Seborrheic dermatitis

Seborrheic Dermatitis: Description

Seborrheic dermatitis (Seborrheic dermatitis) is a yellow-flaking, red rash (eczema) in the area of ​​the sebaceous glands (seborrheic). Sebum is a mixture of fats and proteins that protects the skin from drying out. The sebaceous glands are located primarily in the anterior (thoracic) and posterior (spine) gutters, on the face and on the hairy head – the preferred sites of seborrheic dermatitis. Scalp is also the site most commonly affected by skin disease in infants – hence the second name “head gland”.

Seborrheic dermatitis is not to be confused with seborrheic keratosis, which is also referred to as an old-age wart.

Seborrheic eczema: frequency

Three to five percent of people develop seborrheic dermatitis each year. However, considering mild cases that are not in need of treatment, this figure would probably be much higher. Men between the thirtieth and fortieth years are the most affected and severely affected. Seborrheic dermatitis is especially common in connection with HIV infection (especially AIDS) and Parkinson’s disease.

The form occurring in infants in the first weeks of life (up to the second year of age at the latest) is less common than seborrheic dermatitis in adults.

Seborrheic dermatitis: symptoms

Seborrheic dermatitis is characterized by mostly clear redness of the skin, on which yellowish scales are. Depending on the severity of the disease, however, the skin symptoms are very variable: in some patients, there is only an increased dandruff, others suffer from a massive inflammation of the skin. The infestation may additionally be localized or spread over several skin regions. The dandruff often feels greasy. Seborrheic dermatitis usually causes no pain and rarely itching.

Seborrheic dermatitis most commonly occurs on the head. In addition, the face and the front and rear welding channel are typical localizations. In addition, inflammation of the eyelids (blepharitis) may occur.

Seborrheic dermatitis can cause bacterial and fungal infections. Scratch marks as a result of increased itching additionally damage the skin.

In rare cases, seborrheic dermatitis may cause hair loss. Most such hair loss is associated with the eczema, but not conditioned by this.

Seborrheic Dermatitis: Different forms

There are different forms of seborrheic eczema:

The Seborrheic eczematid is a mild form with plaques that resemble a precursor. Seborrhea and sweat production are particularly pronounced. In part, the local desquamation is the only sign of the disease. The skin may also lose some of its pigmentation (hypopogmentation).

In contrast, that is Herd-shaped seborrheic dermatitis characterized by a fully pronounced symptomatology and often runs chronically and relapsing. The “foci” of seborrheic eczema are clearly reddish, irregular and yellowish.

A so-called intertriginous localization is led by some experts as a subset of Seborrheic Dermatitis. Intertriginous refers to areas on the body where opposite skin surfaces can touch or touch directly. These are for example the armpits, the area under the female breast, navel, groin and anus. In these cases, there is a high risk of infection. However, seborrhoeic dermatitis at these sites can also be confused with a pure fungal infection (mostly candida).

That’s especially hard Disseminated Seborrheic Dermatitisthat is subacute to acute. It occurs either without apparent cause or after irritation of existing flock. These are often symmetrically distributed, large-scale, confluent (confluent), flaky and possibly also characterized by larger weeping and encrusting skin defects (erosions). In pronounced cases, the whole body is reddened (erythroderma).

Rarely does this happen pityriasiform seborrheic dermatitis on, mostly on the fuselage. This form is called pityriasiform, because the rash is very similar to the rosenflechte (pityriasis rosea). The flocks are round-oval and confluent. Typically, the scaling is centrally emphasized. In contrast to the Röschenflechte there is no larger stove, which occurs first (the so-called primary medallion).

Seborrheic dermatitis in infants

Seborrheic dermatitis is most often found on the baby’s head. The so-called “head gneiss” is characterized by thick, yellow-greasy scales. In many cases, the disease begins in the apex area, near the eyebrows, on the cheek or nose. From there, seborrheic dermatitis can spread to the entire scalp and face. The hair appears greasy and stringy. In severe cases, scaling can be severe.

As with adult patients, seborrheic dermatitis is usually not disturbing for the affected infant, in contrast to atopic eczema. The “headgear baby” seems satisfied. It eats and sleeps normally. Seborrheic dermatitis sometimes spreads to the diaper area, groin, navel, armpits or, more rarely, chest. Infestation in different places is also possible. A spread of pathogens, especially fungi, leads to redness and altered scaling in the border area. Disseminated forms of seborrheic dermatitis are rare.

Seborrheic Dermatitis: Causes and Risk Factors

Why some people develop seborrheic dermatitis is unclear. The cause discussed is increased sebum production and excessive colonization of the skin with yeasts (such as Malassazia furfur = Pityrosporum ovale), to which the immune system reacts irritated accordingly. However, according to the current study, seborrheic dermatitis can also occur without increased yeast cell colonization. Overall, it remains unclear which of the factors mentioned plays the decisive role. A genetic predisposition to the disease could also contribute.

