Seborrheic dermatitis

Question 1

What is seborrheic dermatitis?

Answer 1

aka seborrheic eczema

• common, chronic
• affects face, scalp and trunk

Pathology poorly understood, linked to MALASSEZIA fungus (many people carry this asymptomatically in pityriasis versicolor)

Danruff is a type of seborrheic dermatitis

Two types: for Adult and for Infantile seborrheic dermatitis.

Question 2

Pathology of seborrheic dermatitis?

Answer 2

associated with Malassezia fungus (though this is also found in asymptomatic).

Inflammatory response to waste products of fungus.

Individual variation in natural skin barrier and skin lipids may be a factor.

Question 3

Presentation of infantile seborrheic dermatitis?

vs eczema?

Answer 3

• babies <3month
• usually resolves in 12 months
• non itchy
• affects scalp (cradle cap), folds of neck, nappy areas, fold of elbows and knees
• yellow coloured greasy scale
• associated with bad nappy rash with candida co-infection

vs eczema is typically:

• after 3 months
• very itchy
• very dry cracked skin (not oily yellow)
• nappy rash area is spared

Question 4

Management of infantile seborrheic dermatitis?

Answer 4

MEDICAL:
Scalp:
1. 1% suphur + 1-2% salicylic acid cream
- apply overnight, shampoo off next morning
- 3x a week until resolved
2. 6% salicylic acid lotion
3. older children:
- ketoconazole 1-2% shampoo
- miconazole 2% shampoo

Face limps and trunk:

• 2% sulphur + 2% salicylate cream
• ketoconazole 2% cream OD or BD
• severe: corticosteroids, 1% hydrocortisone or 0.05% betamethasone

Nappy area:

• 1% hydrocortisone with 2% ketoconazole (or 1% clotrimazole)
• combo cream eg hydrozole cream

BASIC:

• keep clean and dry
• warm water and pat dry
• keep skin exposed to air
• avoid soap
• cradle cap: was flakes with baby oil or soft parafin
• nappy rash: change nappy frequently
• zinc based cream, sudocreme, acts as a barrier

Question 5

Presentation of adult seborrheic dermatitis?

Answer 5

• presents from teenage years onwards
• often recurrent
• typically head, near hair, eg scalp, eyebrows, eyelids (blepharitis), nasolabial folds
• can affect torso, groin and perinanal area
• red rash with yellow greasy scale
• secondary candidiasis is common in flexures

Question 6

Management of adult seborrheic dermatitis?

Answer 6

SCALP:

• salicylic acid 2% and sulphur 2% (kids face n limbs)
• wash of with selenium sulphide shampoo
• ketoconazole shampoo after the selenium shampoo
• non-responsive try steroid, betamethasone dipropionate 0.5%
• still unresponsive add coal tar 1% overnight

FACE and BODY

• hydrocortisone 1% + clotrimazole 1% (hydrozole) BD for 2 weeks
• unseccessful try steroid and antifungal cream strong and separate