Seborrhoeic dermatitis

Dermatology

Clinicals - History

Fact Explanation
Skin lesion Seborrheic dermatitis is a chronic or relapsing papulosquamous inflammatory disease of the skin. The exact pathophysiology is unknown, but is thought to be due to inflammation induced by metabolites of the proliferating Malassezia furfur, which is a commensal. It mainly affects the scalp and face. It is generally confined to areas where sebaceous glands are most prominent. So, the rash is often prominent around the ear, the eyebrows or the eyelids. With time, it may spread to affect armpit and groin folds. Infantile seborrhoeic eczema affects infants under the age of 3 months. An intermittent active phase (flare) is characterized by gradually appearing diffuse or patchy, greasy scaling on scalp (Cradle cap). The scaly lesion is yellowish in color. Crusting is formed due to secondary infection. It is usually not itchy and does not bother the baby. Seborrheic dermatitis usually resolves by 6–12 months of age. Skin lesion
Seborrheic dermatitis is a chronic or relapsing papulosquamous inflammatory disease of the skin. The exact pathophysiology is unknown, but is thought to be due to inflammation induced by metabolites of the proliferating Malassezia furfur, which is a commensal. It mainly affects the scalp and face. It is generally confined to areas where sebaceous glands are most prominent. So, the rash is often prominent around the ear, the eyebrows or the eyelids. With time, it may spread to affect armpit and groin folds. Infantile seborrhoeic eczema affects infants under the age of 3 months. An intermittent active phase (flare) is characterized by gradually appearing diffuse or patchy, greasy scaling on scalp (Cradle cap). The scaly lesion is yellowish in color. Crusting is formed due to secondary infection. It is usually not itchy and does not bother the baby. Seborrheic dermatitis usually resolves by 6–12 months of age.
Dandruff In older children seborrheic dermatitis can present as dandruff. This is characterized by a fine, powdery white scale on the scalp. Many patients complain of the scalp itching with dandruff. Besides an itchy scalp, patients may complain of a burning sensation in affected facial areas. Dandruff
In older children seborrheic dermatitis can present as dandruff. This is characterized by a fine, powdery white scale on the scalp. Many patients complain of the scalp itching with dandruff. Besides an itchy scalp, patients may complain of a burning sensation in affected facial areas.
At risk population Infantile seborrhoeic dermatitis is common among the babies under the age of 3 months. Oily skin (seborrhoea), family history of psoriasis and immunosuppression may predispose. At risk population
Infantile seborrhoeic dermatitis is common among the babies under the age of 3 months. Oily skin (seborrhoea), family history of psoriasis and immunosuppression may predispose.

Clinicals - Examination

Fact Explanation
Scaly skin lesion Infants present with a mild, patchy scaling to widespread, thick, adherent crusts in the scalp area. The lesion may be spread to the areas like forehead, the posterior part of the neck, the postauricular skin, eyebrows or the eyelids. The distribution is classically symmetrical. Child seems unaffected by the lesion. Scaly skin lesion
Infants present with a mild, patchy scaling to widespread, thick, adherent crusts in the scalp area. The lesion may be spread to the areas like forehead, the posterior part of the neck, the postauricular skin, eyebrows or the eyelids. The distribution is classically symmetrical. Child seems unaffected by the lesion.
Plaque skin lesion More severe seborrheic dermatitis is characterized by erythematous plaques frequently associated with powdery or greasy scale in the scalp and behind the ears. Plaque skin lesion
More severe seborrheic dermatitis is characterized by erythematous plaques frequently associated with powdery or greasy scale in the scalp and behind the ears.

Investigations - Diagnosis

Fact Explanation
Histology Diagnosis of Seborrheic dermatitis is clinical. Skin biopsy may be helpful but is rarely indicated. Microscopic presence of Malassezia is not diagnostic as it is a normal component of the skin flora. Findings in the histology specimen are nonspecific. acanthosis, Acanthosis, hyperkeratosis, parakeratosis, accentuated rete ridges, and focal spongiosis can be seen. Histology
Diagnosis of Seborrheic dermatitis is clinical. Skin biopsy may be helpful but is rarely indicated. Microscopic presence of Malassezia is not diagnostic as it is a normal component of the skin flora. Findings in the histology specimen are nonspecific. acanthosis, Acanthosis, hyperkeratosis, parakeratosis, accentuated rete ridges, and focal spongiosis can be seen.

Management - Supportive

Fact Explanation
Patient education Parents should be educated to care about the patient’s hygiene. Frequent cleansing of the commonly affected areas during the remission has been found to reduce the recurrences as the cleansing with soap removes oils and improves seborrhea. Treatment other than gentle washing is frequently not necessary in most mild cases. Outdoor recreation, especially during summer, will also improve seborrhea, although caution should be taken to avoid sun damage. Patient education
Parents should be educated to care about the patient’s hygiene. Frequent cleansing of the commonly affected areas during the remission has been found to reduce the recurrences as the cleansing with soap removes oils and improves seborrhea. Treatment other than gentle washing is frequently not necessary in most mild cases. Outdoor recreation, especially during summer, will also improve seborrhea, although caution should be taken to avoid sun damage.

Management - Specific

Fact Explanation
Gentle washing In many cases gentle washing the affected area with gentle rubbing is sufficient. Rubbing removes the scales. The lesion usually resolves spontaneously. Gentle eyelash cleaning with both baby shampoo and cotton applicators is effective in Seborrheic blepharitis. Gentle washing
In many cases gentle washing the affected area with gentle rubbing is sufficient. Rubbing removes the scales. The lesion usually resolves spontaneously. Gentle eyelash cleaning with both baby shampoo and cotton applicators is effective in Seborrheic blepharitis.
Topical antifungal agents Topical antifungals such as ketoconazole/ ciclopirox/ clotrimazole can be applied as shampoo or cream to the scalp area of the infant. Topical antifungal agents
Topical antifungals such as ketoconazole/ ciclopirox/ clotrimazole can be applied as shampoo or cream to the scalp area of the infant.
Zinc pyrithione Some strains of Malassezia are resistant to azole antifungals. In such instances zinc pyrithione can be effective. Selenium sulphide is another alternate. Zinc pyrithione
Some strains of Malassezia are resistant to azole antifungals. In such instances zinc pyrithione can be effective. Selenium sulphide is another alternate.
Tar Tar cream can be applied to scaling areas and removed several hours later by shampooing. Coal tar preparations may be used to remove dense scale. Tar
Tar cream can be applied to scaling areas and removed several hours later by shampooing. Coal tar preparations may be used to remove dense scale.
Topical corticosteroids Mild topical corticosteroids (Hydrocortisone) can be used for short intervals such as for 1-3 weeks to reduce inflammation in acute flares. Long term use of these steroids should be discouraged as they may increase the recurrence rate and foster dependence due to the rebound effect. Topical corticosteroids
Mild topical corticosteroids (Hydrocortisone) can be used for short intervals such as for 1-3 weeks to reduce inflammation in acute flares. Long term use of these steroids should be discouraged as they may increase the recurrence rate and foster dependence due to the rebound effect.
Topical calcineurin inhibitors Topical calcineurin inhibitors such as pimecrolimus and tacrolimus are effective in refractory cases. They are available as creams or ointments. Topical calcineurin inhibitors
Topical calcineurin inhibitors such as pimecrolimus and tacrolimus are effective in refractory cases. They are available as creams or ointments.

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