Seborrheic dermatitis of the head, which occurs in infants, normalizes with the decline in sebum production in the first few months of life. The sebum production is initially driven by residues of maternal hormones (androgens) in the body of the infant and thus supports the emergence of a “head gnaw”.

Related to other diseases

Seborrheic dermatitis is more common in certain diseases. These include a number of neurological diseases, in particular Parkinson’s disease, as well as HIV infections:

Parkinson’s patients often suffer from increased sebum production, which promotes the development of seborrheic dermatitis.

Seborrheic dermatitis can be found in up to 85 percent of those with AIDS. The reason for this frequent occurrence is unclear. Seborrheic dermatitis is one of the hallmarks of AIDS and is often very pronounced and resistant to treatment in these patients. The disease often reaches greater and heavier proportions in those infected with HIV than in otherwise healthy persons and can also extend to atypical skin areas. This is especially true for HIV patients, in whom the number of T-immune cells (CD4 +) is greatly reduced. Seborrheic dermatitis may also be considered a sign of regaining the immune system of an HIV patient after treatment has begun.

Also associated with seborrheic dermatitis is the so-called androgen effluvium – a combination of high levels of testosterone and a (hereditary) disorder of hair follicles.

Seborrheic dermatitis: Influencing factors

A number of medications can cause a skin rash similar to seborrheic dermatitis. These include erlotinib, sorafenib or interleukin-2. Also, the treatment with so-called neuroleptics, which are used in a number of psychiatric disorders, can promote the development of seborrheic dermatitis.

Stress and cold seem to worsen seborrheic dermatitis. In summer, however, the skin disease usually improves (under UV radiation). However, the effect of UV light is controversial, as seborrheic dermatitis can also be caused by UVA therapy in psoriasis.

Seborrheic dermatitis: examinations and diagnosis

The specialist in seborrheic dermatitis is the dermatologist or, for infants, the pediatrician. First, the doctor will ask various questions like:

• Since when do the skin symptoms exist?
• Itching the rashes?
• Have there been similar rashes in the past?
• Are there any other illnesses (other skin diseases, HIV infection)?

Then the doctor will examine the appropriate skin areas carefully. Firstly, the localization and secondly the appearance of the skin symptoms are decisive criteria for the diagnosis Seborrheic dermatitis.

In rare cases of doubt, the doctor can take a skin sample (biopsy) and have them examined by a pathologist. Although there are no specific signs of seborrhoeic dermatitis, it is typical to see a thickening of the spiny cell layer of the skin (acanthosis) through increased neoplasm of skin cells, impaired skin keratinization (parakeratosis), immigration of immune cells and water retention (spongiosis) ). In addition, more immune cells are found in the diseased skin than in healthy skin. The microscopic picture may resemble a dandruff (psoriasiform) or pessary rash (pityrasiform), especially in chronic cases. In the case of an existing HIV infection, the microscopic picture of the skin symptoms may be different.

Seborrheic dermatitis: differentiation to other diseases

Seborrheic dermatitis should be distinguished from atopic dermatitis, contact eczema, psoriasis, pollen disease, fungal infections and impetigo contagiosa. Other diseases that can cause similar skin conditions as seborrheic dermatitis include rosacea, lupus, syphilis, head louse infestations and tinea capitis.

In infants, the pediatrician must distinguish seborrheic dermatitis, especially from the “milk scab” (atopic eczema). In the milk scab, the scalp is clearly reddened, weeping and encrusted. It usually occurs later than Seborrheic dermatitis of the infant. In addition, the children seem to feel a strong itching.

Often only by the course distinguishable is the early childhood psoriasis (psoriasis capillitii). The scales are usually white rather than yellow in this case.

If the rash is particularly pronounced in the diaper area, it may be Windelsoor – a yeast infection with the yeast Candida.

Seborrheic dermatitis: treatment

Seborrheic dermatitis often requires treatment because of its usually chronic course, but it can also heal without medication.

The basis of the treatment is skin care and stress reduction. The main therapeutics are anti-fungal drugs (antifungals) and corticosteroids (“cortisone”). In the beard area, a shave can already be helpful.

It takes patience to treat seborrheic dermatitis. If the patient also suffers from conditions such as Parkinson’s disease or HIV, their treatment may already improve the appearance of the skin. As a general rule, if the rash persists despite adequate treatment, the diagnosis of seborrhoeic dermatitis should be reviewed.

Seborrheic Dermatitis: External Therapy

The external treatment is usually long-term and directed mainly against sebum, inflammation and infection. The different applications can usually be combined with each other.

