Seborrheic Dermatitis
Seborrheic Dermatitis: Excerpt from The 5-Minute Pediatric Consult
Kara N. Shah, MD
Seborrheic Dermatitis - BASICS
Seborrheic Dermatitis - description
- An erythematous, scaly, greasy dermatitis that favors the sebaceous areas of the body, including the scalp, face, postauricular, central chest, and intertriginous areas
- The distribution pattern and clinical course varies with age. Infants commonly manifest predominantly self-limiting scalp involvement (“cradle cap”), while adults and adolescents more commonly demonstrate chronic involvement of the face and ears with less prominent scalp involvement.
Seborrheic Dermatitis - general prevention
Frequent washing with a medicated shampoo containing selenium sulfide, tar, or zinc pyrithione or application of a medicated lotion or cream containing either one of the aforementioned compounds or a low-potency topical corticosteroid can reduce disease flares. There are no other preventive measures and modulation of dietary intake is of no benefit.
Seborrheic Dermatitis - epidemiology
- There are 2 populations in whom seborrheic dermatitis develops: Infants, in which seborrheic dermatitis usually develops after the 1st 3–4 weeks of life, peaks at age 3 months, and usually resolves by 1 year of age; and adolescents and adults, in whom it usually persists.
- In adults, seborrheic dermatitis is more common in males.
- The development of seborrheic dermatitis during infancy does not predict the development of adolescent and/or adult disease.
Seborrheic Dermatitis - incidence
Although it is one of the more common skin diseases seen in infants as well as in adolescents and adults, the incidence of seborrheic dermatitis is unknown.
Seborrheic Dermatitis - prevalence
- Affects 2–5% of the adult population.
- Affects 18% of infants <2 years of age.
Seborrheic Dermatitis - risk factors
Seborrheic Dermatitis - genetics
Controversy exists as to whether there is a genetic predisposition. There is evidence that it is more common in families, but not spouses, of affected patients.
Seborrheic Dermatitis - pathophysiology
- Although not an infection per se, there is increasing acceptance that the lipophilic yeast Pityrosporum ovale, a commensal skin organism, is a contributing factor. Increased sebaceous gland activity likely favors the growth of P. ovale. The use of topical antifungal agents such as ketoconazole significantly decreases the number of Pityrosporumyeast in seborrheic dermatitis patients with subsequent clinical improvement.
- The local host immune response to P. ovaletoxins or enzymes also plays a probable role in the development of seborrheic dermatitis. Seborrheic dermatitis is one of the most common cutaneous manifestations of AIDS in adults, where it can be particularly severe and recalcitrant to standard therapy.
- Androgen-mediated stimulation of sebaceous gland activity is likely important, given that seborrheic dermatitis presents in infancy and puberty.
- The histopathologic findings are nonspecific and include parakeratosis, acanthosis, spongiosis, elongation of the rete ridges, and a mild lymphocytic dermal inflammatory infiltrate.
Seborrheic Dermatitis - etiology
- A multifactorial disease influenced by both genetic and environmental factors.
- It is not clear whether the infantile and adolescent/adult forms share a common etiology or whether they are distinct disorders.
Seborrheic Dermatitis - DIAGNOSIS
Seborrheic Dermatitis - signs & symptoms
Seborrheic Dermatitis - history
- Infants usually present after 3–4 weeks of life, with a peak prevalence at age 3 months and resolution usually by 1 year of age. It is generally asymptomatic. There may be a coexistent atopic dermatitis.
- Adolescents and adults usually present with a chronic, recurrent often pruritic rash that began sometime after puberty. Many patients have tried multiple treatments, including shampoos and medicated creams and/or lotions, with initial improvement but prompt recurrence after discontinuation.
Seborrheic Dermatitis - physical exam
- The characteristic lesions are erythematous, often with an orange/yellow hue, scaly, and greasy in appearance.
- In infants, seborrheic dermatitis most commonly involves the scalp (“cradle cap”) but can also involve the face, neck, umbilicus, diaper area, and intertriginous areas. Cradle cap may appear as thick, greasy adherent scaling of the scalp.
