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Seborrheic dermatitis
Classic presentation of greasy scale and erythema involving the central face and glabella regions and the brows.
Inflammation appears when hair is grown on the scalp and beard. Inflammation is more extensive in the elderly.
Seborrheic dermatitis may appear in the ears and be indistinguishable from eczema and psoriasis.
Erythema and scale vary in extent and intensity in the scalp. Scalp hairs become matted with adherent scale and debris, requiring careful and persistent debridement.
DESCRIPTION
Common, chronic. Pattern varies with age. Possibly caused by the yeast Pityrosporum ovale in those genetically predisposed.
HISTORY
• All ages affected. Infantile disease is self-limited; adult form tends to persist, with periods of remission and exacerbation. • Severe in elderly, those with HIV infection, patients with neurologic disease (e.g. Parkinson disease, stroke). • Flares precipitated by stress, fatigue, seasonal climate change.
PHYSICAL FINDINGS
• Infants have yellow, greasy, adherent scale on scalp (cradle cap), with minimal redness. Diaper area may be involved. Scale adherent to eyelashes and lid margins with erythema seen in children. • Adults have yellow, greasy scale on red base, localized in patches or diffuse. Central face, eyebrows, scalp margins, scalp, external ear canals, presternal area, upper back.
TREATMENT
• Facial disease initially treated with antifungal creams ketoconazole (Nizoral) 30 g q.d. or b.i.d. or ciclopirox (Loprox) gel 30 g q.d. or b.i.d. • Skin and scalp disease may be suppressed with daily facial washing with zinc pyrithione ZnP bar soap or Head & Shoulders shampoo; selenium sulfide (Selsun) 2.5% 120 mL; selenium sulphide 2.25% in a vehicle containing urea and zinc pyrithiones (Selseb) 180 mL; sodium sulfacetamide/sulfur cleansers for facial involvement. Scalp scale may be reduced with salicylic acid shampoos (e.g. T-Sal) Scalp inflammation may also be suppressed with tar shampoos (e.g. T-Gel) or corticosteroid shampoos (e.g. Clobex). • Group VI steroid creams or lotions (e.g. Desonide lotion 2 oz b.i.d.) for several days may be required periodically if antifungal creams fail. • Dense scale in children and adults may be removed with Derma-Smooth FS lotion (peanut oil, mineral oil, fluocinolone acetonide 0.01%) applied to the scalp, washed out in the morning. Wetting the scalp before application and using a shower cap will help penetration. • Blepharitis may be suppressed with zinc- or tar-containing anti-dandruff shampoos. Brief applications of 1% hydrocortisone cream may also be used.
