Seborrhoeic dermatitis

Seborrhoeic dermatitis has nothing to do with sebum or any other kind of greasiness. There are two distinct types, adult and infantile.

Adult seborrhoeic dermatitis

The adult type is more common in men and in those with a tendency to scaling and dandruff in the scalp. There are several commonly affected areas:

Seborrhoeic dermatitis affects the central part of the face, scalp, ears, and eyebrows. There may be an associated blepharitis, giving some red eyes and also otitis externa.

• The lesions over the sternum sometimes start as a single "medallion" lesion. A flower-like "petaloid" pattern can occur. The back may be affected as well.

• Lesions also occur in well defined areas in the axillae and groin and beneath the breasts.

Typically the lesions are discrete and erythematous and they may develop a yellow crust. The lesions tend to develop from the hair follicles. It is a persistent condition that varies in severity.

Clinically and pathologically the condition has features of both psoriasis and eczema. There is thickening of the epidermis with some of the inflammatory changes of psoriasis and the intercellular oedema of eczema. Parakeratosis—the presence of nuclei above the basement layer—may be noticeable. Recently, increased numbers of Pityrosporum ovale organisms have been reported.

Treatment

Topical steroids produce a rapid improvement, but not permanent clearing. Topical preparations containing salicylic acid, sulphur, or ichthammol may help in long term control. Triazole antifungal drugs by mouth have been reported to produce clearing and can be used topically. These drugs clear yeasts and fungi from the skin, including P. ovale, which is further evidence for the role of this organism.

Seborrhoeic dermatitis affecting centre of face
Lichen Planus Pathology
Lichen planus—pathology
Seborrhea Infants
Seborrhoeic dermatitis

Characteristics of seborrhoeic dermatitis

Clinical features of psoriasis

Clinical features of eczema

Possible family history

Possible family history

Sometimes related to stress

Sometimes worse with stress

Itching—rare

Usually itching

Extensor surfaces and trunk

Flexor surfaces and face

Well defined, raised lesions

Poorly, demarcated lesions

Hyperkeratosis

Oedema, vesicles, lichenification

Scaling, bleeding points

Secondary infection sometimes,

beneath scales

present

Koebner's phenomenon

Nails affected

Scalp affected

Mucous membranes

not affected

Distribution Pattern Lichen Planus

Seborrheoic dermatitis under breasts Seborrhoeic dermatitis—distribution pattern

Infantile seborrhoeic dermatitis

In infants less than six months old a florid red eruption occurs with well defined lesions on the trunk and confluent areas in the flexures associated with scaling of the scalp. There is no consistent association with the adult type of seborrhoeic dermatitis. It has been suggested that infantile seborrhoeic dermatitis is a variant of atopic eczema. It is said to be more common in bottle fed infants. A high proportion of affected infants develop atopic eczema later but there are distinct differences.

Itching is present in atopic eczema but not in seborrhoeic dermatitis.

The clinical course of atopic eczema is prolonged with frequent exacerbation, whereas seborrhoeic dermatitis clears in a few weeks and seldom recurs.

Treatment comprises emollients, avoiding soap, and applying hydrocortisone combined with an antibiotic plus nystatin (for example, Terra-Cortril plus nystatin cream). Hydrocortisone can be used on the scalp.

Allergy

IgE concentrations are often raised in atopic eczema and food allergy is common, but not in seborrhoeic dermatitis.

Perioral dermatitis

Perioral dermatitis is possibly a variant of seborrhoeic dermatitis, with some features of acne. Papules and pustules develop around the mouth and chin. It occurs mainly in women.

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