Mind the Gap atlas
Seborrheic dermatitis on Black skin
Key cue: Ring-shaped (annular/petaloid) hypopigmented patches with fine scale on the face are a Black-skin variant distinct from the flaky-scalp textbook picture.
Seborrheic dermatitis is a chronic inflammatory condition involving skin with high sebaceous gland density (scalp, face, chest). It's associated with overgrowth of the commensal yeast Malassezia and is very common — but its presentation on Black skin is distinct enough that it often goes unrecognised as such.
What it actually looks like
Textbook says
Textbook: erythematous, greasy-looking scale on scalp (dandruff), eyebrows, nasolabial folds, and central chest. Infants get cradle cap.
On Black skin
A distinct 'petaloid' (flower-petal-like) pattern is classically described on Black skin and is under-taught:
- Petaloid / annular variant: hypopigmented arcuate or ring-shaped patches with fine peripheral scale, most commonly on the central face (hairline, eyebrows, nasolabial folds, central forehead, moustache area). This can look like tinea and is often misdiagnosed as such.
- Scalp: typical greasy yellowish-white scale, identical to other skin tones, often more prominent because of less frequent hair washing practices common in Black haircare routines (this is not bad hygiene — it's healthy hair practice to reduce dryness; antifungal shampoo use is calibrated to weekly washing).
- Post-inflammatory hypopigmentation after seb derm resolves can persist for weeks to months and is often the patient's chief complaint.
Treatment works across skin tones: topical antifungal (ketoconazole, ciclopirox), low-potency topical steroid for flares, and weekly/biweekly antifungal shampoo. For Black patients with tightly coiled hair who shampoo less often, leave-in ketoconazole foam or anti-yeast tonics may be more practical than daily shampoos.
What to look for
- Ring-shaped or arcuate lighter patches on the central face with very fine scale at the edges.
- Flaking/scaling of the scalp, beard, eyebrows, sideburns, or centre of the chest.
- Itchy or slightly irritated, but not severely painful.
- Worse with stress, cold weather, and less hair washing.
When to seek care
Seb derm is rarely urgent. Schedule a routine dermatology or primary-care visit for persistent symptoms unresponsive to over-the-counter antifungal shampoos. Unusual presentations (severe, refractory, or associated with unintentional weight loss or other symptoms) warrant a workup for HIV and neurodegenerative disease.
Common misdiagnosis
The petaloid Black-skin variant is commonly misdiagnosed as tinea (a KOH prep will be negative), vitiligo (tends to be chalk-white without scale), pityriasis alba (different distribution), or discoid lupus (more atrophy and scarring alopecia).
See it for yourself — curated external imagery
We don't host clinical photos here. The links below go to peer-reviewed or open-access sources (Mind the Gap, DermNet NZ, PubMed Central, and similar). Each opens in a new tab.
- DermNet NZ — Seborrhoeic dermatitis — including petaloid pattern images.
- Mind the Gap handbook.
- Skin of Color Society — Seborrheic dermatitis.
References
- Elgash M, Dlova N, Ogunleye T, Taylor SC. Seborrheic dermatitis in skin of color: clinical considerations. J Drugs Dermatol. 2019;18(1):24-27. PMID: 30681789.
- Taylor SC. Skin of color: biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46(2 Suppl Understanding):S41-62. PMID: 11807469.
Medical disclaimer
Educational content only. This is not a substitute for in-person evaluation. If you are worried about yourself or someone you love, see a clinician — and if you are concerned about an emergency sign described here, call 911 or your local emergency number. We do not host clinical imagery; the external references are for reader self-education and are not owned by or affiliated with Black Health.