for taking so long to finally publish this. I assure you I’ve read everyone’s messages, and I’m so sorry if I haven’t gotten back to you.

This article took an unbelievable amount of trials and research. A lot more than I expected. I ended up trying over 20 different treatments before coming to the conclusion.

It’s no secret that treating pityrosporum folliculitis is complicated business. I mean seriously, a recent medical paper in 2014 was literally titled “MALASSEZIA INFECTIONS: A MEDICAL CONUNDRUM,” because of how problematic and complex these diseases are becoming.

BUT…. today you will be learning absolutely everything you need to know about how to DESTROY this thing once and for all.

This blogpost is ~13,000 words long, or about 50 pages if this were a book, and references north of 180 studies. Take your time with it. You will learn a lot, and I’ve tried to answer every possible question you might have.

With that said, here’s a list of everything we will be talking about today.

What is Seborrheic Dermatitis?

A f*cking a**hole that’s what! Alright, but seriously…..

Seborrheic dermatitis is a skin disease caused by Pityrosporum Folliculitis a.k.a malassezia folliculitis. This causes an acne-like breakout often accompanied by itchiness that flares most in areas with a lot of sebaceous activity. (1) This includes the t-zone area of face (especially forehead), shoulders, chest, and back.

It’s frequently misdiagnosed as “normal” acne, which is extremely frustrating because this often leads to unnecessary and prolonged treatment with medications like antibiotics that only further exacerbate the condition. (23172)

Like a pair of researchers put it,

“Malassezia (Pityrosporum) folliculitis is a fungal acneiform condition commonly misdiagnosed as acne vulgaris. Although often associated with common acne, this condition may persist for years without complete resolution with typical acne medications.” (4)

And by typical acne medications, they’re even referring to Accutane a.k.a. the most powerful prescription drug available today. Yup, can you believe that? This damn thing is so stubborn that there have been several cases of relapse after courses of accutane. (5)

It distinguishes itself from traditional acne in that it’s fungus not bacteria causing the breakouts.

Particularly, a little son a b*tch called malassezia. This is a genus of fungi that is an ordinary part of the skin’s microbiome (i.e. the healthy bacteria and yeast that live on skin), and is found in an estimated 92% of all people, but for poorly understood reasons becomes pathogenic for select individuals. (678)

It’s a polymorphic, lipophilic microorganism meaning it thrives on the lipid composition of sebum. (9) Or more simply put, it grows in the presence of human skin oil.

“Human sebum is the lipid source these yeasts thrive on because it is a complex mixture of lipids. It contains triglycerides, fatty acids, wax esters, sterol esters, cholesterol, cholesterol esters, and squalene. Sebum is utilized by breaking down triglycerides and esters, into diglycerides, monoglycerides, and free fatty acids.” (10)

This fungi starts causing skin problems when it transitions from the yeast to mycelial phase. If you have no idea what that means, here’s a quick refresher:

Fungi like malassezia have something called a hypha (hyphae for plural), which is collectively known as the mycelium. This is the part of the organism that allows it to grow via asexual reproduction. It does this by absorbing nutrients from its environment. In the case of malassezia, that’s facilitated by the fatty acids in your skin’s oil (sebum).

If you're confused, all you need to know is that Seborrheic dermatitis is caused by a fungal yeast called Malassezia (Pityrosporum) folliculitis. This is an active organism that causes the irritation, flaking, and itchiness you experience on your face, scalp, or other areas.

Seborrheic Dermatitis Skin Conditions

Unfortunately, pathogenic malassezia isn’t limited to just pityrosporum folliculitis. (1011) Research has shown that this fungus may play a role in all the following skin conditions:

And of course…..

Because there is a lot of overlap between all these skin conditions, the treatment guidelines I will list in this blog post for pityrosporum folliculitis can be applied to treat many of the other diseases with success.

Fun fact #1M. furfur is a combination of pityrosporum orbiculare and pityrosporum ovale.

