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. 2024 Jul 3;160(8):846–855. doi: 10.1001/jamadermatol.2024.1987

The Global Prevalence of Seborrheic Dermatitis

A Systematic Review and Meta-Analysis

Meredith Tyree Polaskey 1,2, Christy H Chang 3, Karishma Daftary 2, Sheiva Fakhraie 2, Corinne H Miller 2, Raj Chovatiya 1,4,✉
PMCID: PMC11223058  PMID: 38958996

Abstract

Importance

Seborrheic dermatitis is a prevalent chronic inflammatory skin disease, yet its global prevalence, pathogenesis, and epidemiology remain inadequately defined.

Objective

To provide a detailed estimation of the global prevalence of seborrheic dermatitis, analyze demographic variations, and explore differences in various settings.

Data Sources

Embase, PubMed, Scopus, and Cochrane Database of Systematic Reviews were searched from inception through October 2023.

Study Selection

Original investigations on seborrheic dermatitis prevalence were included after duplicate screening of titles, abstracts, and full articles, including only studies with clinician-diagnosed cases.

Data Extraction and Synthesis

Following PRISMA guidelines, data were extracted and quality was assessed independently by multiple reviewers. A random-effects model using restricted maximum likelihood was used for meta-analysis and subgroup analyses.

Main Outcome and Measure

The primary outcome was the pooled estimate of global seborrheic dermatitis prevalence.

Results

From 1574 identified articles, 121 studies were included, encompassing 1 260 163 individuals and revealing a pooled global seborrheic dermatitis prevalence of 4.38% (95% CI, 3.58%-5.17%), with significant heterogeneity (I2 = 99.94%). Subgroup analyses showed variations by age, with a higher prevalence in adults (5.64% [95% CI, 4.01%-7.27%]) compared to children (3.70% [95% CI, 2.69%-4.80%]) and neonates (0.23% [95% CI, 0.04%-0.43%]). Geographic analyses indicated variability, with the highest prevalence in South Africa (8.82% [95% CI, 3.00%-14.64%]) and the lowest in India (2.62% [95% CI, 1.33%-3.92%]).

Conclusions and Relevance

This comprehensive meta-analysis provides a detailed estimation of the global prevalence of seborrheic dermatitis, highlighting significant variability across different demographics and settings.

Key Points

Question

What is the global prevalence of seborrheic dermatitis, and how do demographic variations affect its prevalence?

Findings

In this meta-analysis of 121 studies including 1 260 163 individuals, the pooled global prevalence of seborrheic dermatitis was 4.38%, with significant variations across age groups and geographical regions.

Meaning

This study highlights the global prevalence of seborrheic dermatitis and its significant variations across demographics and geographical regions.

This meta-analysis provides a detailed global prevalence estimate of seborrheic dermatitis, examining variations across different sociodemographic factors and settings.

Introduction

Seborrheic dermatitis is a chronic inflammatory skin disease marked by erythema and characteristically yellow or white, greasy, scaly plaques.1,2 Predominantly occurring in adolescents and young adults, its incidence notably rises in individuals older than 50 years3 and is also common in infants, typically presenting as cradle cap.4,5 Despite its benign nature, seborrheic dermatitis significantly impacts quality of life, particularly among women, younger adults, and those with severe symptoms, leading to psychological distress and social challenges.6,7,8,9

Despite its burden and frequent occurrence in clinical settings, the pathogenesis and epidemiology of seborrheic dermatitis remain poorly understood,10 and an accurate measure of the global prevalence of seborrheic dermatitis remains unclear. Studies reveal a broad range in seborrheic dermatitis point prevalence across different populations and settings, from 0.24% in rural India11 to 30.30% in a dermatology center in Jamaica,12 indicating vast geographical and demographic variability. For adults, reported prevalence rates vary from 0.50% in imprisoned male individuals in Italy,13 to 16.30% in geriatric dermatology clinics,14 while in children, reports range from 0.02% in pediatric emergency departments in Saudi Arabia15 to 13.20% in infants at well-baby clinics in Thailand.16

Given these diverse findings, a significant gap in the consolidated understanding of the global prevalence of seborrheic dermatitis is evident. No comprehensive meta-analysis has been conducted, to our knowledge, that thoroughly addresses the global prevalence of seborrheic dermatitis, especially one that accounts for variations across different settings. This systematic review with meta-analysis aims to address these gaps by providing a detailed global prevalence estimate of seborrheic dermatitis, examining variations across different sociodemographic factors and settings.

