BEAUTY IN THE SKIN 

Rosacea and seborrheic dermatitis are two common skin disorders. On the face, they both might look alike, and hard to tell which one you have. This is why I have created the article “Rosacea vs. Seborrheic Dermatitis.” In this article, I will share my knowledge of medicine and skin therapy and look into the differences between these two disorders.

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What Is Rosacea?


Rosacea is a common skin condition that causes erythema (facial redness), blushing, flushing, and burning sensation, sometimes clearly visible vessels, telangiectasias, and pus-filled papules on the face. In severe cases, rosacea may cause nose swelling (rhinophyma) and skin thickening on the forehead, cheeks, and chin. Sometimes ocular rosacea develops and causes red, dry eyes and swollen red eyelids.

Young woman with rosacea
Rosacea (Shutterstock)

The causes of rosacea are not clearly understood. Heredity, fair skin, an overactive immune system, hot and spicy foods, histamine-containing foods, alcohol, and wind are among the triggering factors. Demodex mites are involved in pimple formation.

What Is Seborrheic Dermatitis?


Seborrheic Dermatitis is also a common skin condition that causes redness, swelling, and scaly greasy patches on the face, scalp, and other areas with many oil glands (upper back, chest, armpit, groin).

The most likely cause of seborrheic dermatitis is yeast overgrowth. The Malassezia yeast belongs to the natural skin’s flora. When the skin’s microbiome is balanced, this yeast does not cause any trouble. But when Malassezia overgrows, our immune system reacts to it and causes inflammation and skin issues.

A man with seborrheic dermatitis
Seborrheic dermatitis (Shutterstock)

Some factors may trigger seborrheic dermatitis: hormonal changes, stress, medical conditions (acne, psoriasis, rosacea, immunodeficiency diseases, alcoholism, Parkinson’s disease, depression), and medications used to treat these conditions (psoralen, interferon, lithium), harsh cosmetics ingredients and detergents, lack of vitamins (A, B6, B12, C, biotin), dry and cold weather.

Rosacea vs. Seborrheic Dermatitis: What Are the Similarities?


Comparison: rosacea vs. seborrheic dermatitis; rosaceaComparison: rosacea vs. seborrheic dermatitis; seborrheic dermatitis
Rosacea vs. Seborrheic Dermatitis (Shutterstock)

The two conditions sometimes may look alike, especially on the face. They both are inflammatory skin disorders. The skin, in both cases, may look pinkish or red and have visible vessels, scales, and follicular plugs. They both may cause itchiness. And they both may occur together (they both are caused by the overgrowth of a particular natural skin’s flora and the immune system’s reaction).

Rosacea vs. Seborrheic Dermatitis: What Are the Differences?


Besides being very similar conditions, they are totally different disorders and have many differences. They usually affect different age groups and genders, different areas of the body and face, and may look different.

Skin with rosacea
Rosacea (Shutterstock)

I have put all the differences between rosacea and seborrheic dermatitis in the table.

 RosaceaSeborrheic Dermatitis
AgeIt usually affects middle-aged or older persons, but it might affect all ages.It usually affects babies but is often seen in teenagers and adults.
GenderMore often affects womenMore often affects men
Skin ColorMore often, dark redMore often, pinkish
VesselsProminent in network-like patternDotted or curved vessels in a patchy pattern
ScalesMore often, white scales with scattered distributionMore often, yellow scales with a patchy distribution
Follicular plug/bumpsVery commonCommon
Affected body areasFaceFace, scalp, upper chest, back, under breasts, armpits, groin area, and sometimes hands.
Affected face areasUsually, cheeks, but also the nose, forehead, eyelids, ears, and chin may be affected.Around the nose, nasolabial folds, forehead, inner eyebrows, external ear canal, behind the ear, and sometimes eyelids.
Triggering factorsGenetics, fair skin, hot, spicy foods, histamine-containing foods, alcohol, wind.  Cold, stress, hormonal imbalances, certain medical conditions and medications, harsh cosmetics, and detergents.
Associated microorganismDemodex mitesMalassezia yeast
Nutritional CausesLack of zincLack of vitamins (A, B6, B12)
ImmunodeficiencyNoYes
TreatmentAcaricides (kill mites), azelaic acid, benzoyl peroxide, tea tree oil, laser treatmentsAntifungals, salicylic acid, selenium sulfide, sulfur, tea tree oil, turmeric, probiotics, and sometimes steroids.
Differences Between Rosacea and Seborrheic Dermatitis

As the table indicates, rosacea and seborrheic dermatitis are pretty different conditions despite sometimes being mistaken.

Rosacea vs. Seborrheic Dermatitis: How Are They Diagnosed?


They both are usually diagnosed by observing the skin. Seborrheic dermatitis appears on some characteristic regions and can be diagnosed just by examining the skin and typical areas.

Man with seborrheic dermatitis
Seborrheic Dermatitis (Shutterstock)

Rosacea can be diagnosed by examining the scrapes of the skin under the microscope or performing a dermoscopy to find mites.

Seborrheic dermatitis can be diagnosed by performing a skin biopsy, but it is done more to exclude other diseases than diagnose seborrheic dermatitis.

