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/
