Seborrhoeic dermatitis

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Seborrhoeic dermatitis
SpecialtyDermatology Edit this on Wikidata

Seborrhoeic dermatitis (also seborrheic dermatitis AmE, seborrhea) (also known as "seborrheic eczema"[1]) is an inflammatory[2] skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceous-gland-rich areas of skin. In adolescents and adults, seborrhoeic dermatitis usually presents as scalp scaling similar to dandruff or as mild to marked erythema of the nasolabial fold.

Causes

Acute form of seborrhoeic dermatitis on scalp

Fungal

Seborrhoeic dermatitis may involve an inflammatory reaction to a proliferation of a form of the yeast Malassezia,[3][4] though this has not been proven.[5]

The main species found in the scalp is Malassezia globosa, others being Malassezia furfur (formerly known as Pityrosporum ovale) and Malassezia restricta. The yeast produces toxic substances that irritate and inflame the skin. Patients with seborrhoeic dermatitis appear to have a reduced resistance to the yeast.[citation needed] However, the colonization rate of affected skin may be lower than that of unaffected skin.[6]

Only saturated fatty acids (FAs) have been shown to support Malassezia growth. It has also been shown that while number density of M. globosa and M. restricta do not directly correlate to dandruff presence or severity, removal correlates directly with amelioration of flaking. Furthermore, in dandruff-susceptible individuals pure oleic acid, an unsaturated FA and Malassezia metabolite, induces flaking in the absence of Malassezia by direct effects on the host skin barrier. These findings support the following hypothesis:

Malassezia hydrolyze human sebum releasing a mixture of saturated and unsaturated fatty acids. They take up the required saturated FAs, leaving behind unsaturated FAs. The unsaturated FAs penetrate the stratum corneum and because of their non-uniform structure breach the skin's barrier function. This barrier breach induces an irritation response, leading to dandruff and seborrheic dermatitis.[7]

Other

Genetic, environmental, hormonal, and immune-system factors have been shown to be involved in the manifestation of seborrhoeic dermatitis.[8][9]

Seborrhoeic dermatitis may be aggravated by illness, psychological stress, fatigue, sleep deprivation, change of season and reduced general health.[10]

In children, excessive vitamin A intake can cause seborrhoeic dermatitis.[11] Lack of biotin,[10] pyridoxine (vitamin B6)[10][12] and riboflavin (vitamin B2)[10] may also be a cause.

Those with immunodeficiency (especially infection with HIV) and with neurological disorders such as Parkinson's disease (for which the condition is an autonomic sign) and stroke are particularly prone to it.[13]

Symptoms

Seborrhoeic dermatitis on scalp

Seborrhoeic dermatitis' symptoms appear gradually and usually the first signs are flaky skin and scalp.[14] Symptoms occur most commonly anywhere on the skin of the face, behind the ears and in areas where the skin folds. Flakes may be yellow, white or grayish.[15] Redness and flaking may also occur on the skin near the eyelashes, on the forehead, around the sides of the nose, and the chest and upper back.

In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[16]

Commonly, patients experience mild redness, scaly skin lesions and in some cases hair loss.[17] Other symptoms include patchy scaling or thick crusts on the scalp, red, greasy skin covered with flaky white or yellow scales, itching, soreness and yellow or white scales that may attach to the hair shaft.[18]

Seborrheic dermatitis can occur in infants younger than three months and it causes a thick, oily, yellowish crust around the hairline and on the scalp. Itching is not common among infants. Frequently, a stubborn diaper rash accompanies the scalp rash.[16] Usually, when it occurs in infants the condition resolves itself within days and with no treatment.

In adults, symptoms of seborrheic dermatitis may last from few weeks to years. Many patients experience alternating periods of inflammation. The condition is referred to a specialist when self-care has proven unsuccessful.

Hair loss

It is unclear if seborrheic dermatitis causes permanent hair loss, although the inflammation involves the hair follicles.[19] Hair loss can result from many factors individually and combined, including excess oil production from hormonal imbalance, stress, extreme hot or cold weather, weakened immune system, Parkinson's disease, certain neurological conditions and poor scalp hygiene.