Methods

This systematic review with meta-analysis adhered to the Meta-analysis of Observational Studies in Epidemiology (MOOSE)17 and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)18 reporting guidelines. The prespecified study protocol was registered with PROSPERO (CRD42023472150). Given its nature as a systematic review of existing literature, institutional review board approval was not required, and informed consent was not required from study participants.

Literature Search

We conducted a systematic review and meta-analysis to establish the prevalence of seborrheic dermatitis. We searched Embase (1947 to present) PubMed (1946 to present), Scopus (1788 to present), and Cochrane Database of Systematic Reviews (1996 to present) in June 2022 and October 2023. Keywords and subject headings were used to locate literature on the prevalence of seborrheic dermatitis or dandruff. Searches were limited to English language documents. No publication date limit was applied. Full search strategies are provided in eTable 1 in Supplement 1. Results were collated and deduplicated in EndNote (Microsoft) and uploaded to Rayyan (Qatar Computing Research Institute)19 for screening.

Study Selection

Titles and abstracts were independently screened by at least 2 authors based on predefined criteria, followed by a detailed review of full texts to finalize inclusion (M.T.P., C.H.C., K.D, and S.F). Discrepancies were resolved through consensus. Only original investigations reporting seborrheic dermatitis prevalence were considered, including both prospective and retrospective studies. Our inclusion criteria encompassed studies conducted in both general population and general clinical settings. Studies were included only if patients received a diagnosis from a clinician, excluding solely self-reported diagnoses. Abstracts and unpublished studies lacking detailed data or failing to meet these criteria were excluded. Reviews and qualitative studies were also excluded. Additionally, studies involving special populations with known elevated seborrheic dermatitis rates, including patients with HIV, Parkinson disease, and drug-induced seborrheic dermatitis, were excluded. In cases where studies reported findings from overlapping datasets, preference was given to those reporting data at a later point.

Data Extraction and Quality Assessment

Two authors (M.T.P. and C.H.C.) independently conducted data extraction using a predefined extraction form tailored to the details of the study. Extracted data included study characteristics, including title, country/region, setting, study design, study period, and inclusion/exclusion criteria. Participant demographics, including age group or mean age and pediatric/adult status, were recorded, along with study outcomes such as the number of patients with seborrheic dermatitis and total sample size. Additional details (eg, any notes or comments regarding each study’s unique aspects) were also documented (eTable 2 in Supplement 1).

The Joanna Briggs Institute Critical Appraisal Instrument for prevalence studies was used to assess study quality, focusing on aspects like sample frame suitability, sampling strategy, sample size adequacy, description of study participants and setting, sufficient coverage, reliability and validity of seborrheic dermatitis diagnosis, reliability of measurement, appropriate statistical analysis, and adequacy of response rate.20

Statistical Analysis

Meta-analyses were performed using the MAJOR package in Jamovi, version 2.3.28.0 (The Jamovi Project). The Tweedie trim-and-fill method to correct for publication bias was performed using the metafor package in R software, version 4.1.1 (R Project for Statistical Computing). Through 2-sided testing, P < .05 was considered significant.

In our meta-analysis, we used the restricted maximum likelihood method with a random-effects model to estimate the pooled prevalence of seborrheic dermatitis. A random-effects approach was chosen due to the expected clinical heterogeneity present across the included studies. We assessed between-study heterogeneity using the Cochran Q statistic and quantified it with the I2 statistic. Publication bias was evaluated through fail-safe N (Rosenthal method), Kendall τ for funnel plot asymmetry, and a regression test for further asymmetry analysis. To assess variations in prevalence, subgroup analyses were performed according to study setting, geographic location (for countries represented by at least 4 studies), and age group.

Results

The literature search identified 1574 nonduplicate articles, with 1394 excluded after the title and abstract review. A thorough full-text review resulted in 121 studies being selected for meta-analysis, including 1 260 163 individuals (Figure 1).18 The majority of studies were conducted in clinical settings (84 [69%]), with fewer studies in community (29 [24%]) and institutional settings (6 [5%]). Additionally, 1 study focused on military recruits, and another did not specify the setting. The studies predominantly came from India (18 [15%]), Turkey (13 [11%]), and the US (8 [7%]).

