Seborrheic Dermatitis: Is it Danger? How to Treat?

Seborrheic dermatitis is also known as seborrheic eczema, seborrhea. Seborrheic dermatitis is a common chronic skin condition affecting areas with sebaceous glands: head, face, torso.

Seborrheic dermatitis is very common in both adults and children. It affects between 1% and 3% of the population. The incidence of the disease has three peaks: during infancy, puberty and the age of 40-60 years.

Forms and complications of seborrheic dermatitis

A distinction is made between children’s and adult forms of seborrheic dermatitis.

Sometimes the disease is associated with psoriasis (seborrheic psoriasis).

The severity of the disease ranges from mild dandruff to severe erythroderma. Dandruff affects the scalp in the hair growth area. In 70% of children, seborrheic dermatitis usually appears at 3 months of age and resolves spontaneously by 6-12 months.

Information verified by the iythealth.com team.

In adults, seborrheic dermatitis begins in adolescence. It predominates in young and elderly individuals. It most often affects men.

Classification and stages of seborrhea

There are two forms of the disease:

Congenital – develops in early childhood due to a genetic predisposition of the sebaceous glands to produce large amounts of sebum;
Acquired – marginal blepharitis, seborrheic dermatitis of the external auditory canal, blotchy dermatitis, asbestos-like lichen (scaling of the scalp).

By localization:

scalp;
face;
widespread (scalp, face and upper third of chest and back).

Stages of disease development:

acute;
chronic.

There are such clinical variants of the disease:

Marginal blepharitis – dermatitis, in which the eyelids are affected, there is a yellowish-pink coloring of the skin and pruffy whitish scales. Patients are bothered by moderate itching, a feeling of grittiness in the eyes, slight swelling and hyperemia of the conjunctiva, lacrimation, and photophobia.
Seborrheic dermatitis of the external ear canal is similar to otitis externa. It is manifested by erythema (redness), peeling, and itching. There is also swelling and cracking in the areas behind the ears and on the skin under the shells of the ears.

Spotted seborrheic dermatitis is a common form with a chronic relapsing course. The lesion is localized in the middle third of the forehead, in the area of the eyebrows and the scalp.
Asbestiform lychee (follicular asbestiform keratosis, psoriasiform seborrhea) is a buildup of solid white scales and crusts on the scalp that stick to the hair. In severe inflammation, normal or erythematous and edematous skin is exposed under the crusts (when removed).

Causes of seborrheic dermatitis

The reasons for the development of the disease are not fully understood. Seborrheic dermatitis is not a sebaceous gland disease, although it develops in areas saturated with them.

A significant role in the development of the disease is played by yeast-like fungi of the genus Malassezia (which exist on the skin of most healthy people, but in some people can cause rashes and skin irritation), the specific composition of skin surface lipids, as well as the characteristics of the immune response to Malazessia fungi and products of their activity.

In adults, a severe course is associated with the following conditions:

Oily skin (seborrhea);

lack of sleep and stress;
history of seborrheic dermatitis and psoriasis in relatives;
Immunosuppressive conditions (organ transplants, HIV, lymphoma);

neurological or psychiatric disease.

The main cause of seborrheic dermatitis in children is increased sebum activity (rapid growth and secretion of sebum), resulting from the circulation of maternal hormones in the child’s blood during the first weeks of life. Malassezia is not a leading factor in children, unlike in adults.

Symptoms

Seborrheic dermatitis is manifested by redness, peeling “greasy” scales with a certain localization of foci.

In children – isolated on the scalp (in the frontal area it is called “baby bonnet” or “milk crust”), behind the ears and in the external auditory canal, on the face (in the eyebrows, wings of the nose), on the back of the neck (on the edge of hair growth), in the skin friction areas (in folds), under the diaper.

Sometimes seborrheic dermatitis in children is widespread. It is a rash in the form of spots with greasy crusts, merging into more extensive areas. In some cases, accompanied by itching.

In adults, seborrheic dermatitis is present in the scalp area, on the face: the eyebrows, behind the ears, inside the auricles, on the wings of the nose and in the areas adjacent to the nose cheeks.

It may appear as individual spots with peeling, total lesions of the scalp, eyelid lesions as blepharitis, lesions of the chest wall as individual nodules and spots with crusts on the surface, inflammation of hair follicles on the skin of the upper half of the trunk (ostiofolliculitis).

In typical cases, seborrheic dermatitis has exacerbations in winter and improvements in summer.

Diagnosis

The diagnosis of seborrheic dermatitis is most often made on the basis of the clinical picture. However, it is necessary to make a differential diagnosis with a number of other diseases: eczema, psoriasis, microbial and fungal skin lesions. For this purpose, mycological and microscopic examinations of scales from the skin surface are performed.

Diagnosis is based on the clinical picture, if necessary, histological examination – the study of a sample of the affected tissue under a microscope.

Differential diagnosis depends on the location of seborrheic dermatitis:

on the facial skin, the disease must be differentiated with rosacea, discoidal lupus erythematosus, psoriasis, in exceptional cases with erythematous vesicular disease;
on the scalp – with psoriasis;

on the skin of the back and chest – with psoriasis, multicolor and pink lupus.

Discoid lupus erythematosus (redness), hyperkeratosis (thickening of the skin) and cicatricial skin atrophy are typical triad signs of the disease. The affected areas are located in the facial area (wings of the nose and cheeks) and visually resemble a butterfly. Lesion foci are also found on the auricles, scalp, upper chest and back, and fingers of the hands. The positive Benier-Meshchersky symptom (scraping of whitish scales that sit tightly in the central part of the pink spots causes pain) and exacerbation of the dermatosis in the spring and summer distinguish lupus from seborrheic dermatitis. However, in cases where scar atrophy has not yet formed or is mildly expressed, it is advisable to perform a histological examination.