Principle of treatment should be a good skin care. Use alkali-free detergents. They are intended to promote the degreasing of the skin and avoid infections.

keratolytics

Seborrheic dermatitis on the head can be treated well with special shampoos that dissolve dandruff and help fight infections. The active ingredients in a seborrhoeic dermatitis shampoo include selenium, zinc, urea, tar, salicylic acid, chloramphenicol, and ethanol. Such hair remedies are usually applied two to three times a week in the evening. Overnight you wrap a bandage around your head and in the morning you wash your hair. Possible side effects are mainly local reactions such as itching, burning and also color changes of the hair or the scalp.

antifungals

Seborrheic dermatitis is often treated with a cream containing anti-fungal agents (antifungals) such as ketoconazole or ciclopirox. These reduce the skin colonization with the yeast Malassezia and the inflammatory reaction. Such anti-fungal agents are also available as hair tinctures. Before washing it should be allowed to act for about five to ten minutes. It can be used daily for several weeks until seborrheic dermatitis recedes. Possible side effects include local irritation and burning sensation. Serious side effects from the local use of antifungal shampoos or ointments are rare.

corticosteroids

Seborrheic dermatitis can also be treated with cortisone-containing preparations for a short time – for example as shampoo, lotion or foam. It is important to start the treatment with the lowest possible cortisone preparations. Compared to the antifungal drugs, the cortisone application has been found to be equivalent. Cortisone also helps against any existing itching. An inflammation of the eyelids (blepharitis) in the context of Seborrheic dermatitis is usually treated with cortisone (and possibly antibiotics).

Calcineurin inhibitors

As effective as antimycotics and corticosteroids is the treatment of seborrheic dermatitis with so-called calcineurin inhibitors (such as pimecrolimus or tacrolimus). These drugs directly inhibit the immune system. However, the use as a long-term treatment is controversial because of a possibly increased risk for tumors (especially lymphomas and skin tumors).

antibiotics

Seborrheic dermatitis is only treated with antibiotics if there is an additional clear bacterial infection.

lithium

Seborrheic dermatitis can also be treated with lithium ointments. Presumably their positive effect is based on an anti-inflammatory effect. However, lithium supplements should not be used on the head.

Seborrheic Dermatitis: Internal Therapy

An internal use of medication may be particularly indicated when the disseminated variant of the disease is present or a seborrheic dermatitis shows a clear tendency to spread. Even with resistance to therapy and more than three affected areas, an internal treatment with cortisone or antimycotics may be considered. Antifungals are prescribed for daily use over a week. This is usually followed by a follow-up treatment (for example, two applications per month for three months). Isoretinoin can be used as a last resort to inhibit sebum production. An internal antibiotic treatment should be carried out only with clear signs of infection. Especially in patients with HIV infection Seborrheic dermatitis is often early on and longer to treat internally.

Treatment in infants

Since the “head gnee” usually heals spontaneously, a treatment is not necessarily required. To remove the scales, it is best to soften them overnight with oil (such as almond or olive oil). This way the scales of the head gneiss can be removed more easily the next day, for example with a comb. You can also use zinc containing ointments. Thereafter, the hair should be washed with a care shampoo. For effective removal of dandruff, this procedure usually needs to be repeated several times.

If these measures do not help, or if Seborrheic Dermatitis does not regress or even widen, a pediatrician should be consulted. If necessary, for example, he may prescribe a local antifungal treatment twice weekly for two weeks or a cortisone cream once a day for one week. The short-term treatment with local corticosteroids, even in children, is considered safe. If the symptoms do not improve within one week, the diagnosis Seborrheic Dermatitis should be reconsidered.

When using medications locally, it is important to always consider possible absorption through the skin, especially in infants and children.

Seborrheic Dermatitis: Homeopathy & Co.

There are a variety of alternative therapies for treating seborrheic dermatitis, including homeopathy, Bach flower remedies, Schuessler salts, home remedies and medicinal herbs. For example, bathing with wheat bran and oatstraw extract should promote healing. Menthol and thymol can reduce the itching. Shale oils are said to lower secretion. Such treatments should be accompanied by an experienced therapist.

Seborrheic dermatitis: disease course and prognosis

Seborrheic dermatitis in adults is often chronic and reoccurs after stopping the medication. For this reason, therapy often has to be repeated or continued continuously to prevent recurrence.

Seborrheic dermatitis damages the skin barrier to protect it from infection, promoting bacterial and fungal infections of the skin. These must be properly observed and treated to prevent the germs from advancing or spreading.

In rare cases, a contact sensitization develops in the sense of an allergic reaction or a seborrhoeic eczema passes into psoriasis (psoriasis vulgaris). With the help of modern therapy methods, seborrhoeic dermatitis is usually well controlled.

baby

The growth of the infant is not affected by the “head gnee” in most cases. The disease is therefore considered harmless. Nevertheless, the skin disease can recur within weeks or even months and then require re-treatment. Seborrheic eczema usually disappears by the end of the second year of life at most.

Seborrheic Dermatitis: Prevention

To prevent recurrence of seborrheic dermatitis, repeated use of the prescribed medications with rest may be necessary. However, even a good skin care and stress relief contribute to the fact that a seborrhoeic eczema does not flare up again. A possible treatment concept would be the once-weekly use of antifungal shampoos, also as facial or body wash. The long-term use of corticosteroids is not recommended because of the side effects: The drugs can lead to extensions of superficial small vessels (telangiectasia) and tissue loss of the skin (atrophy). Softening shampoos, on the other hand, can be used without restriction to prevent it Seborrheic dermatitis reappears.