Perhaps you noticed that M. globosa and M. furfur are found in all of the skin conditions above. You’ll want to remember these asswads. For many of us, eradicating these suckers will do the trick and cure us of our skin woes.

NOTE: I say “many of us” because that’s not always true. The pathology of malassezia is very complicated, and varies tremendously according to geographical location and ethnicity. (30)

For example, Iranians with seborrheic dermatitis have very high levels of M. globosa and almost no M. restricta, and M. sympodialis, whereas South Koreans with seborrheic dermatitis show the opposite — predominantly high levels of M. restricta, and M. sympodialis, and a lot less M. globosa. 

The differences in what species cause the problem probably has to do with climate. (31) We will discuss this more later.

Causes of Seborrheic Dermatitis

Like I mentioned above, pityrosporum folliculitis is poorly understood but there are a few predisposing factors that may cause it to flair. Let’s go over them.

There are higher incidences of malassezia folliculitis among patients with diabetes, HIV, Hodgkin’s disease, organ or bone marrow transplant recipients, or those with nutritional disorders, neurotransmitter abnormalities, and immunologic deficiencies. (323334)

Another fairly common way pathogenic malassezia is brought about is through antibiotics! (35) Indeed, prolonged use of broad-spectrum antibiotics (e.g. tetracyclines) can alter the gut microbiota and skin flora causing malassezia to proliferate. (35)

This is something that is especially frustrating because:

  1. As we mentioned earlier, malassezia folliculitis is often misdiagnosed as acne.
  2. Doctors are quick to prescribe antibiotics in the cases of acne despite their subpar success rate and potential side effects like fungal superinfection, gastrointestinal intolerance, and oxidative stress. (3637)

All the more reason you should inoculate yourself with high quality probiotics following your antibiotic use.

And lastly, there have been reported cases of malassezia folliculitis because of obesity, pregnancy, after steroid use, birth control pills, and stress/fatigue. (38394041)

We will discuss this in more detail in the “things to avoid” section, but in short many skincare products, high humidity, hot weather, sweat, and excessive occlusion can cause malassezia skin conditions to get worse.

Fun fact #2: pityrosporum folliculitis coexists in 56% of acne patients in the Philippines, which is probably has to do with the hot and humid environment over there. (42)

The Philippines is also number 2, in terms of region that searches the word “acne” the most on google. :'( Stay strong my Filipino brothers and sisters!

Seborrheic Dermatitis. How to tell if you have it?

Have you tried many acne medications with no success? Are you an adult wondering why the hell you still have acne? Do most skincare products cause you to breakout? DO YOU EVEN REMEMBER WHAT IT FEELS LIKE TO BE PIMPLE-FREE?

(I feel like I’m doing an awful infomercial here….)

If you answered yes to any of these questions CALL 1-800-555 — okay, I’m kidding. :p But seriously, those are all a couple of warning signs. Let’s break them down.

Firstly, if you’re an adult with acne this should give you food for thought. I mean, one of the first papers ever published on this subject (1985) was literally called, “pityrosporum folliculitis: a common disease of the young and middle-aged.” As in teen-young and adults.

More recent papers have confirmed this is quite common among young adults (20s and 30s), (43) and one study found that 30 year olds had significantly more species of malassezia than any other age group over 40. (44)

The more obvious signs that you have it include acne-like bumps on the face (especially t-zone), back, chest, and shoulders which are sometimes accompanied by itching.

These “pimples” are incredibly stubborn and don’t respond to typical acne medications. They’re usually in the form of papules and pustules (i.e. no cystic acne), and when extracted the material is white/yellow.

IF YOU NEED A VISUAL HERE’S A GOOGLE SEARCH.

Another tale-tell sign is if you breakout out from literally EVERYTHING. Creams, moisturizers, toners — it doesn’t matter they’re all the same: a oneway trip down breakout boulevard. And don’t even get me started on sunscreens….