Scalp psoriasis is manifested by plaques, itching, and silvery scales on the skin. Psoriasis does not cause hair loss, which distinguishes this disease from dermatitis. In dermatology, the localization of rashes at the edge of hair growth is called “psoriatic crown”. In some types of psoriasis, the plaques have a reddish or even purplish color. The presence of areas of spongiosis (intercellular swelling of the epidermis) also distinguishes seborrheic dermatitis from psoriasis.

Rosacea presents as redness with stinging and burning sensations. Blood vessels are clearly visible under the skin surface, and papules or papulopustules appear on the skin, which are very similar in appearance to blackheads.

Treatment of seborrheic dermatitis

Seborrheic dermatitis may go untreated. But it often runs in waves, with remissions and exacerbations.

The disease is chronic and prone to relapses, so the goal of therapy is not so much to cure it as to prolong remission.

At the heart of the pathological process is a disorder of the sebaceous glands, so it is important to eliminate the factors affecting their activity. An important role is played by nutrition and the state of the gastrointestinal tract. Therefore, patients with seborrhea is recommended to reduce consumption of sweet, fatty, smoked and spicy foods, and take enzyme medications that facilitate digestion. Patients should also undergo preventive examinations by a gastroenterologist and treat chronic gastrointestinal diseases.

Treatment of seborrheic dermatitis begins with the identification of possible pathogenetic factors of the dermatosis and their further correction, often in the form of long-term systematic therapy. In most cases, the seborrheic dermatitis is successfully treated, but usually only a clinical remission rather than a complete recovery is achieved.

Seborrheic dermatitis is treated with anti-inflammatory, antimicrobial and antifungal agents. Combination drugs containing glucocorticosteroids, antibiotics and fungicides are highly effective. Such a composition allows to simultaneously influence several links in the pathogenesis of the disease:

Corticosteroids have anti-inflammatory, anti-allergic, anti-exudative (reduce secretions) and antipruritic effects;
a fungicide has antifungal activity against Malassezia;
an antibiotic fights pathogenic bacteria.

Such external remedies include Pimafucort, Triderm, Tetraderm, Akriderm. However, corticosteroids should not be applied to the face for a long time, as it can lead to the development of rosacea-like dermatitis.

Seborrheic dermatitis is also treated with the following drugs: azelaic acid, zinc perithione and topical calcineurin inhibitors (pimecrolimus, tacrolimus).

Azelaic acid. The action of azelaic acid is associated with the following properties: antimicrobial, anti-inflammatory and normalizing keratinization (skin density and elasticity). With a mild to moderately severe form of seborrheic dermatitis of the facial skin, the drug “Skynoren” is effective.

Zinc pyrithione. The effectiveness of activated zinc pyrithione in seborrheic dermatitis is due to a combination of anti-inflammatory action with antifungal activity against yeast-like fungi Malassezia furfur. Zinc pyrithione is included in “Tsinovit” – a shampoo for dandruff and shower gel. The products help remove dandruff, irritation, and itching. You can also use the therapeutic shampoo “Sebiprox” with 1% cyclopyroxolamine.

Sulsena forte. Available as a shampoo and paste. Sulsena shampoo is suitable for frequent regular use. Paste “Sulcena” (2%) is used regularly twice a week for one month. For prevention use paste “Sulsena” (1%) twice a week for one month. Frequency of prophylactic use is once every six months.

Specifics of treatment methods

When selecting external skin care products, choose preparations containing the following ingredients that reduce inflammation of the skin:

Keratolytics: salicylic acid, lactic acid, urea, propylene glycol.
Topical antifungal agents: shampoos and creams containing ketoconazole (cyclopyrox).
Products with selenium disulfide or zinc pyrithione.

Low potency topical corticosteroids may only be used when prescribed by a physician to relieve the acute phase of the disease, except on the face.
In cases of resistant forms, patients may be offered oral antifungal medications.
In severe cases, isotretinoin or phototherapy may be considered.

Sulfur-salicylic ointment (2%) is used to remove scales and crusts in asbestos-like lichen, applied for 4-6 hours, and then washed off with an antifungal shampoo. Sulfur salicylic ointment has exfoliating, antibacterial and antiparasitic effects. In some cases, corticosteroids in the form of ointments or solutions are effective. Ointments can be used under a dressing.

Removal of crusts on the scalp of infants is carried out with a 2% salicylic acid solution in olive oil. Foaming shampoo for babies with salicylic acid and “milk bark” gel-oil are also used.

External treatment with keratoplastic disinfectants (restoring the stratum corneum of the epidermis) such as naphthalan (3%) and ichthyol ointment (2%) is enough for a mild form of seborrheic dermatitis. In places of maceration (impregnation of skin with liquid and swelling) affected areas are pre-lubricated with 1% aqueous solution of methylene blue and drying agents – spray and lotion “Neotanin” zinc ointment, zinc balm.

To eliminate the dyspeptic syndrome – nausea, heaviness in the abdomen, feeling of congestion, pain and burning in the epigastrium – digestive enzymes are prescribed.

When monitoring the diet of a child with seborrheic dermatitis, the type of feeding must be taken into account. With artificial feeding it is important to choose an adapted milk formula, with breastfeeding – you need a full and balanced diet of proteins, fats and micronutrients for the mother.

Prognosis. Prevention

The disease is chronic in nature, but with timely treatment, prolongation of remission is possible. Juvenile seborrheic dermatitis can be cured completely.

Seborrheic dermatitis occurs as a result of immune and endocrine disorders, so prevention will focus on the treatment of underlying diseases and the exclusion of provoking factors. For prevention, it is also necessary to observe personal hygiene and use special care products for the skin, body and hair avoid stress and control the condition of the digestive organs.