Treatments

Proper scalp hygiene is primary in treating seborrheic dermatitis. Dermatologists recommend topical treatments such as shampoos, cleansers or creams/lotions that contain antifungal, anti-inflammatory, sebo-suppressive or keratolytic ingredients:

One combination approach combines a dandruff shampoo, antifungal agent and topical steroid. If a class III steroid is unsuccessful, short-term "pulse fashion" use of a more potent topical steroid in combination with a dandruff shampoo and antifungal agent may put some resistant patients into remission and actually decrease total steroid exposure. Therapeutic choices include a nonfluorinated class III steroid such as mometasone furoate (Elocon) or an extra-potent class I or class II topical steroid such as clobetasol propionate (Temovate) or fluocinonide (Lidex). The more potent agents may be applied once or twice per day, even on the face, but must be stopped after two weeks because of the increased frequency of side effects. If the patient responds before the two-week limit, the agent should be stopped immediately. Some prescription creams such as topical cortisone may be effective in minimizing inflammation and itchiness. Antihistamines are used primarily to reduce itching, if present. However, research studies suggest that some antihistamines have anti-inflammatory properties.[20]

Antifungals

Over-the-counter
Prescription

Antihistamines

Other medications

Phototherapy

Some dermatologists recommend photodynamic therapy using UV-A and UV-B laser or red and blue LED light to inhibit the growth of Malassezia fungus and reduce seborrhoeic inflammation.[30][31][32]

Natural treatments

  • Aloe Vera applied topically[33][34]
  • Coconut oil applied topically[35]
  • Tea tree oil: diluted to 5% applied topically[36][37]
  • Viola tricolor or Heartsease: applied topically. Is recognised by Germany's Commission E as Monograph 195 for the treatment of Cradle Cap a form of seborrheic dermatitis.[38][39][40]
  • Honey apply diluted crude (raw) honey (90% honey diluted in warm water) every other day on the lesions with gentle rubbing for 2-3 mins. Honey is left on for 3 hr before gentle rinsing with warm water. Treatment is continued for 4 weeks.[41]
  • Avocado Extracts: AV119[42] & 5-alpha Avocuta, also known as butyl avocadate[43] applied topically.
  • Monarda fistulosa[44]

Supplements

Diet

There is evidence of a relationship between seborrheic dermatitis and intestinal yeast, such as candida.[58] An antifungal diet consisting of the elimination of sugar and increasing vegetable intake should reduce seborrheic dermatitis.[59][60]

Prevention

A clean scalp is essential to preventing a flare-up of seborrhoeic dermatitis. Daily use of an over-the-counter or prescription anti-fungal shampoo is recommended., April 1, 2012 {{citation}}: Missing or empty |title= (help)

Both natural and artificial UV radiation curbs the growth of Malassezia yeast.[61] Low humidity also inhibits yeast growth. A short hair cut allows air and sun to readily reach affected areas of the scalp.

See also

References

  1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  2. ^ "seborrheic dermatitis" at Dorland's Medical Dictionary
  3. ^ Hay, R.J.; Graham-Brown, R.A.C. (1997). "Dandruff and seborrhoeic dermatitis: causes and management". Clinical and Experimental Dermatology. 22 (1): 3–6. doi:10.1046/j.1365-2230.1997.d01-231.x. PMID 9330043.
  4. ^ Nowicki R (2006). "[Modern management of dandruff]". Polski Merkuriusz Lekarski (in Polish). 20 (115): 121–4. PMID 16617752. {{cite journal}}: Unknown parameter |month= ignored (help)
  5. ^ Parry, ME; Sharpe, GR (1998). "Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast". British Journal of Dermatology. 139 (2): 254–63. doi:10.1046/j.1365-2133.1998.02362.x. PMID 9767239.
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  8. ^ Johnson, Betty Anne; Nunley, Julia R. (2000). "Treatment of seborrheic dermatitis". American Family Physician. 61 (9): 2703–10, 2713–4. PMID 10821151. {{cite journal}}: Unknown parameter |month= ignored (help)
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  11. ^ MedlinePlus Encyclopedia: Hypervitaminosis A
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External links

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