DANDRUFF/ SEBORRHOEIC DERMATITIS

Seborrhoeic dermatitis is characterized by inflammation and scaling in areas with a rich supply of oil producing glands (sebaceous glands), namely the scalp, face and upper trunk. Dandruff is the mildest manifestation of the disease.

Epidemiology

Seborrhoeic dermatitis is a common disease, and the prevalence ranges from 2 to 5% in different studies. It is more common in males than in females. The disease usually starts during puberty and is more common around 40 years of age.

Causation

They are now many studies indicating that the lipophilic yeast Malassezia plays an important role in seborrhoeic dermatitis.

Exacerbating factors

·         Parkinson’s disease.

·         Neuroleptic drugs.

·         Emotional stress.

·         HIV disease.

Clinical characteristics and course

Seborrhoeic dermatitis is one of the most common skin diseases. The disease is characterized by red scaly lesions predominantly located on the scalp, face and upper trunk. It is more common in males than in females. The disease usually starts during puberty and is most common around 40 years of age. The skin lesions are distributed on the scalp, eyebrows, nasolabial folds, cheeks, ears, central chest and back regions, axillae (armpit) and groins. Around 90-95% of all patients have scalp lesions and lesions on body are found in approximately 60% of the patients. The lesions are red and covered with greasy scales. Itching is common in the scalp.

Complications include skin thickening (lichenification), boils (secondary bacterial infection) and infection in ear canal (otitis externa). The course of seborrhoeic dermatitis tends to be chronic with recurrent flare-up. A seasonal variation is observed with the majority of patients being better during the summertime. Mental stress and dry air are factors that may aggravate the disease. A genetic predisposition is also of importance in the disease.

Treatment

General therapeutic guidelines

Seborroeic dermatitis is a chronic disease and to inform the patients about the risk for relapse and predisposing factors is very important. Stress and winter climate have a negative effect on the majority of patients and summer and sunshine have a positive effect.  

Avoidance of oil application on scalp and hair is a must

Regular head wash (daily/alternate days) with a normal shampoo is recommended

Recommended therapies

Antifungal treatment

Antifungal therapy is effective in the treatment of seborrhoeic dermatitis and, because it reduces the number of the Malassezia yeasts.                                                                                                                      Ketoconazole is very effective in vitro against the Malassezia yeasts. It can be prescribed in the form of topical shampoo/lotion. Severe cases may require oral ketoconazole. Shampoos containing zinc pyrithione, ciclopirox olamine, sertakonazole, fluconazole or selenium sulfide are also effective and widely used.

Corticosteroids

Mild corticosteroid solutions, creams or ointments are effective in the treatment of seborrhoeic dermatitis due to a non-specific anti-inflammatory activity.

Keratolytic therapy

When lesions are covered with thick adherent scales keratolytic therapy, especially in the scalp, is necessary.

Calcipotriol

It is a vitamin D3 analogue and effective in the treatment of seborrheic dermatitis

Antibiotics

Seborrhoeic dermatitis especially in the scalp and external ear canal may be secondarily infected with bacteria. In these patients topical or oral antibacterial therapy in combination with regular treatment are indicated.

Dr Arika Sethi

Dr Pradeep Sethi

@ http://www.directhairtransplantation.com/