- Adolescents and adults may present with a pruritic, scaling scalp dermatitis or with involvement of the face (favoring the perinasal areas, beard area, and eyebrows), postauricular area and external ear canals, and presternal area. Blepharitis with erythema and scaling of the eyelid margins may also occur.
Seborrheic Dermatitis - tests
Seborrheic Dermatitis - lab
- There are no specific tests for seborrhea.
- Microscopic examination with a potassium hydroxide wet mount preparation or a fungal culture of skin scrapings will differentiate seborrheic dermatitis from a dermatophyte infection
Seborrheic Dermatitis - diag proced-surgery
Skin biopsy may be helpful if the presentation is unusual or in cases not responding to conventional therapy; however, findings are not necessarily diagnostic for seborrheic dermatitis.
Seborrheic Dermatitis - differencial diagnosis
- Infection:
- Fungal infections with dermatophytes are commonly confused with seborrheic dermatitis. Tinea facei, tinea corporis, and tinea barbae usually cause localized scaly circinate inflammatory lesions, although infection of hair follicles can result from misdiagnosis and use of topical steroids and can present with a more inflammatory papular or pustular eruption.
- Tinea capitis presents most commonly with diffuse or patchy fine white adherent scaling on the scalp with broken hairs and/or patchy or diffuse hair loss. Cervical adenopathy is often present.
- Tinea capitis is primarily a disease of infants and prepubertal children.
- Dermatophyte infections can be differentiated by microscopic examination of hairs using a potassium hydroxide wet mount preparation and by fungal culture.
- Malignancy:
- Langerhans cell histiocytosis is an uncommon infiltrative disease that may present with a scaly erythematous eruption on the scalp, behind the ears, or in the intertriginous regions. It is differentiated from seborrheic dermatitis by the presence of small reddish-brown crusted papules or vesicles, purpuric lesions, hepatosplenomegaly, and adenopathy.
- Immunologic:
- Atopic dermatitis usually begins in infancy and is characterized by a chronic, recurrent pruritic dermatitis that is usually seen in the context of a personal or family history of atopy.
- Atopic dermatitis in infants favors the face (but sparing the perinasal area) and extensor aspects of the extremities and spares the diaper area. In children and adults.
- Atopic dermatitis favors the flexural aspects of the extremities but may also involve the face, scalp, and trunk.
- Some infants and adolescents manifest features of both atopic dermatitis and seborrheic dermatitis.
- Psoriasis vulgaris in children and adults is characterized by symmetric, well-demarcated erythematous plaques with a thick white micaceous scale.
- Lesions favor the extensor aspects of the extremities.
- Scalp involvement is common and present with erythematous scaly plaques in the scalp.
- Other features of psoriasis include characteristic nail changes such as nail pitting and onycholysis.
- In infants, psoriasis may involve the diaper area and other intertriginous areas or may present with diffuse involvement of the trunk, face, and extremities.
- It is generally accepted that there is often an overlap in the clinical manifestations of psoriasis and seborrheic dermatitis, which is often referred to as “sebopsoriasis.”
- Leiner disease results in a severe generalized erythematous, exfoliative dermatitis accompanied by severe diarrhea, recurrent infections, and failure to thrive. It may result from a number of nutritional and immunologic disorders, such as acrodermatitis enteropathica, severe combined immunodeficiency syndrome, and complement deficiencies.
Seborrheic Dermatitis - TREATMENT
Seborrheic Dermatitis - general measures
- In infants, mild scalp seborrhea can be treated with intermittent use of a mild shampoo.
- A sulfur or salicylic acid shampoo (i.e., Sebulex) may be used for several days as needed.
- Scales can be loosened 1st with application of mineral oil or baby oil, followed by brushing or combing of the scalp.
- Persistent scalp seborrhea and seborrheic dermatitis involving the face, diaper area, and body will usually respond to treatment with a short course of a low-potency topical corticosteroid lotion or cream or ketoconazole cream.
- Adolescents with mild scalp seborrhea often respond to intermittent use of a shampoo with zinc pyrithione (e.g., Head and Shoulders), selenium sulfide (e.g., Selsun), or tar.
- Those with more erythema, scaling, and/or and severe pruritus may consider treatment with a medium-potency topical corticosteroid solution or foam.
