• Clinical science

Seborrheic dermatitis (Seborrheic eczema)

Abstract

Seborrheic dermatitis is a common chronic inflammatory skin condition that affects areas with high sebaceous activity (e.g., scalp). The etiology remains unknown, but microbial colonization of the skin (esp. Malassezia), immunological factors, climate, or stress have been implicated. This condition is characterized by intermittent flares with intervening asymptomatic periods. Patients may exhibit either an erythematous, patchy scaling, or greasy yellow crusts, both of which could be associated with burning or itching. Early treatment of acute flares with topical glucocorticosteroids is recommended. Topical ketoconazole is used to relieve symptoms. The condition tends to recur over a lifetime despite treatment. Infantile seborrheic dermatitis (also referred to as “cradle cap”) is a subtype of seborrheic dermatitis and appears shortly after birth, primarily affecting the scalp. As opposed to seborrheic dermatitis in adults, it usually heals without treatment after a few months.

Epidemiology

References:[1][2][3][4][5]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[4][5][6][7][8][9]

Pathophysiology

  • The pathophysiology is not yet fully understood
    • Colonization of the yeast Malassezia furfur (previously known as Pityrosporum ovale) in areas with sebaceous glands
    • → inadequate or abnormal immune response to the yeast ) and/or exposure to irritants (toxin production or lipase activity) responses
    • → inflammatory reaction of the skin
  • Endogenous precipitants; : psychological stress; , fatigue, sleep deprivation, and hormonal changes
  • Exogenous precipitants; : climate (the condition improves in the summer months and worsens in winter; ), trauma (e.g., excoriation of the skin from scratching), medication

References:[10][4][5][11]

Clinical features

  • Chronic course with episodic, active phases (associated burning and itching) alternating with inactive, asymptomatic periods
  • Ranges from erythematous plaques with patchy scaling → greasy yellow crusts, distributed along areas with hair and oily skin:
    • Scalp (dandruff and itching)
    • Forehead/hairline and retroauricular area
    • Nasolabial fold, eyebrows and periocular region (blepharitis: scaly red eyelid margins)
    • Cheeks and chin
    • Presternal and interscapular regions
    • Axillae, under breasts, umbilicus, and groin area

References:[12][4][5]

Diagnostics

Consider HIV or Parkinson's disease if there is a marked or unusual distribution of seborrheic dermatitis!References:[5]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

  • Exposure to the sunlight may help relieve symptoms.
  • Avoid precipitating factors if possible
  • Medical therapy

Local use of steroidal creams is not advised for long term use because it increases the risk of recurrences and can lead to dependence!

References:[4][5][13]

Complications

References:[4]

We list the most important complications. The selection is not exhaustive.

Prognosis

  • No cure: often a chronic, recurrent course
  • The active phases of seborrheic dermatitis are easily controllable with treatment

References:[5]

Special patient groups

Infantile seborrheic dermatitis

References:[14][15][16][17]

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  • 3. Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015; 91(3): pp. 185–190. pmid: 25822272.
  • 4. Handler MZ. Seborrheic Dermatitis. In: James WD. Seborrheic Dermatitis. New York, NY: WebMD. http://emedicine.medscape.com/article/1108312. Updated April 10, 2017. Accessed May 16, 2017.
  • 5. Sasseville D. Seborrheic Dermatitis in Adolescents and Adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.uptodate.com/contents/seborrheic-dermatitis-in-adolescents-and-adults. Last updated December 30, 2015. Accessed May 16, 2017.
  • 6. Zisova LG. Malassezia species and seborrheic dermatitis. Folia Med (Plovdiv). 2009; 51(1): pp. 23–33. pmid: 19437895.
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  • 8. Feinstein RP. Androgenetic Alopecia. In: Khardori R. Androgenetic Alopecia. New York, NY: WebMD. http://emedicine.medscape.com/article/1070167. Updated February 24, 2017. Accessed May 16, 2017.
  • 9. Levin NA. Beyond spaghetti and meatballs: Skin diseases associated with the Malassezia yeasts. Dermatology Nursing. 2009; 21(1). url: http://www.medscape.com/viewarticle/589255_1.
  • 10. Agabegi SS, Agabegi ED. Step-Up To Medicine. Baltimore, MD, USA: Lippincott Williams & Wilkins; 2013.
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  • 12. Cunliffe T. Seborrhoeic Eczema. http://www.pcds.org.uk/clinical-guidance/seborrhoeic-eczema. Updated December 20, 2016. Accessed May 16, 2017.
  • 13. Gold MH, Bridges T, Avakian EV, Plaum S, Fleischer AB, Hardas B. An open-label pilot study of naftifine 1% gel in the treatment of seborrheic dermatitis of the scalp. J Drugs Dermatol. 2012; 11(4): pp. 514–518. pmid: 22453590.
  • 14. Gary G. Optimizing treatment approaches in seborrheic dermatitis. J Clin Aesthet Dermatol. 2013; 6(2): pp. 44–49. url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3579488/.
  • 15. Ngan V. Leiner Disease. http://www.dermnetnz.org/topics/leiner-disease/. Updated January 1, 2003. Accessed May 16, 2017.
  • 16. Agrawal R. Diaper Dermatitis. In: Elston DM. Diaper Dermatitis. New York, NY: WebMD. http://emedicine.medscape.com/article/911985. Updated August 11, 2016. Accessed May 16, 2017.
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last updated 11/19/2018
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