Seborrheic dermatitis is an inflammation of areas of skin with high sebaceous gland density (z. B. face, scalp, upper body). The cause is unknown, but types of Malassezia a normal skin yeast, play a role. Seborrheic dermatitis is more common in patients with HIV and in those with certain neurological disorders. It is associated with occasional pruritus, scalp dandruff, and a yellow, greasy scaling on the hairline and face. Diagnosis is made on the basis of physical examination. Treatment is with tar shampoos or other medicated shampoos, as well as topical corticosteroids and antifungals. Despite the name, composition. The amount of sebum secretion is normal. The pathogenesis of seborrheic dermatitis is unknown, with disease severity related to skin colonization density with Malassezia-Yeast has been associated. Seborrheic dermatitis is most common in infants (usually within the first 3 months of life) and in adults between 30 and 70 years of age. Incidence and severity of the condition appear to be influenced by genetic factors, emotional or physical stress, and climate (usually worse in cool weather). Seborrheic dermatitis may resemble psoriasis Psoriasis is an inflammatory disease usually associated with sharply demarcated erythematous papules and plaques covered with silvery scales. Several factors. Learn more precede or are associated with it and form the so-called seborrhiasis. Seborrheic dermatitis may be more common and severe in patients with neurological disorders (especially Parkinson's disease M. Parkinson's M. Parkinson's disease is a slowly progressive degenerative disease characterized by resting tremor, rigor (stiffness), slow and decreased movements (bradykinesia) and gait and/or. Learn more ) or HIV/AIDS. Very rarely the dermatitis generalizes.
Symptoms and complaints
Symptoms of seborrheic dermatitis develop gradually, and the dermatitis is usually apparent only as dry flakes (scales) or greasy diffuse scaling of the scalp (dandruff) with variable itching. In severe disease, yellow-red scaly papules appear at the hairline, behind the ears and in the external auditory canal, on the eyebrows, in the axillae, on the bridge of the nose, in the nasolabial folds, and over the sternum. Occasionally, eyelid rim inflammation with dry yellow crusts and conjunctival irritation develops. Seborrheic dermatitis does not cause hair loss.
In newborns, seborrheic dermatitis is occasionally found with a thick, yellow, crusted scalp lesion (cradle cap), fire formation and yellowish scaling behind the ears, red papules on the face, and persistent diaper dermatitis. In older children and adults, thick, adherent, scaly plaques often develop on the scalp, which may be 1-2 cm in diameter.
Seborrheic dermatitis manifests as dry or greasy scales on the scalp; in severe cases, yellow-red scaly papules may appear at the hairline, behind the ears and in the external auditory canal, on the eyebrows, in the axillae, on the nose, and over the sternum.
Erythematous scaly lesions of seborrheic dermatitis in the retroauricular area.
© Springer Science+Business Media
This illustration shows cradle cap with thick, yellow crusted scalp lesions and diffuse erythema.
Biophoto Associates/SCIENCE PHOTO LIBRARY
Diagnosis
The diagnosis of seborrheic dermatitis is made on the basis of physical examination.
Seborrheic dermatitis may occasionally be difficult to distinguish from other conditions, such as. B. Psoriasis Psoriasis is an inflammatory disease usually associated with sharply defined erythematous papules and plaques covered with silvery scales. Multiple factors. Learn more , atopic dermatitis Atopic dermatitis (eczema) Atopic dermatitis (often referred to as eczema) is a chronic inflammatory skin disease with a complex pathogenesis involving genetic susceptibility, immunologic and. Learn more or Contact dermatitis Contact dermatitis Contact dermatitis is an acute inflammatory reaction of the skin triggered by irritants or allergens. The primary symptom is pruritus. The skin lesions. Learn More , Tinea Overview of Dermatophytosis Dermatophytosis is the term used to describe fungal infections of the keratin of the skin and nails. (Nail infection is referred to as tinea unguium or onychomycosis). The symptoms. Complaints. Learn More and Rosacea Rosacea is a chronic, inflammatory disease that causes facial redness, telangiectasias, erythema, papules, and pustules, as well as severe cases with rhinophyma. Learn more , be distinguishable.
Treatment
Topical therapy with antifungals, corticosteroids, and calcineurin inhibitors
Adults and older children
For adults with scalp involvement, zinc pyrithione, selenium sulfide, sulfur and salicylic acid, ketoconazole (2% and 1%), and tar shampoo (available over the counter) should be used daily or every other day until dandruff subsides and then 2 times per week thereafter. Until the scaling heals. Redness can be treated 2 times a day with a corticosteroid lotion (z. B. 0.01% fluocinolone acetonide solution, 0.025% triamcinolone acetonide lotion) are rubbed into the scalp or other hairy areas.
For seborrheic dermatitis (SD) of the postauricular areas, nasolabial folds, eyelid margins, and bridge of the nose, 1- to 2.5% hydrocortisone cream is rubbed in 2 to 3 times daily, and only 1 time daily after the lesions have responded. Hydrocortisone cream is the safest corticosteroid for the face, as fluorinated corticosteroids can cause side effects here (z. B. telangiectasias, atrophy, perioral dermatitis). In some patients, twice-daily administration of 2% ketoconazole cream or other topical imidazoles for 1-2 weeks results in months of remission. Imidazole or hydrokrtisone can be used as first line therapy. If necessary, both agents can be used at the same time. Calcineurin inhibitors ( Pimecrolimus and Tacrolimus) are also particularly effective when long-term use is required. For eyelid margin seborrhea, a solution of 1 part baby shampoo and 9 parts water is applied with a cotton swab.
Infants and children
Baby shampoo is used daily for infants, and 1 to 2.5% hydrocortisone cream or fluocinolone 0.01% oil can be used once or twice daily for redness and scaling on the scalp or face. Topical antifungals such as ketoconazole 2% cream or econazole 1% cream may also be helpful in severe cases. For thick lesions on an infant's scalp, mineral oil, olive oil, or a corticosteroid gel or oil is applied to the affected area before bedtime and rubbed with a toothbrush. The scalp is shampooed daily until the thick scales have disappeared.
Important points
In adults, seborrheic dermatitis causes scalp flaking and sometimes scaling around the eyebrows, nose and auricles, behind the ears, in the armpit and on the breastbone.
Seborrheic dermatitis may cause a thick, yellow, crusted lesion on the scalp in newborns or thick, scaly plaques on the scalp in older children.
The treatment can be. B. with medicated shampoos as well as topical corticosteroids.