Seborrheic dermatitis is a common skin condition that can affect anyone, regardless of skin color. Some research indicates that it might be more common for African Americans than other groups in the United States. Why is it, then, that a quick internet image search for “seborrheic dermatitis” only shows this skin disorder on white skin?

A lack of representation can make it difficult for people with darker skin to get a diagnosis and find treatment for skin conditions like seborrheic dermatitis. It’s important for people with seborrheic dermatitis to have access to representative and accurate health resources. Knowing how the condition appears on your skin tone can reduce uncertainty and help you advocate for yourself in a medical setting.

This article will explore the symptoms and appearances of this condition on Black skin, potential barriers to diagnosis, and how this might affect treatment options.

Who Gets Seborrheic Dermatitis?

A variety of demographic, health, and environmental factors determine who gets seborrheic dermatitis.

Age

Seborrheic dermatitis affects approximately 3 percent of the global population. It can show up in the teenage years and also appears for adults in their 30s and older. Seborrheic dermatitis is also common in infants, but the risk decreases during childhood.

Other Health Conditions

Many people with other health conditions also have a higher risk for seborrheic dermatitis. For example, 35 percent of people with HIV and most people with AIDS develop seborrheic dermatitis. Parkinson’s disease, congestive heart failure, epilepsy, and alcoholism are also risk factors for seborrheic dermatitis.

Race and Ethnicity

The amount of people with seborrheic dermatitis varies in different racial and ethnic groups. While more studies are needed, early research is shedding some light about seborrheic dermatitis in people of color:

• Seborrheic dermatitis could be more common in African Americans than the rest of the U.S. population. Some research estimates it affects 6.5 percent of African Americans, as compared to only 3 percent of the general population.
• In a study of more than 1,400 patients at one dermatology practice, seborrheic dermatitis was among the top five most common diagnoses for Black patients. It was not in the top five for white patients.
• Scalp seborrheic dermatitis can be worsened by the use of certain hair products (such as hair oil or pomade) and by hairstyles that require infrequent shampooing. Cultural hairstyle trends are one hypothesis for why seborrheic dermatitis may disproportionately impact Black women.

Given that many people of color are affected by this condition, it’s important to understand how it may appear differently on darker skin.

Unique Qualities of Seborrheic Dermatitis on Dark Skin

Seborrheic dermatitis is a common form of eczema that affects the scalp, face, armpits, groin, and other areas of oily skin. It typically causes skin discoloration, itching, and flaking, including scalp dandruff. However, these symptoms can appear differently on darker skin tones compared to lighter skin, making diagnosis and management more challenging.

If you’re a person of color and you think you may have seborrheic dermatitis, keep these additional symptoms in mind.

Darker-skinned adults with seborrheic dermatitis may have temporary hypopigmentation (lightening of the skin) in the areas that are affected.

Redness and swelling may be more difficult to see on darker skin. In fact, the affected areas might not appear red at all.

Petaloid seborrheic dermatitis, also known as flowering dermatosis, usually occurs on dark skin. It appears as pink, raised discs, usually on the face or hairline.

Children of color with seborrheic dermatitis do not usually have the “cradle cap” appearance of children with lighter skin. Instead, they often have flaking, swelling, and light spots on the skin.

Knowing these unique characteristics can help you identify flare-ups and treat them accordingly.

Difficulty Getting a Diagnosis

An accurate diagnosis of seborrheic dermatitis can be particularly challenging for people with skin of color. Historically, medical research and education have often focused on conditions as they present on white skin. As a result, health care providers may not be as familiar with how seborrheic dermatitis manifests on darker skin, potentially leading to misdiagnosis or delayed diagnosis.

Many other conditions may be easily confused for seborrheic dermatitis, especially in people of color. These conditions include the following:

• Tinea capitis — A fungal infection of the scalp
• Psoriasis — A skin disease causing itchy, scaly patches all over the body, sometimes including the scalp
• Atopic dermatitis — Commonly known as eczema, an inflammatory disease of the skin
• Rosacea — A discolored rash on the cheeks
• Vitamin B deficiency — A nutritional imbalance that can cause hair loss on the scalp
• Cutaneous lupus — A red or purple scaly rash on the skin from an autoimmune disorder

These and other skin conditions, which are all prevalent in people of color, should be ruled out by a dermatologist before a seborrheic dermatitis diagnosis can be made.

The stigma surrounding skin conditions in some cultures can discourage individuals from seeking medical attention. A lack of access to medical care, especially dermatologists, in some communities may lead individuals to attempt to self-diagnose and self-treat, which can worsen the condition.

Treatment Considerations

Seborrheic dermatitis is usually treated with moisturizers, antifungal medicine, or steroids applied to the skin. These medications may come in the form of a gel, cream, lotion, foam, or shampoo, depending on what part of your body is most affected. Research is limited on the specific treatment of seborrheic dermatitis for people of color.

Using Shampoo Treatments

When used on the scalp, where seborrheic dermatitis often resides, certain antifungal treatments (such as ketoconazole) can dry out curly or chemically treated hair. If this applies to you, speak to your dermatologist about using such treatments only once a week with a moisturizing conditioner.

Tar shampoos, while often recommended for seborrheic dermatitis treatment, can discolor hair that has been bleached, lightened, or tinted.

Medicated shampoos are usually meant to be used two to three times per week. However, many people do not wash their hair that regularly. One MySebDermTeam member shared, “I don’t like to wash my hair daily and have historically used aerosol dry shampoos, but am realizing they exacerbate my seb derm.”

If you are someone who washes your hair infrequently, shampoo treatments may not work well for you.

Remove Seborrheic Dermatitis Triggers

It’s important to note that many hair and skin care products and habits can trigger or worsen seborrheic dermatitis symptoms. Consider these tips:

• Make sure to look for alcohol-free products to reduce drying effects on the skin and scalp.
• If you get seborrheic dermatitis symptoms under your facial hair, consider keeping facial hair clean-shaven or washing facial hair with medicated shampoos.
• Use moisturizer that is fragrance-free, as fragrances can irritate your skin.

Speak to your doctor about your self-care regimen, so they can work with you on a treatment plan you can follow.

Advocate for Yourself

Seborrheic dermatitis research has historically been focused on people with white skin. This means many doctors and other health care providers have not been trained to identify and diagnose seborrheic dermatitis on darker skin tones.

This is why it’s especially important to seek out resources, such as those from the Skin of Color Society, that discuss the effects of seborrheic dermatitis and other skin conditions on diverse skin tones. Having this support can help you advocate for yourself at doctors’ visits and make sure you get the medical care you deserve.

Talk With Others Who Understand

On MySebDermTeam, the social network for people with seborrheic dermatitis and their loved ones, more than 4,700 members come together to ask questions, give advice, and share their stories with others who understand life with seborrheic dermatitis.

Are you a person of color living with seborrheic dermatitis? How do symptoms appear on your skin? What treatments have helped you? Share your experience in the comments below, or start a conversation by posting on your Activities page.