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Seborrheic
dermatitis
Seborrheic dermatitis has several different names and differences
in spelling. While seborrheic is the common US spelling, in Europe
an "o" may be added to make "seborrhoeic" dermatitis.
Seborrheic eczema, seborrhea oleosa, and pityriasis capitis are
other names for the same condition. Diagnosis of this condition
is generally straightforward, but the differential diagnosis includes
a variety of conditions, such as psoriasis vulgaris, atopic dermatitis,
tinea capitis and candidiasis, as well as other, more rare conditions.
Seborrheic dermatitis is first and foremost a skin condition, but
it can also involve temporary hair loss if the dermatitis is located
on the scalp or other terminal haired skin areas. The dermatitis
shows up as scaly inflamed skin which can be itchy or painful to
touch. This is an inflammatory condition the cause of which is not
well understood. It seems that the sebaceous glands attached to
the hair follicles begin to produce a very rich form of sebum. The
sebum contains fewer free fatty acids and squalene but increased
amounts of triglycerides and cholesterol. The trigger for this is
most likely androgen steroid sensitivity. Times of hormone fluctuation,
such as during puberty, can activate the onset of seborrheic dermatitis.
Seborrheic dermatitis can also be observed in some new born babies
when maternal androgens are passed from the mother to the baby across
the placenta.
The exact cause of seborrheic dermatitis is not known but there
is probably a genetic component involved. The prevalence of seborrheic
dermatitis changes in different locations and communities around
the world. The most susceptible ethnic group are Caucasians and
people of Celtic descent in particular. People with Parkinson's
disease are also very susceptible to seborrheic dermatitis. People
with Parkinson's disease produce very high levels of of sebum. This
can be partly improved by patients taking L-dopa supplements.
The excess rich sebum production in seborrheic dermatitis can
trigger the proliferation of skin flora. Yeast Pityrosporon ovale
(also called Malassezia furfur) has been shown to gradually
increase in numbers with the intensity of seborrheic dermatitis.
This excessive yeast proliferation may further be a cause of irritation
and inflammation. Although all this inflammation is not specifically
directed at the hair follicle, if hair follicles are in the vicinity
of the inflammatory cells then they can still be adversely affected.
Hair follicles find inflamed skin an unhealthy environment in which
to grow. Thus seborrheic dermatitis may non specifically cause hair
loss. This hair loss should be reversible with reduction of the
inflammation intensity.
Seborrheic
dermatitis treatment
There are several treatments for seborrheic dermatitis. The most
simple treatment involves the use of medicated anti-dandruff type
shampoos to control the skin proliferation and scaling. Several
shampoos might be recommended for alternating use on different days
and each with its own particular activity. Some shampoos for seborrheic
dermatitis contain sulfur and tar or oil of Cade. These shampoos
have been available for many years. More recently Azole based shampoos
(Nizoral) have been made available over the counter. Other shampoos
may contain fluconazole. All can be effective in treating seborrheic
dermatitis.
Some dermatologists may prescribe antibiotics to control the skin
flora and in doing so indirectly reduce the inflammation. The inflammation
may be directly treated using a corticosteroid cream to control
the immune response. Where excess androgen production in women is
suspected as the root cause of seborrheic dermatitis this may be
controlled with antiandrogen treatment. Some European dermatologists
use topical estrogen treatments or low dose isotretinoin to treat
seborrheic dermatitis.
Seborrheic
dermatitis references
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