And that’s really it. Besides a couple warning signs and looking at photos on google and comparing things visually, there’s only so much you can do at home unfortunately. :/

The best way to know for sure is by getting a proper diagnoses. This is usually done through a shave biopsy in one of the areas where it flares most (i.e. upper back, chest, shoulders, scalp, or t-zone area of the face). (45)

However, even this has limitations and might come out negative because it reveals what yeast are on the surface of skin (i.e. stratum corneum) rather than within the follicle where it’s most present. If you can, tell your doctor to extract a pustule with a comedone extractor and examine its contents under a microscope.

The most accurate way would be having a microbiologist extract a comedone and analyze the DNA using a real-time PCR system and a quantitative PCR reagent. (190193) But most of us have to just use what we have access to.

What to avoid if you have Seborrheic Dermatitis

And this is where things get depressing because there’s a lot we need to steer clear of….

Fatty acids and Oils.

Unfortunately malassezia feeds on fatty acids with carbon chain lengths 12-24. (464748)

Source: Wilde, P. F., and P. S. Stewart. 1968. “A study of the fatty acid metabolism of the yeast Pityrosporum ovale.” Biochem. J. 108225–231.

This means that most skincare products available today (I’d say over 95% of them) are problematic because they almost always contain a variation of a fatty acid that will feed malassezia.

Keep in mind that oils also contain fatty acids, usually in the from of triglycerides. Unfortunately, malassezia is quite the practical fella and has enzymes (lipases and phospholipases) that can hydrolyze triglycerides into free fatty acids. (49) In other words, it can break down the fatty acids in oils and use them to grow. This has been demonstrated in many studies.

Let me say that again because it bares repeating: if you have pityrosporum folliculitis you must avoid most oils and fatty acids. I say “most oils” because there are 3 that we can use (more about this in the next section).

To have it handy, here’s a list of the main 11-24 fatty acids you need to steer clear of.

Source: M. Nazzaro Porro, S. Passi, F. Caprilli, P. Nazzaro, G. Morpurgo. 1975. “Growth Requirements And Lipid Metabolism Of Pityrosporum Orbiculare.” Institute of Dermatology, St. Gallicano, Rome, Italy.

Esters.

Ah, esters…. I’ve been asked a lot about whether these will feed malassezia. It’s a bit complicated, but the answer is yes. However, it depends on what esters, alcohol moiety, and species of malassezia we’re talking about.

Seriously, as if this sh*t wasn’t complicated enough already…..

Let me try my best to simplify and explain this.

For those that don’t know, esters in skincare are a combination of a fatty acid with an alcohol or glycerol. This is called a fatty acid ester. For example, you can combine palmitic fatty acid with isopropyl alcohol (i.e. rubbing alcohol) and you get isopropyl palmitate — a common ingredient in many moisturizers like the popular Aveeno Daily Moisturizing Lotion.

You can use different types of alcohols for this process. For example, combining ethanol and linoleic acid gives you ethyl linoleate, whereas combining decyl alcohol and oleic acid gives you decyl oleate.

When a fatty acid is paired with glycerin (a.k.a. glycerol) instead of an alcohol you get a glyceride. For example, glycerin plus stearic acid gives you glyceryl stearate.

You can find esters in your skincare products easily because they end in -ATE, like isopropyl palmitate, decyl oleate, glyceryl stearate etc.

NOTE: this is not a hard and fast rule! There are exceptions, but it’s a good rule of thumb.

Make sense? Cool. Now to put it into context.

Turns out that malassezia species can grow with esters, but it depends on what fatty acids and alcohols are present in those esters.

For example, 96 hour culture testing revealed that M. sympodialis grew in the presence of ethyl esters (specifically ethyl linoleate and ethyl oleate), whereas M. furfur (a species that causes pityrosporum folliculitis) only grew with ethyl linoleate. (52)

Moreover, some alcohols are worse than others. To quote a paper:

“Depending on the inoculum, yeast-dependent hydrolysis [by M. furfur] occurred immediately and was best effected in ethyl esters, followed by isopropyl esters, whereas hydrolysis of decyl oleate was only limited.” (53)

What does all this mean?