- Dense, diffuse scalp involvement may be treated overnight for several days as needed with Derma-Smoothe/FS lotion.
- Ketoconazole shampoo is an alternative therapy.
- Seborrheic dermatitis of the face and body may be treated with a low-potency topical corticosteroid lotion or cream, ketoconazole cream, or with one of the topical calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream, which have anti-inflammatory properties and have also been shown to have potent antifungal activity against Malassezia furfur and P. ovale in vitro.
- If the seborrheic dermatitis is particularly widespread, severe, or is refractory to topical treatment, oral ketoconazole has been shown to be effective against seborrheic dermatitis of the scalp and body.
- Blepharitis should be treated with warm water compresses, cleansing with a baby shampoo, and if necessary, sodium sulfacetamide ophthalmic ointment.
- Topical steroids may suppress this lesion, but the side effects of its use around the eye (such as glaucoma) make this a poor choice for chronic therapy.
Seborrheic Dermatitis - FOLLOW UP
- In infants, seborrheic dermatitis self-resolves by the age of 1 year, but often requires intermittent therapy until resolution occurs.
- Although some improvement should be seen with treatment by 10–14 days, long-term intermittent therapy may be required, especially in adolescents in whom seborrheic dermatitis is often chronic.
- Seborrhea may rarely be complicated by secondary bacterial or candidal infections, with erythema, tenderness, and ulceration.
- Patients who are intermittently using topical corticosteroids should be monitored for adverse effects, including local cutaneous atrophy, dyspigmentation, and striae.
- Seborrhea may be caused or complicated by associated underlying disorders, including immune defects such as AIDS, which should be considered in cases that are resistant to treatment.
Seborrheic Dermatitis - prognosis
- The infantile form will self-resolve by the end of the 1st year of life.
- The adolescent form may persist into adulthood
Seborrheic Dermatitis - complications
Usually none
Seborrheic Dermatitis - bibliography
- Cohen S. Should we treat infantile seborrheic dermatitis with topical antifungals or topical steroids? Arch Dis Child. 2004;89:288–289.
- Gupta AK, Bluhm R, Cooper EA, et al. Seborrheic dermatitis. Dermatol Clin. 2003;21:401–412.
- Gupta AK, Madzia SE, Batra R. Etiology and management of seborrheic dermatitis. Dermatology. 2004;208:89–93.
- Mimouni K, Mukamel M, Zeharia A, et al. Prognosis of infantile seborrheic dermatitis. J Pediatr. 1995;127:744–746.
- Williams JV, Eichenfield LF, Burke BL, et al. Prevalence of scalp scaling in prepubertal children. Pediatrics. 2005;115:e1–e6.
Seborrheic Dermatitis - CODES
Seborrheic Dermatitis - icd9
- 690 Erythematosquamous dermatosis
- 690.1 Seborrheic dermatitis
- 690.11 Seborrhea capitis, cradle cap
- 690.12 Seborrheic infantile dermatitis
- 690.18 Other seborrheic dermatitis
Seborrheic Dermatitis - FAQ
- Q: Does therapy speed resolution of the disorder?
- A: Treatment does not appear to influence the underlying cause of this disorder, which appears to be caused by hormonally-mediated sebaceous gland activity, skin colonization with the lipophilic yeast P. ovale, and the resultant local inflammatory response).
- Q: Shouldn’t the use of topical corticosteroids worsen the dermatitis if it is caused by a fungal infection?
- A: Topical corticosteroids are commonly used to treat seborrheic dermatitis. These agents seem to work because of their anti-inflammatory effect. Although in the past, high-potency steroids were used for this indication, adverse effects are associated with their prolonged use. Currently, low-potency corticosteroids are preferred.
- Q: Does seborrheic dermatitis cause permanent hair loss?
- A: Patients can be reassured that it does not cause permanent hair loss.
>
Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
More About Dandruff
More Medical Textbooks Online about Dandruff
Review other book chapters online related to Dandruff:
Medical Books Excerpts
- DANDRUFF
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Dermatitis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
- Dandruff
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
|
|
» Next page: Surveys relating to Dandruff
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
