Seborrheic dermatitis


Chronic, relapsing inflammation of the skin with predilection for areas with sebaceous cysts.

Characterized with inflammatory changes, scaling and erythematous patches.

Redness and itching frequently occur around the folds of the nose and eyebrow areas, not just the scalp.

Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common condition of scalp psoriasis.

Inflammation can be characterized by redness, heat, pain, swelling and can cause sensitivity.

Varies in extent and clinical findings depending on the skin area involved.

Scalp almost always involved.

Frequent areas of involvement include face, chest, and intertriginous areas.

Seborrheic dermatitis appears as erythematous plaques or patches topped by white or yellow scale, and most commonly affects the scalp and the face, particularly the ears, eyebrows, and nasal alae.

Seborrheic dermatitis can also manifest on the chest, anus, and groin, ref2242ed to as the seborrheic areas.

Etiology likely to be related to active sebaceous glands with a reaction to the Malassezia yeast, part of the flora of the skin.

Has a chronic and relapsing course requiring topical antifungal shampoos and creams.

Seasonal changes, stress, and immunosuppression seem to affect seborrheic dermatitis.

Rarely oral antifungals such as fluconazole or itraconazole are required.

In persons of color, seborrheic dermatitis can appear as white, minimally scaly patches on the face underlying the eyebrows.

Blepharoconjunctivitis may occur.

Male genitalia may have lesions.

Itching is moderate and usually involves the scalp and external ear.

In infants cradle cap (involving the scalp), the face and diaper region involvement up to 70% of newborns during the first 3 months of life.

Infantile form usually disappears by the first year.

Acutely associated with moist scaling areas.

Prevalence greater than 11%.

No genetic predisposition.

More common and severe with HIV infection and this especially true in patients with CD4 counts below 400 cell/mm.

Rare in African blacks.

Associated with Parkinsonism, familial amyloidosis with polyneuropathy and in trisomy 21.

Diseases associated with seborrheic dermatitis include epilepsy, congestive heart failure, obesity, and chronic alcoholism.

Various factors contribute to seborrheic dermatitis, including the presence of sebaceous glands and sebum, overgrowth of Pityrosporum ovale, stress, low humidity and temperature, and activation of the alternative complement pathway.

May be precipitated by stress.

Patients frequently indicate sun exposure improves skin lesions.

May be associated with long term exposure to solar ultraviolet radiation.

May be related to patients treated for psoriasis treated with psoralens and ultraviolet A light.

Not regularly associated with excessive secretion of sebum.

Sebaceous glands are not primarily involved, but such glands may be a permissive factor as dermatitis occurs most often during periods of active sebum production and in areas of the skin where sebum is produced.

lipid laden fungi of the genus molasses considered potentially pathogenic, but their number of organisms does not correlate with presence and severity of symptoms.

Diagnosis by history and physical examination.

Differential diagnosis include: psoriasis, atopic dermatitis and childhood tinea capitis.

Topical antifungal agents are the major treatment.

Initial treatment consists of mild topical corticosteroids and topical antifungal agents used once or twice a day.

Fluocinolone acetonide 0.01% scalp oil is helpful in patients who have thick scalp plaques.

Corticosteroids in foam preparations useful in lesions of the scalp.

Shampoos with antifungal agents, salicylic acid, tar, selenium sulfide, corticosteroids, and zinc pyrithione all are helpful in treating scalp disease.

Agents that are effective include ketoconazole, bifonazole, and ciclopiroxolamine as creams, gels and shampoos.

Bifonazole is effective treatment as a 1% cream or shampoo.

Ciclopiroxolamine shampoo may be effective in treatment

In randomized clinical trials comparing sort term topical corticosteroids with topical antifungal agents have shown no significant differences or a small difference in favor of antifungal agents.

Topical corticosteroids useful in the short term to control erythema and itching.

Topical calcineurin inhibitors, tacrolimus, pimecrolimus, can be useful.

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