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Seborrheic Dermatitis

Seborrheic dermatitis is a common chronic, inflammatory skin disorder.


Presentation

Seborrheic dermatitis symptoms appear slowly and mostly the first symptom is flaky skin and scalp. Symptoms develop anyplace on the skin of the face, back of the ears and in places where the skin folds are seen. Flakes may be yellow, white or grayish. The skin near the eyelashes, forehead, nose, chest and upper back can have redness and flaking.

In serious conditions, yellowish to reddish scaly pimples are seen behind both pinnae, inside the ear canal, topping the eyebrows, on the nasal bridge, along the hairline, around the nose, chest, and upper back.

Generally, patients experience little redness, scaly skin lesions and in few cases hair loss. Various other symptoms are patchy scaling or hard coating on the scalp, red, greasy skin enclosed with flaky white or yellow scales, intense itching, pain and yellow or white scales that can be attached to the shaft of hair.

Seborrheic dermatitis in infants younger than three months can present as thick, oily, yellowish crust surrounding the hairline and on the scalp. This condition is also known as cradle cap. Itching is not common in infants. Commonly, a persistent diaper rash develops along with the scalp rash. Generally, when the rash develops in infants it resolves on its own in a few days, without any treatment, whereas in adults the symptoms can last from couple of weeks to years.

Turkish
  • Both patients and controls were evaluated by the validated Turkish versions of the Hospital Anxiety and Depression Scale (HADS), Maudsley Obsessive Compulsive Inventory (MOCI), and Toronto Alexithymia Scale (TAS-26).[ncbi.nlm.nih.gov]
Plethora
  • Topical Corticosteroid Therapy for Scalp and Non-Scalp Seborrheic Dermatitis Review of adult SD treatments revealed that there has been a relative conspicuous absence of recent published data on the use of TCS for SD, especially when compared to the plethora[ncbi.nlm.nih.gov]
Rectal Bleeding
  • A 52-year-old man with intensive SD complained of a four-month-long rectal bleeding, tenesmus, pain, and difficulty during defecation.[ncbi.nlm.nih.gov]
Tenesmus
  • A 52-year-old man with intensive SD complained of a four-month-long rectal bleeding, tenesmus, pain, and difficulty during defecation.[ncbi.nlm.nih.gov]
Corneal Deposit
  • We present a case of transient band-like corneal deposit, a novel complication of fluocinonide and ketoconazole exposure.[ncbi.nlm.nih.gov]
Conjunctival Hyperemia
  • Examination revealed white clumpy deposits in a horizontal band across the inferocentral corneal epithelium and conjunctival hyperemia. Corneal scrapings revealed no cells or organisms, and culture was negative.[ncbi.nlm.nih.gov]
Eczema
  • ; seborrhea, eczema; seborrheic, seborrhea; dermatitis, seborrhea; eczema, seborrheic; eczema, Seborrhea, NOS, Seborrhoea, NOS, dermatitis seborrheica, Seborrheic dermatitis NOS, Dermatitis;seborrheic, Eczema;seborrheic, seborrhoea, seborrhoeic dermatitis[fpnotebook.com]
  • Darier's disease is commonly misdiagnosed as seborrheic dermatitis or eczema. We present the case of a young adult active duty Air Force member with 5 years of skin complaints.[ncbi.nlm.nih.gov]
  • Areas affected Seborrheic eczema tends to develop in oily areas of the body.[healthline.com]
Erythema
  • Advanced digital photography, equipped with technology able to provide a detailed evaluation of red skin components corresponding to vascular flare (erythema-directed digital photography), is a useful tool for evaluation of erythema in patients affected[ncbi.nlm.nih.gov]
Pruritus
  • Treatment-related AEs occurred in 14% of subjects, including application-site irritation (8%), application-site pain (4%), application-site pruritus (1%), and increased alanine aminotransferase (1%).[ncbi.nlm.nih.gov]
  • SD treatment focuses on clearing signs of the disease; ameliorating associated symptoms, such as pruritus; and maintaining remission with long-term therapy.[doi.org]
Eruptions
  • All patients exhibited scaly erythematous macules on the face and/or scalp, and their eruptions improved rapidly with tacalcitol cream.[ncbi.nlm.nih.gov]
Alopecia
  • Berthold Rzany and Frank Bachmann, Common Hair Problems: Dandruff and Androgenetic Alopecia, The Male Patient in Aesthetic Medicine, 10.1007/978-3-540-79046-4_5, (61-71), (2009).[dx.doi.org]
  • There is evidence showing that topical vitamin D is ineffective in the treatment of actinic keratosis, seborrheic keratosis, lichen planus, seborrheic dermatitis, alopecia areata, chemotherapy-induced alopecia, and hypertrophic scars.[ncbi.nlm.nih.gov]
Distractibility
  • When to see a doctor See your doctor if: You're so uncomfortable that you're losing sleep or are distracted from your daily routines Your skin is painful You suspect your skin is infected You've tried self-care steps without success References Weston[web.archive.org]
  • When to see a doctor See your doctor if: You're so uncomfortable that you're losing sleep or being distracted from your daily routines Your condition is causing embarrassment and anxiety You suspect your skin is infected You've tried self-care steps without[mayoclinic.com]

