Seborrhea Dermatitis Flashcards
What is seborrhea dermatitis? What causes it?
Sub-acute or chronic inflammatory disorder
Accelerated cell turnover (9 to 10 days)
Primarily found on the scalp, face and trunk
Also seen in eyebrows, eyelid margins, cheeks, external ear canal, central back
Affects men more often than women
Possible yeast infection (Malassezia)
Possible abnormality of the oil glands and hair follicles
When completing differential diagnosis of seborrhoea, what other conditions should you consider?
Psoriasis, rosacea, demodex dermatitis, atopic eczema, pityriasis veriscolor contact dermatitis, tinea infections
What are risk/aggravating factors?
Increased incidence in HIV or AIDS patients
Genetics may predispose persons
Medical conditions (Parkinson’s, depression, mood disorders)
Environmental (low humidity and temperature, stress)
Medications (lithium, cimetidine, haloperidol, methyldopa)
What are the signs and symptoms?
Mild, greasy scaling of the scalp area
Starts as small patches and spreads
Dull, yellowish, oily, scaly areas on red skin
Itching is common
Groin area, axillae show lesions that are bright red, without scaling
“Cradle cap” in infants (thick, dry, yellowish-brown scales no the face, forehead, ears or entire scalp
What are red flags?
Under 2 years of age
No improvement with OTC treatment after 2 weeks
Symptoms are severe
Symptoms spread to other parts of the body (face and groin)
Signs of infections (pus or drainage from areas, crust formation)
What are the treatment goals?
Reduce inflammation and the epidermal turnover rate of the scalp skin
Minimize or eliminate visible erythema and scaling
What are non-pharmacologic treatment options?
Remove triggers/aggravating factors (avoid irritating soaps, gels, greasy creams, hair products, avoid excessive hot water, avoid or decrease exposure to cold, dry air, use a cool air humidifier, warm compresses to area)
Wash hair with a general, non-medicated shampoo every other day or daily
Control stress
What are OTC options?
Treatment should loosening and remove scale and crust, inhibit yeast and decrease redness and itching. Initial treatment with an agent that reduces Malassezia is recommended (zinc pyrithione, selenium sulfide or ketoconazole shampoo).
Second line treatements reduce scaling and decreasing epidermal turnover (keratolytic agent (salicylic acid), anti proliferative agent (coal tar), hydrocortisone cream once or twice daily until symptoms clear for 1 to 2 weeks - apply after shampooing to enhance absorption
Which anti fungal shampoo is the most effective for the treatment of scalp seborrhea?
Ciclopirox 1%
How should medicated shampoo be used?
Medicated shampoos need to be used only 2 to 4 times weekly for until controlled (approximately 4 to 5 weeks) then reduce to once a week to prevent relapse
What is ciclopriox?
A broad spectrum agent. It is effective against dermatophytes, yeast and some bacteria. It is available as a 1.5% shampoo (Stieprox). It should be used 2 to 3 times per week for treatment of final infections associated with seborrheic dermatitis until remission, then once weekly to prevent relapse
It contains coconut diethanolamide
May discolour hair (grey, white or dyed hair)
Adverse effects: pruritus, irritation
What are the monitoring parameters?
Scaling (monitor daily for improvement within 7 to 10 days)
Redness (monitor daily for improvement within 8 to 12 weeks)
Thickness of plaques (monitor daily for improvement within 6 to 8 weeks)
Itching (monitor for improvement within 1 to 2 weeks)
What is cradle cap?
A self limited condition
Usually starts in infants first month and resolves by age three or four months
No proven relationship between experiencing cradle cap and the development of seborrhea dermatitis as an adult
Presentation: yellowish, greasy scale on scalp
How is cradle cap treated?
Wash hair daily with mild baby shampoo
Loosen scales with soft brush before rinsing
Gently massage in mineral oil or baby oil to loosen scales, then washed with baby shampoo
If on the face, use mild soap and moisturizer