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Flow Diagram18.

Figure 1.

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aThese studies were excluded based on title and abstract review.

Global Prevalence of Seborrheic Dermatitis

Our analysis included 121 studies to calculate the pooled global prevalence of seborrheic dermatitis. These studies encompassed 1 260 163 participants with clinician-diagnosed seborrheic dermatitis, uncovering an overall pooled prevalence of 4.38% (95% CI, 3.58%-5.17%) with an IQR of 1.55% to 5.45%, alongside significant statistical heterogeneity (I2 = 99.94%; df = 120; Q = 38 414.25) (Table, Figure 2,11,12,15,16,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76 Figure 313,14,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131,132,133,134,135). Sensitivity analyses confirmed the stability of this prevalence estimate, showing minimal variation in the sequential exclusion of individual studies.

Table. Summary of Meta-Analysis Findings on the Prevalence of Seborrheic Dermatitis Across Various Models.

Model No. of studies Prevalence (95% CI), % IQR, % Z value Q value P value for Q I2, %
Full model 121 4.38 (3.58-5.17) 1.55-5.45 10.82 38 414.25 <.001 99.94
Adult population 30 5.64 (4.01-7.27) 2.15-10.14 6.79 1920.16 <.001 99.77
Pediatric population 45 3.70 (2.69-4.80) 1.55-4.14 6.57 9939.88 <.001 99.93
Neonate population 7 0.23 (0.04-0.43) 0.25-0.89 2.32 6.56 .36 31.17
Clinical setting 84 4.08 (3.17-5.00) 1.68-5.05 8.72 27 623.53 <.001 99.94
Community setting 29 4.71 (2.99-6.43) 0.89-9.68 5.36 7254.43 <.001 99.90
Institutional setting 6 4.53 (1.19-7.87) 2.15-5.88 2.66 87.70 <.001 98.03
India 18 2.62 (1.33-3.92) 0.77-3.57 3.97 3658.59 <.001 99.63
Turkey 13 3.74 (2.10-5.37) 1.22-5.25 4.48 761.47 <.001 98.71
US 8 5.86 (3.21-8.52) 3.68-7.03 4.32 666.99 <.001 98.12
Brazil 7 3.36 (0.52-6.2) 0.88-4.28 2.32 667.01 <.001 99.76
Pakistan 8 3.48 (2.22-4.73) 2.32-3.92 5.43 108.36 <.001 99.05
Nigeria 7 3.61 (0.92-6.30) 1.88-3.64 2.63 110.91 <.001 98.79
South Africa 5 8.82 (3.00-14.64) 5.95-10.19 2.97 1050.11 <.001 99.66
Egypt 4 3.52 (1.03-6.02) 2.54-4.53 2.77 223.06 <.001 98.80
Iran 4 2.69 (0.78-4.60) 1.87-3.87 2.76 182.46 <.001 97.29
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Figure 2. Forest Plot of Individual Study Estimates and Event Rates for Seborrheic Dermatitis Prevalence, Part 1.

Figure 2.

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All sources were weighted based on sample size.

Figure 3. Forest Plot of Individual Study Estimates and Event Rates for Seborrheic Dermatitis Prevalence, Part 2.

Figure 3.

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All sources were weighted based on sample size.

Pooled Prevalence by Study Setting

Meta-analyses were conducted separately for studies conducted in clinical, community, and institutional settings. In clinical settings, the pooled prevalence was 4.08% (95% CI, 3.17%-5.00%) with an IQR of 1.68% to 5.05%. This setting exhibited substantial heterogeneity (I2 = 99.94%; df = 83; Q = 27 623.53). Studies based in community settings yielded a pooled prevalence of 4.71% (95% CI, 2.99%-6.43%) with an IQR of 0.89% to 9.68%. The heterogeneity remained high (I2 = 99.90%; df = 28; Q = 7254.43). Institutional settings showed a pooled prevalence of 4.53% (95% CI, 1.19%-7.87%) with an IQR of 2.15% to 5.88% and high heterogeneity (I2 = 98.03%; df = 5; Q = 87.70) (Table).