So what the hell does all this mean for us? That there are a lot of skin care ingredients that feed the yeast which in turn causes Seborrheic dermatitis!

If only there was a way to tell which products are safe for Seborrheic skin and which may be causing the irritation on your face. Voila, I tested over 20 different treatments so you don't have to. Here are my findings listed in the order in which I tried them.

1. Nizoral

To my dismay, my Seborrheic Dermatitis occurred on my scalp, face, and eyebrows. It was a real nightmare to deal with. The first thing I tried was Nizoral, which was recommended to me by a friend. The primary ingredient is Ketoconazole which has been shown to be effective in killing Seborrheic Dermatitis causing yeast; however, it does not work on the face, and I wouldn't recommend anyone applying shampoo over their face. Yeast may also grow resilient against Ketoconazole, so it is not a long term solution

Effectiveness: 

Long Term Solution: No

Conclusion: Nizoral works if you have mild symptoms and they only occur on the scalp. It is not a long term solution.

LINK TO PRODUCT

2. Dermoscribe Seborrheic Dermatitis Cream

Stay away from this one! This is one of the best selling seb derm creams on Amazon. If you take a look at the ratings, you'll realize why there are so many complaints. This is a steroid. That means it is just a temporary solution. You never want to apply steroids to your skin for prolonged periods of time. Do yourself a favor and skip this one.

Effectiveness: 

Long Term Solution: Absolutely NOT

Conclusion: Avoid this cream. It is a steroid and should not be used long term.

LINK TO PRODUCT

3. Dermgentle Seborrheic Dermatitis Treatment Cream

Spoiler Alert, the itchy red flakes on my skin started to clear within 4 days of trying this cream. This cream uses 3 main ingredients. Xylitol - neutralizes the yeast's biofilm, making it vulnerable to anti-fungals. Medium Triglycerides - Anti-fungal that kills the yeast after the biofilm is weakened. Squalane - one of the best moisturizers to repair the skin barrier, and it does not feed the yeast. Best of all, these ingredients are suitable for long term use because the yeast does not build tolerance to them.

If you've tried countless products and had little to no results, you need to try this cream. When I purchased this cream, they had a 60 days refund guarantee, so there's nothing to lose.

Effectiveness: 

Long Term Solution: Yes, the ingredients will continue to be effective long term

Conclusion: Many readers have asked me which product made the biggest difference. I have to say this one, and it worked extremely fast. Jump on this cream if you want a long term solution against Seb Derm.

LINK TO PRODUCT

4. pHat 5.5

Another very popular treatment on Amazon with many poor reviews. I tried the cream, and it didn't seem to do anything. My itchiness remained, but it didn't get worse. There are some very mix results. Some people found that it worked, and others had worsened symptoms. It seems the manuka honey can be a hit or a miss, but this is unlikely to be a long term solution because there isn't anything in the ingredients that actually kills the yeast that causes Seb Derm.

Effectiveness: 

Long Term Solution: No

Conclusion: More of an anti inflammatory. It does not actually get rid of the yeast that causes Seb Derm.

LINK TO PRODUCT

5. Ketoconazole

This was one of the first treatments I tried when I went to the dermatologist for the first time. 2% is prescription only, so you will need to see a doctor to get it prescribed. It worked in clearing the redness a little, but then stopped working after 2 weeks. It seems the yeast developed a resilience to the medication.

Effectiveness: 

Long Term Solution: No

Conclusion: Works if you have very mild dermatitis. Not a long term solution.

