Disease: Seborrheic Dermatitis

    Seborrheic dermatitis facts

    • Seborrheic dermatitis is probably the single most common inflammatory skin condition affecting humans aside from acne vulgaris.
    • Seborrheic dermatitis is highly treatable but incurable.
    • The course of seborrheic dermatitis is characterized by apparently spontaneous remissions and exacerbations.
    • Seborrheic dermatitis affects all ages.

    What is seborrheic dermatitis?

    Seborrheic dermatitis is a chronic skin inflammation that becomes worse and better spontaneously. Seborrheic dermatitis causes an eczema-type eruption commonly affecting portions of the head and upper torso. Seborrheic dermatitis is also known as seborrhea.

    Picture of seborrheic dermatitis along the hairline; photo courtesy of Gary W. Cole, MD, FAAD

    What are risk factors for seborrheic dermatitis?

    Although almost all patients with seborrheic dermatitis are generally entirely healthy, there does seem to be an association with diseases of the central nervous system and AIDS.

    What causes seborrheic dermatitis?

    The causes of seborrheic dermatitis are poorly understood. Since this condition tends to occur in areas of heavy sebum production, it is felt that oily skin may be a factor leading to seborrheic dermatitis. In addition, it seems that many patients with seborrheic dermatitis have excessive growth of a normal skin yeast (Pityrosporum or Malassezia) in the affected areas. Whether this common microorganism really leads to seborrheic dermatitis or is just a secondary phenomenon remains to be determined.

    The fact that topical antifungal medications are effective in controlling this disease has led some to conclude that this is a fungal condition. However, this theory is not yet accepted.

    What are seborrheic dermatitis symptoms and signs?

    The rash itself is characteristically red and scaling but occasionally can become weepy and oozy. The scaling can be extensive enough to be called dandruff and can be the patient's major complaint.

    The distribution of this rash is often of great help in making the diagnosis. In adults, areas commonly involved include the scalp, the outer ear, and external auditory canal, the forehead, the brows, the eyelids, the cheeks adjacent to the nose, including the folds that extends from the nose to the sides of the mouth, and less commonly the armpits, the mid-chest, and mid-back regions. In babies, the rash causes a scalp eruption commonly called "cradle cap." It can also be more extensive and involve the diaper area as well. Although in both adults and children the rash may have no symptoms, it commonly causes itching, especially in the scalp.

    Picture of seborrheic dermatitis on the forehead; photo courtesy of Gary W. Cole, MD, FAAD

    How is seborrheic dermatitis diagnosed?

    The diagnosis of seborrheic dermatitis is usually made clinically, meaning that the doctor recognizes it on the basis of its appearance. Occasionally, a scraping of skin scales treated with potassium hydroxide is examined using a microscope to exclude a fungal infection. A skin biopsy is rarely required for diagnosis.

    What is the treatment for seborrheic dermatitis?

    Treatment of hair-bearing areas, like the scalp, often includes the use of a shampoo that may contain one or more of the following ingredients:

    • Tar
    • Antifungal antibiotic
    • Zinc pyrithione
    • Selenium sulfide

    In addition, the application of a topical steroid lotion or solution of weak to moderate potency is effective such as desonide (Desonate, DesOwen, LoKara, Verdeso), clobetasol (Temovate), hydrocortisone, and 0.025% triamcinolone (Aristocort, Aristocort HP, Kenalog, Triderm).

    For non-hair-bearing areas, the application of a weak to moderately potent topical steroid or topical antifungal cream is frequently effective. The use of tacrolimus (Protopic) or pimecrolimus (Elidel) ointments can be effective but is quite an expensive alternative.

    It needs to be stressed that since this condition is incurable but easily controllable; if the disease is active and the treatment is stopped, one should expect the seborrheic dermatitis to recur. One should also use effective medications just enough to control the symptoms. Excessive treatment of apparently normal skin is economically wasteful as well as potentially dangerous.

    What are seborrheic dermatitis symptoms and signs?

    The rash itself is characteristically red and scaling but occasionally can become weepy and oozy. The scaling can be extensive enough to be called dandruff and can be the patient's major complaint.

    The distribution of this rash is often of great help in making the diagnosis. In adults, areas commonly involved include the scalp, the outer ear, and external auditory canal, the forehead, the brows, the eyelids, the cheeks adjacent to the nose, including the folds that extends from the nose to the sides of the mouth, and less commonly the armpits, the mid-chest, and mid-back regions. In babies, the rash causes a scalp eruption commonly called "cradle cap." It can also be more extensive and involve the diaper area as well. Although in both adults and children the rash may have no symptoms, it commonly causes itching, especially in the scalp.

    Picture of seborrheic dermatitis on the forehead; photo courtesy of Gary W. Cole, MD, FAAD

    How is seborrheic dermatitis diagnosed?

    The diagnosis of seborrheic dermatitis is usually made clinically, meaning that the doctor recognizes it on the basis of its appearance. Occasionally, a scraping of skin scales treated with potassium hydroxide is examined using a microscope to exclude a fungal infection. A skin biopsy is rarely required for diagnosis.

    What is the treatment for seborrheic dermatitis?

    Treatment of hair-bearing areas, like the scalp, often includes the use of a shampoo that may contain one or more of the following ingredients:

    • Tar
    • Antifungal antibiotic
    • Zinc pyrithione
    • Selenium sulfide

    In addition, the application of a topical steroid lotion or solution of weak to moderate potency is effective such as desonide (Desonate, DesOwen, LoKara, Verdeso), clobetasol (Temovate), hydrocortisone, and 0.025% triamcinolone (Aristocort, Aristocort HP, Kenalog, Triderm).

    For non-hair-bearing areas, the application of a weak to moderately potent topical steroid or topical antifungal cream is frequently effective. The use of tacrolimus (Protopic) or pimecrolimus (Elidel) ointments can be effective but is quite an expensive alternative.

    It needs to be stressed that since this condition is incurable but easily controllable; if the disease is active and the treatment is stopped, one should expect the seborrheic dermatitis to recur. One should also use effective medications just enough to control the symptoms. Excessive treatment of apparently normal skin is economically wasteful as well as potentially dangerous.

    Source: http://www.rxlist.com

    Treatment of hair-bearing areas, like the scalp, often includes the use of a shampoo that may contain one or more of the following ingredients:

    • Tar
    • Antifungal antibiotic
    • Zinc pyrithione
    • Selenium sulfide

    In addition, the application of a topical steroid lotion or solution of weak to moderate potency is effective such as desonide (Desonate, DesOwen, LoKara, Verdeso), clobetasol (Temovate), hydrocortisone, and 0.025% triamcinolone (Aristocort, Aristocort HP, Kenalog, Triderm).

    For non-hair-bearing areas, the application of a weak to moderately potent topical steroid or topical antifungal cream is frequently effective. The use of tacrolimus (Protopic) or pimecrolimus (Elidel) ointments can be effective but is quite an expensive alternative.

    It needs to be stressed that since this condition is incurable but easily controllable; if the disease is active and the treatment is stopped, one should expect the seborrheic dermatitis to recur. One should also use effective medications just enough to control the symptoms. Excessive treatment of apparently normal skin is economically wasteful as well as potentially dangerous.

    Source: http://www.rxlist.com

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