Pooled Prevalence in Children vs Adults

Of the 121 studies included in the full model, 30 specifically addressed adult prevalence, and 45 focused on children, with an additional 7 targeting neonates. The seborrheic dermatitis prevalence in adults was higher than the overall prevalence at 5.64% (95% CI, 4.01%-7.27%). Children, excluding neonates, showed a lower prevalence of 3.70% (95% CI, 2.69%-4.80%), with neonates presenting the lowest rate at 0.23% (95% CI, 0.04%-0.43%) (Table).

Pooled Prevalence by Country

Among the studies analyzed, 9 countries were represented by at least 4 studies each, revealing significant variation in seborrheic dermatitis prevalence globally. South Africa exhibited the highest prevalence at 8.82% (95% CI, 3.00%-14.64%) based on 5 studies. The US followed with a prevalence of 5.86% (95% CI, 3.21%-8.52%) based on 8 studies, and Turkey with 3.74% (95% CI, 2.10%-5.37%) based on 13 studies. Conversely, India demonstrated the lowest reported prevalence at 2.62% (95% CI, 1.33%-3.92%) based on 18 studies. Substantial heterogeneity was observed across the included studies (Table).

Publication Bias

The funnel plot analysis revealed signs of potential publication bias or study heterogeneity, with a notable concentration of studies positioned to the left of the overall mean effect size. The regression test for funnel plot asymmetry was significant (Z = 6.80; P < .001). Kendall τ indicated a minor but significant trend (−0.15; P = .01). However, despite using the Tweedie trim-and-fill method to correct for publication bias, the pooled estimate remained consistent, and the fail-safe N was large at 804 286 (P < .001).

Study Quality

The appraisal of the 121 studies through the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies revealed overall high quality, although 18 studies exhibited deficiencies in 1 domain, and 4 studies in 2 domains. Ambiguities were more prevalent, with unclear ratings in several domains. All studies used appropriate statistical analyses. Notably, a fraction of studies faced issues with sample frame quality (8 problematic, 6 unclear), sample size adequacy (11 inadequate), clarity in sample and setting description (2 poor, 5 unclear), and sampling methods (5 inappropriate, 17 unclear). Additionally, 6 studies showed unclear data analysis coverage. The validity of measurement and identification methods was unclear in 1 study, and response rate adequacy was ambiguous in 20 studies. We combined yes responses and not applicable for the item concerning response rates, given its inapplicability to a significant portion of the studies, particularly retrospective reviews (eFigure in Supplement 1).

Discussion

Our meta-analysis with random effects revealed an overall seborrheic dermatitis pooled prevalence of 4.38% (95% CI, 3.58-5.17%) across diverse populations worldwide. This value notably surpasses the estimate provided by the 2019 Global Burden of Disease study, which suggested a global age-standardized prevalence of 0.29%.136 The Global Burden of Disease study’s reliance on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes for data aggregation suggests a potential clinical underreporting of seborrheic dermatitis prevalence. Given the frequent perception of seborrheic dermatitis as a mild condition, clinicians might not prioritize its documentation unless it presents as a primary concern, potentially leading to its undercoding. Additionally, individuals with dermatological conditions tend to minimize or postpone seeking care for symptoms that, while not deemed medically urgent, can significantly affect their emotional and psychological well-being.137,138,139 Furthermore, given the tendency for individuals to self-treat common dermatological conditions such as acne or fungal infections, it is plausible that a similar approach is taken with seborrheic dermatitis,140 despite evidence linking such practices to worse dermatological outcomes.141

We found similar pooled prevalence rates between community and clinical settings, highlighting the consistency of our findings across diverse study environments. Despite the prevalence of clinical studies in the published literature, which might inflate the pooled global seborrheic dermatitis prevalence, our analysis shows a similar prevalence compared to community-based studies. This consistency reinforces the reliability of our overall prevalence estimate. In addition, although some skin diseases can be common among the incarcerated population, due to overcrowded and humid living conditions,142 our findings indicate that seborrheic dermatitis does not show a higher prevalence in this group.