Workup

Doctors can generally determine seborrheic dermatitis by a simple physical examination or they might scrape off skin cells for examination (biopsy) to rule out conditions with some symptoms similar to seborrheic dermatitis like psoriasis, atopic dermatitis and rosacea.

Trichophyton Mentagrophytes
  • Cultural examination on Sabouraud medium led to the identification of the Trichophyton mentagrophytes species.[ncbi.nlm.nih.gov]

Treatment

The main line of treatment for seborrheic dermatitis includes medicated shampoos, creams and lotions that control inflammation, fungal growth and keratolysis.

Creams, shampoos or ointments that control inflammation like hydrocortisone, fluocinolone or desonide which are corticosteroids are applied to the scalp or other troubled area. They are efficient and simple to use. In case they are used for a long period of time continuously, than they can lead to side effects like thinning skin or striae on skin and must be stopped soon.

Antifungal shampoos when used along with a stronger medication are very effective. Ketoconazole shampoo can be effective when used with clobetasol scalp product in turns twice weekly.

The antifungal medication terbinafine may be a treatment option. 
Medications that affect your immune system are also beneficial in the treatment. Therefore creams or lotions having calcineurin inhibitors tacrolimus and pimecrolimus may be adequate and have lesser side effects as compared to corticosteroids.

A cream or gel that fights bacteria is also helpful in the treatment. One can use metronidazole as a cream or gel once or twice daily till recovery is seen.

Light therapy along with medicines is a method of treatment that combines psoralen with light therapy (photochemotherapy). Once psoralen is taken by mouth or is applied on affected skin, the person is exposed to ultraviolet light. People with thick hair may not be benefited much with this therapy.

Antihistamines are used primarily to reduce itching. The research studies propose that some antihistamines have anti-inflammatory properties [9].

Prognosis

Cradle cap typically disappears on its own as a child develops. Other types of seborrheic dermatitis generally respond to treatment with shampoos and medication.

Etiology

The exact cause is yet unknown, but the disease is thought to be the result of a combination of factors like microbes, sebum, and some trigger factors. At present various studies suggest, that a weakened immune system, the inadequacy of particular nutrients, or problems with the nervous system are causes of this condition.

Epidemiology

Seborrheic dermatitis has a prevalence of about 1 to 5%. The incidence among patients with human immunodeficiency disease (HIV)/acquired immunodeficiency syndrome (AIDS) is about 34 to 83%.

In infants, seborrheic dermatitis is also known as cradle cap. It is due to the maternal androgens and affects up to 70% infants in the first three months of infancy. Recurrence is common around puberty and post 50 years age. Males are affected more than females by a narrow margin.

Sex distribution
Age distribution

Pathophysiology

Seborrheic dermatitis can be due to an inflammatory reaction to multiplication of Malassezia, a type of yeast [2] [3]. Malassezia globosa is the form of yeast found on the scalp, whereas Malassezia furfur (called previously as Pityrosporum ovale) and Malassezia restricta are the other two types that are seen. The yeast yields poisonous substances that irritate and burn the skin. Individuals suffering from seborrheic dermatitis seem to have low resistance to the yeast. Anyhow, the degree of colonization might be lesser in affected skin as compared to the unaffected skin.

Malassezia dissolves human sebum, dispensing a blend of saturated and unsaturated fatty acids. It picks up the needed saturated fatty acids, leaving behind unsaturated fatty acids. The unsaturated fatty acids penetrate the stratum corneum. Due to their non-consistent structure, they break the skin's barrier function which results in irritation, causing dandruff and seborrheic dermatitis.