How Are Rosacea and Seborrheic Dermatitis Treated?


Before you start treating rosacea or seborrheic dermatitis, consult with a doctor.

Papulopustular rosacea is treated with acaricides that kill mites. Among them are permethrin, metronidazole, ivermectin, selenium sulfide, sulfur, and salicylic acid.

Azelaic acid, pulsed light, and diode laser treatments are best for erythematous rosacea. Also, blood vessel strengthening with Centella Asiatica, green tea, Ginkgo, and other ingredients is highly recommended. 

The overgrowth of yeast causes seborrheic dermatitis, so antifungals work best. You can use creams, gels, washes, and shampoos containing antifungals such as ketoconazole, sertaconazole, and ciclopirox. If this is not enough, oral antifungal pills might be prescribed.

All these medications require a prescription; only shampoos (such as Nizoral or Zincon) and Athlete’s foot creams containing antifungals are sold over the counter. Tip: you can use shampoo or Athlete’s foot cream on other body parts, not only your head or feet.

Corticosteroids are prescribed in doctor’s offices to reduce inflammation. They include hydrocortisone, fluocinolone (Capex, Synalar), clobetasol (Clobex, Temovate), and desonide (Desowen, Desonate). Use them if you really need them and for a short period because steroids have many side effects, such as skin thinning, perioral dermatitis, loss of skin pigment (vitiligo-like conditions), skin ruptures, striae, lines, ulcers, bruising, facial erythema, rosacea, contact allergy and other. Of course, steroids cause these side effects if used for a long time. My recommendation – stay cautious while using them.

Topical calcineurin inhibitors such as tacrolimus (Protopic) or pimecrolimus (Elidel) work, as well as corticosteroids, only have fewer side effects. They were not used widely as the US Food and Drug Administration warned of possible increased cancer risk in 2006. A systematic review published in 2021 revealed no association between topical calcineurin inhibitor use and the risk of skin cancer or cancer overall. The downside of calcineurin inhibitors is that they are pretty costly.

Salicylic acid (yes, again!) is one of the ingredients that reduce the number of yeast, has an anti-inflammatory effect, and removes the excess of dead skin cells.

Overall, acids create an acidic environment that fungi do not like and cannot live in. Azelaic acid, found in Skinoren cream, is also helpful.

Whether you perform a professional chemical peel or use washes, creams, or masks with acids at home, they are really helpful in treating seborrheic dermatitis.

Sulfur has an antifungal effect and is one of the safest ingredients. In fact, it is one of my favorite ingredients in treating fungal skin conditions. Look for skincare products containing sulfur (De La Cruz Sulfur Ointment or Margarite Zinc cream, which also contains sulfur).

Benzoyl peroxide, tea tree oil, and turmeric can also help.

Probiotics may help you restore a healthy microbiome balance. Oral probiotics restore gut health (there is a connection between the gut and the skin), and skincare products with probiotics restore the skin’s flora.

Control your sebum secretion and avoid oils and fatty acids in skincare because oil feeds yeast.

Remember to strengthen your immune system as seborrheic dermatitis flares up in immunodeficient persons.

And hydrate, hydrate, hydrate your skin. Without moisture, your skin will produce more oil to restore the skin’s hydration and create a perfect environment for the yeast to flourish. Also, dehydrated skin will have a damaged barrier and be more susceptible to infection and inflammation.

Takeaway


Let’s wrap up our final thoughts on our article “Rosacea vs. Seborrheic Dermatitis.”

Rosacea and seborrheic dermatitis might look alike and be mistaken, but they are totally different disorders.

Rosacea is caused by an overactive immune system triggered by hot and spicy foods and is most often seen in fair skin. It causes facial redness, flushing, burning sensation, visible vessels, telangiectasias, and sometimes pustules caused by Demodex mites. It usually affects the face: nose, cheeks, and other areas.

On the other hand, seborrheic dermatitis is caused by the overgrowth of yeast Malassezia, the inflammatory reaction of the skin. It is most often seen in patients with some immunodeficiency.

Seborrheic dermatitis causes redness and scaly greasy patches on specific areas on the face (around the nose, nasolabial folds, inner eyebrows, forehead, behind the ear), scalp, body folds (under the breasts, groin area, armpits) and sometimes hands.

Rosacea requires acaricides to eliminate mites and means to strengthen vessels, while seborrheic dermatitis needs to be treated with antifungals and sebum regulators. It can be tricky to tell by yourself which one you have, therefore I always recommend consulting a healthcare provider.

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ARTICLE SOURCES:


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  2. Difference between rosacea and seborrheic dermatitis. Difference between. Read
  3. Red skin rashes are not always the result of rosacea. National Rosacea Society. Read
  4. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014 Oct;5(4):416-25. doi: 10.4103/2229-5178.142483. PMID: 25396122; PMCID: PMC4228634. Read
  5. Lam M, Zhu JW, Tadrous M, Drucker AM. Association Between Topical Calcineurin Inhibitor Use and Risk of Cancer, Including Lymphoma, Keratinocyte Carcinoma, and Melanoma: A Systematic Review and Meta-analysis. JAMA Dermatol. 2021;157(5):549–558. doi:10.1001/jamadermatol.2021.0345 Read
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