6. Noble Formula Pyrithione Zinc 2% Soap

2% Pyrithione Zinc has been shown to be effective in killing the yeast that causes Seb Derm. This bar of soap is too harsh for cleaning the face, but it is a great soap for the body. I use this daily and it has kept the Seb Derm off my body for the most part. Again, do not use this on your face, it will dry you up without fixing the issue. If you need this for the scalp, use is a 2% zinc shampoo.

Effectiveness: 

Long Term Solution: Yes, for the body only

Conclusion: Works well for the body, not for the face. P. Zinc is a viable long term solution.

LINK TO PRODUCT

7. Vanicream Z-Bar

This is another Pyrithione Zinc 2% body bar. It works the same as the Noble Formula soap, except it does not have exfolliating beads. It is a personal preference, but they both work about the same. Do not use on the face.

Effectiveness: 

Long Term Solution: Yes, for the body only

Conclusion: Works well for the body, not for the face. P. Zinc is a viable long term solution.

LINK TO PRODUCT

8. Selsun Blue 1% Selenium Sulfide

Another shampoo, but the active ingredient is Selenium Sulfide 1%. Studies have shown that this works against Seb Derm causing yeast, however, it is very harsh on the skin. When I tried it, my skin broke out. There are also concerns about hair loss. I would stick to a Zinc shampoo instead.

Effectiveness: 

Long Term Solution: No

Conclusion: Too harsh on the skin, however it does work in killing Seb Derm.

LINK TO PRODUCT

9. Dermazen Calming Serum / Moisturizer

This product comes as a serum and moisturizer. I ordered both. The ingredients seemed to work well on paper, but I think there was simply too many active ingredients at once. Silver, MCT Oil, Aloe, Tea Tree Oil, MSM, Niacinamide, the list goes on. Although these ingredients do not feed the yeast, many of them are strong irritants. If you're suffering from Seb Derm, your skin is most likely already irritated. You need to heal your skin before working in ingredients like niacinamide.

Effectiveness: 

Long Term Solution: Yes, if your skin can tolerate some of the harsh ingredients

Conclusion: Ingredients sound good on paper, but many of them may irritate your skin. I immediately felt a stinging feeling when I applied it to my red areas.

LINK TO PRODUCT

10. Head and Shoulders Classic

This is probably the most popular item on the list. Most people use it for anti dandruff, and they probably don't even realize that they have Seb Derm. It's not a strong active so it does not help with the Seb Derm on my face at all.

Effectiveness: 

Long Term Solution: Yes, if you have very very light Seb Derm

Conclusion: Not really effective at such low active percentages.

LINK TO PRODUCT

11. Happy Cappy Shampoo

At less than 1% Zinc Pyrithirone, it isn't doing much against Seb Derm. It will help if you have a very mild case. It is also gentle enough for kids.

Effectiveness: 

Long Term Solution: For mild cases

Conclusion: Use it for kids or if you have very mild scalp SD.

LINK TO PRODUCT

Final Thoughts

After much trial and error with all these products, it really comes down the ingredients. Not just the active ingredients, but also inactive ingredients. If you read the post thoroughly, you know that many ingredients may cause Seborrheic Dermatitis flareups because they feed the yeast and further irritate the skin. Therefore, the most effective products have active ingredients that:

  1. Remove the biofilm that protects the Seborrheic Dermatitis causing yeast.
  2. Kills the yeast on your skin
  3. Do not further feed the yeast

Many products on the list either do 1 or 2 of the mentioned, but only one product really does all three. If I had to pick one product to recommend, it would be the Dermgentle Seborrheic Dermatitis Treatment Cream (phew that's a mouthful). It clears the yeast's biofilm with active ingredient Xylitol. It kills the yeast with medium triglycerides, and it does not contain ingredients that feed the yeast. When I tried this cream, it started clearing my seb derm within 4 days, so it does not take long to see the results.

When I purchased the cream, they offered a 60 days refund guarantee, so there's no reason not to give it a try.

That sums up several months worth of studies, testing, and research. I sincerely hope this post helps you as much as it has helped thousands of others on this grueling journey for clear skin.