Factors like genetic, hormonal, environmental and immune-system are seen to be responsible in causing seborrheic dermatitis [4] [5].

Seborrheic dermatitis can be provoked by ill health, psychological stress, tiredness, reduced sleep, change of season and diminished general health [6].

In children, increased intake of vitamin A can lead to seborrheic dermatitis. Deficiency of vitamins pyridoxine (vitamin B6) [7], biotin, and riboflavin (vitamin B2) can also cause it.

People having immunity compromising conditions (infection with HIV) and those with neurological conditions like Parkinson's disease or stroke are especially prone to it [8].

Prevention

Good personal hygiene is extremely essential for patients at a higher risk of developing the condition. Daily bathing and hair washes are recommended, especially for those having an oily skin. A clean scalp is a must to avoid outburst of seborrheic dermatitis. Natural and artificial UV radiations help in restricting the production of Malassezia yeast [10].

Pre-existing medical conditions that might predispose to seborrheic dermatitis should be attended to on a priority basis. As doctors do not know what causes seborrheic dermatitis, it cannot be prevented with precision, but the symptoms can be controlled with effective treatment.

Summary

Seborrheic dermatitis is a common chronic, relapsing inflammatory [1] skin condition defined by the fine scaling and erythematous patches. Most times, it affects the sebaceous gland-rich areas in our body like scalp, face and torso.

Patient Information

Seborrheic dermatitis does not have any harmful effect on your general health, but it can be distressing. It can cause embarrassment as it presents in the form of scaling on the exposed areas of the body like face, scalp, folds around the nose etc along with severe itching many a times. Neither is it a communicable condition, nor an evidence of low personal hygiene.

The true cause of the disease is not known but many theories have been put forth and hence it’s advisable to maintain personal hygiene to keep it at bay or under control like washing your skin regularly and rinsing off the soap completely from the body. Avoid using harsh soaps and use a moisturizer regularly. Avoid products that contain alcohol as they can cause a flare up. Wear pure cotton clothing as it reduces irritation. Avoid scratching as it tends to increase skin irritation and the chances of infection. Along with these measures, you can always seek medical help from a professional who can prescribe medicated creams, lotions, shampoos etc. to treat this condition. Sometimes even meditation, yoga and other stress relieving techniques can help in easing this skin condition.

References

Article

  1. Gupta AK, Kogan N. Seborrheic dermatitis: current treatment practices. Expert Opin Pharmacother. 2004 Aug;5(8):1755-65. Review.
  2. Hay RJ, Graham-Brown RA. Dandruff and seborrheic dermatitis: causes and management. Clin Exp Dermatol. 1997 Jan; 22 (1): 3–6.
  3. Nowicki R. Modern management of dandruff. Pol Merkur Lekarski (in Polish). 2006 Jan; 20 (115): 121–4.
  4. Johnson BA, Nunley JR. Treatment of seborrheic dermatitis. Am Fam Physician. 2000 May 1;61 (9): 2703–10, 2713–4.
  5. Janniger CK, Schwartz RA. Seborrheic dermatitis. Am Fam Physician. 1995 Jul; 52 (1): 149–55, 159–60.
  6. Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician. 2006 Jul; 74 (1): 125–30.
  7. Stone OJ. Pyridoxine deficiency and antagonism produce increased ground substance viscosity with resulting seborrheic dermatitis and increased tumor resistance. Med Hypotheses. 1989 Dec;30(4):277-80.
  8. Ippolito F, Passi S, Di Carlo A. Is seborrheic dermatitis a clinical marker of HIV disease? Minerva Ginecol. 2000 Dec;52(12 Suppl 1):54-8.
  9. Grob JJ, Castelain M, Richard MA, Bonniol JP, et al. Antiinflammatory properties of cetirizine in a human contact dermatitis model. Clinical evaluation of patch tests is not hampered by antihistamines. Acta Derm Venereol. 1998 May; 78 (3): 194–7.
  10. Wikler JR, Janssen N, Bruynzeel DP, Nieboer C. The effect of UV-light on pityrosporum yeasts: ultrastructural changes and inhibition of growth. Acta derm venereol (Stockholm). 1990; 70 (1): 69–71.

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Last updated: 2019-07-11 20:58