Seborrheic dermatitis, SD

Notes

## Basic introduction

  • SD is an inflammatory scaling disease that mainly affects the scalp and the face and to a lesser extent other parts of the body with a high density of oil glands like the upper chest, axilla and anogenital areas.
  • In infants, SD presents as infantile seborrheic dermatitis that presents and resolves within the first 3 to 4 months of life, in the majority of cases.
  • In immunocompetent adults, the disease is characterized by periods of exacerbation and remission.

## Etiology of adult SD

  • Etiology of adult SD is not fully known
  • Sebaceous gland secretion
  • Change in colonization and metabolism of cutaneous microflora, Malassezia
  • Individual susceptibility and host response

## Epidemiology and Statistics

  • Globally, the prevalence of SD among the general population is 1-5%.
  • Globally, the prevalence of SD among the HIV positive patients is 34-83%.
  • The prevalence of SD in males > females.

## Risk factors

  • Acne
  • Head injury stroke
  • HIV
  • Infrequent shampoos or skin cleaning
  • Lotions that contain alcohol
  • Obesity
  • Oily skin
  • Parkinson disease
  • Stress or fatigue
  • Weather extremes

## Possible Complications

  • Psychological distress
  • Low self-esteem

Secondary bacterial or fungal infections

Symptoms
  • Dandruff (dry or greasy diffuse scaling)
  • Yellow-red scaling papules along the hairline, external auditory canal, the eye brows, conjunctivae and naso-labial folds
  • There can be cradle cap in newborn (infantile seborrheic dermatitis)
  • Pruritus (in some cases)
  • Oval, discoid plaques (medallion lesions)
Diagnosis
  • Clinical evaluation
Differential
  • Candidiasis
  • Contact dermatitis
  • Dandruff (pityriasis sicca)
  • Lichen simplex
  • Pityriasis rosea
  • Pityriasis versicolor
  • Psoriasis
  • Rosacea
  • Systemic lupus erythematosus
  • Tinea capitis
Prevention
  • Controlling the risk factors
  • Careful attention to skin care
Reference

1. Clark GW, Pope SM, Jaboori KA; Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015 Feb 1;91 (3):185-90.

2. Del Rosso, J. Q. (2011). Adult Seborrheic Dermatitis: A Status Report on Practical Topical Management. The Journal of Clinical and Aesthetic Dermatology, 4(5), 32–38.

3. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

4. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

Picardo M, Cameli N. Seborrheic dermatitis. In: Williams H, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B, editors. Evidence-Based Dermatology. Second Edition. Malden, Massachusetts: Blackwell Publishing; 2008. pp. 164–170

Management
  • Ketoconazole shampoo OR,
  • Selenium sulphide shampoo OR,
  • 2% salicylic acid in olive oil OR,
  • Sulphur and salicylic acid or tar preparation OD OR,
  • Mild topical steroid preparations
  • Treatment of superimposed infections (fungal, bacterial or viral)

## Other products that can be used in treatment of SD

  • Propylene glycol solution 35 to 50%
  • Hydrocortisone 1% cream
  • Ketoconazole 2% cream
  • Miconazole 2% cream
  • Bifonazole 1% shampoo
  • Ciclopirox 1% cream
  • Ciclopirox 1.5% shampoo
  • Lithium succinate 8%/, zinc sulfate 0.05% ointment
  • Terbinafine 1% cream/solution
  • Metronidazole 1% gel
  • Azelaic acid
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