Dermatitis, Seborrheic

General Illness Information

Common Name: Dermatitis, Seborrheic

Medical Term: None Specified

Description: Seborrheic dermatitis is a common , chronic skin condition presenting as dry whitish scales or greasy scales. Can involve the scalp, eyebrows, forehead, face, trunk, or skin folds. It is not considered contagious.

Dandruff and cradle cap are both forms of seborrheic dermatitis.

Causes:

Mechanism of disease unknown. Recently discovered to be probably caused by a fungus Malassezia fur fur. Eradication of this fungus causes the disease to subside.

Other factors that may play a part in development of this condition are genetic predisposition, hormones, nutrition, infection and emotional stress. Disease seems to parallel increased sebaceous gland activity in infancy and adolescence.

Prevention:

It can be prevented by:

  • shampooing frequently, with anti-fungal shampoo e.g.. Nizoral.
  • Drying skin folds thoroughly after bathing.
  • Wearing loose, ventilating clothing.
  • Sunlight in moderate doses may be helpful.

Signs & Symptoms

  • Flaking, white scales over reddish patches on the skin- usually involving  the scalp, eyebrows, forehead, face, trunk, or skin folds.
  • In infants, it presents as thick, greasy, yellow to white scales and crusts on a reddish base mainly on the scalp as well as in the skin folds. however, the face, neck, chest and extremities may also be involved in extensive disease. Age of onset is typically one month and usually resolves by 8 to 12 months.
  • In adolescent and adults, the scales are thin, white and greasy and are classically  distributed on the scalp, eyebrows, on the nasolabial folds (crease between the nose and the upper lip), behind the ears, in the ear canal and central chest.
  • Itching may be present.
  • Redness, fissuring and secondary infection may be present.

Risk Factors

  • Hot, humid weather or cold, dry weather.
  • Infrequent shampoos.
  • Oily skin.
  • Other skin disorders, such as acne rosacea, acne or psoriasis.
  • Use of drying lotions that contain alcohol.
  • HIV infection.
  • Stress.

Diagnosis & Treatment

Diagnosis is made by history and physical findings.

General Measures:

  • Shampoo often ,about twice a week, with anti-fungal shampoo. Shampoos that contain tar, zinc pyrithione or selenium are used daily, if possible. For very resistant cases, 2.5% suspension of selenium sulfide may be used as a shampoo once a week. Patient should be instructed to shampoo vigorously without using the nails once and then shampoo again, leaving the shampoo on for 5 to 10 minutes to loosen the scales.
  • Seborrheic dermatitis of the eyelid margin usually responds to gentle cleaning of the lid margins nightly as needed, with undiluted Johnson and Johnson baby shampoo using a cotton swab.
  • Remove thick scales by applying warm olive or mineral oil and then wash off several hours later with Dawn washing detergent and a soft bristle tooth brush.
  • For dense scalp scaling, 10% Liquor Carbonic Detergens (LCD) in nivea oil may be used at bedtime, covering the head with a shower cap. This should be done nightly for 1-3 weeks.
  • Once controlled, washing with zinc soaps or selenium lotion with periodic use of steroid cream will help maintain remission.

Medications:

  • For minor dandruff, you may use non-prescription dandruff shampoos with selenium sulfide or zinc pyrithione and lubricating skin lotion.
  • For severe problems, shampoos such as ketoconazole ( Nizoral), or those that contain coal tar or scalp creams that contain cortisone may be prescribed. To apply medication to the scalp, part the hair a few strands at a time, and rub the ointment or lotion vigorously into the scalp
  • Topical steroids for other affected parts
  • Ketoconazole cream – usually gives a satisfactory response in 2 weeks.

Activity:

No restrictions. Outdoor activities in summer may help.

Diet:

No special diet. Avoid foods that seem to worsen your condition.

Possible Complications :

  • Skin atrophy (thinning of skin) or striae from prolonged use of fluorinated corticosteroids, especially if used on the face.
  • Photosensitivity – occasionally caused by tars
  • Secondary bacterial infection in affected areas.

Prognosis

This is a chronic condition, but it is often characterized by long periods of inactivity. During active phases, symptoms can be controlled with treatment. It does not cause hair loss.

In infants, seborrheic dermatitis usually resolves in 6-8 months.

Other

Nothing Specified.

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