The prevalence of seborrheic dermatitis among children was lower compared to the overall population at 3.70%. This finding supports the notion that seborrheic dermatitis is most prevalent after puberty, with the exception of infantile seborrheic dermatitis.143 The onset of puberty triggers the activation of sebaceous glands, leading to an increased rate of sebum secretion,144 which is thought to contribute to the uptick in seborrheic dermatitis cases.145 Similarly, seborrheic dermatitis is thought to be most common in infants, manifesting as cradle cap, due to early sebaceous gland activity from maternal androgens in neonates.146 Yet, our findings indicated a relatively low seborrheic dermatitis prevalence of 0.23% in neonates, corroborating the literature that infantile seborrheic dermatitis chiefly emerges between 3 and 8 months of age.147 However, our ability to conduct a direct comparison and in-depth analysis was hampered by the scarcity of prevalence data within this age group within the reviewed studies, highlighting a key gap in the literature.

Variability in the prevalence of seborrheic dermatitis was observed across different countries, potentially influenced by a range of factors, including environmental conditions and cultural practices. For instance, hair care routines involving chemical relaxers and hair extensions, prevalent in certain cultures, have been identified as potential exacerbating factors for seborrheic dermatitis symptoms.148 Additionally, environmental factors such as temperature, ultraviolet index, and humidity,149 as well as living in highly urbanized areas or regions with heavy traffic,150 are associated with seborrheic dermatitis frequency. Furthermore, dietary habits, which vary among cultures and countries, can also impact seborrheic dermatitis occurrence.151 Furthermore, presently, a distinct genetic predisposition for seborrheic dermatitis development has not been definitively established. Nonetheless, recent research suggests the presence of specific genetic markers that may heighten susceptibility to the condition.152

Strengths and Limitations

The strengths of this review are underscored by the comprehensive search across multiple databases and an extensive manual review process. Nonetheless, caution is warranted in interpreting the findings due to notable gaps in research coverage from regions such as Central Asia, significant portions of Sub-Saharan Africa (apart from South Africa and Tanzania), Eastern Europe, the majority of Southeast Asia, Latin America (excluding Brazil), and the Caribbean. Additionally, our analysis may be limited by the potential underreporting of seborrheic dermatitis in regions with restricted access to health care.

Additionally, this systematic review and meta-analysis faced challenges due to the considerable heterogeneity among the included studies, evidenced by a high I2 and a significant Q value. However, the reliability of our prevalence estimate is bolstered by a significant Z value and a precise 95% CI. The observed heterogeneity could stem from diverse study designs, populations, and geographic settings, pointing to the multifaceted nature of seborrheic dermatitis prevalence globally. Despite this variability, the statistical significance of our results, supported by a robust fail-safe N and the stability of our pooled estimate following the Tweedie trim-and-fill adjustment, underscores the reliability and comprehensiveness of our analysis. The consistency of our prevalence estimates across both community and clinical settings offers further reassurance against potential overestimation that might arise from the inclusion of highly selected environments like dermatology clinics and suggests that our pooled prevalence accurately reflects the broader population’s experience with seborrheic dermatitis beyond the confines of specialized medical settings.

Conclusions

Our comprehensive meta-analysis demonstrates a global pooled prevalence of seborrheic dermatitis at 4.38%, higher than previous large-scale global estimates, with notable geographic and sociodemographic variability, highlighting the potential impact of environmental factors and cultural practices. These findings underscore the need for further research to better understand the global distribution of seborrheic dermatitis, its variations across diverse populations, and the influence of environmental factors and cultural practices on its prevalence. It is also crucial to consider the potential heterogeneity resulting from inconsistent diagnostic criteria, emphasizing the need for standardized guidelines. Further research should additionally address potential sources of bias, including ascertainment, publication, and diagnostic biases, to provide a clearer understanding of the incidence and prevalence of seborrheic dermatitis.

Supplement 1.

eTable 1. Full Literature Search Strategy

eTable 2. Comprehensive Overview of Included Studies in the Systematic Review and Meta-Analysis

eFigure. Study Quality Assessed Using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies

jamadermatol-e241987-s001.pdf (523.4KB, pdf)
Supplement 2.

Data Sharing Statement

jamadermatol-e241987-s002.pdf (14.2KB, pdf)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplement 1.

eTable 1. Full Literature Search Strategy

eTable 2. Comprehensive Overview of Included Studies in the Systematic Review and Meta-Analysis

eFigure. Study Quality Assessed Using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies

jamadermatol-e241987-s001.pdf (523.4KB, pdf)
Supplement 2.

Data Sharing Statement

jamadermatol-e241987-s002.pdf (14.2KB, pdf)

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