Seborrheic Dermatitis

Seborrheic Dermatitis

Seborrheic dermatitis is generally limited to the scalp; however, dry scales and underlying erythema can occur on the face, ears, chest, back, and body folds. Skin may be dry or oily. In infants, a widespread reaction is associated with minimal discomfort. The yeast organism, Pityrosporum, may be a factor. Mild scaling without any erythema is often termed simple dandruff. Tinea capitis may simulate dandruff or seborrheic dermatitis, and scrapings should be taken for KOH examination and fungal culture, especially in children, if hair loss is present.

 Signs and symptoms of Seborrheic Dermatitis 

History findings in seborrheic dermatitis may include the following:

• Intermittent, active phases manifesting with burning, scaling, and itching, alternating with inactive periods; activity is increased in winter and early spring, with remissions commonly occurring in summer
• In active phases, potential secondary infection in intertriginous areas and on the eyelids
• Candidal overgrowth (common in infantile napkin dermatitis)
• Generalized seborrheic erythroderma (rare)

Treatment Of Seborrheic Dermatitis 

Early treatment of flares is encouraged. Behavior modification techniques in reducing excoriations are especially helpful with scalp involvement.

Topical corticosteroids may hasten recurrences, may foster dependence because of a rebound effect, and are discouraged except for short-term use. Skin involvement responds to ketoconazole, naftifine, or ciclopirox creams and gels. Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), sulfur or sulfonamide combinations, or propylene glycol. Class IV or lower corticosteroid creams, lotions, or solutions can be used for acute flares. Systemic ketoconazole or fluconazole may help if seborrheic dermatitis is severe or unresponsive. Combination therapy has been recommended.

Dandruff responds to more frequent shampooing or a longer period of lathering. Use of hair spray or hair pomades should be stopped. Shampoos containing salicylic acid, tar, selenium, sulfur, or zinc are effective and may be used in an alternating schedule. Overnight occlusion of tar, bath oil, or Baker's P&S solution may help to soften thick scalp plaques. Derma-Smoothe F/S oil is especially helpful when widespread scalp plaques are present. Selenium sulfide (2.5%), ketoconazole, and ciclopirox shampoos may help by reducing Malassezia yeast scalp reservoirs. Shampoos may be used on truncal lesions or in beards but may cause inflammation in the intertriginous or facial areas.

Siadat et al reported that 1% metronidazole gel is effective for seborrheic dermatitis of the face. Some suggest using a nonsteroidal cream. Bikowski recommends azelaic acid. Seborrheic blepharitis may respond to gentle cleaning of eyelashes with baby shampoo and cotton applicators. The use of ketoconazole cream in this anatomical region is controversial.

 Source By Medscape

 

Another presentation of Seborrheic Dermatitis :