Seborrhoeic dermatitis

From Wikipedia, the free encyclopedia - View original article

Seborrhoeic dermatitis
Classification and external resources
ICD-10L21
ICD-9690.10
DiseasesDB11911
MedlinePlus000963
eMedicinederm/396
MeSHD012628
 
Jump to: navigation, search
Seborrhoeic dermatitis
Classification and external resources
ICD-10L21
ICD-9690.10
DiseasesDB11911
MedlinePlus000963
eMedicinederm/396
MeSHD012628

Seborrhoeic dermatitis (also seborrheic dermatitis AmE, seborrhea) (also known as "seborrheic eczema"[1]) is an inflammatory[2] skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceous-gland-rich areas of skin. In adolescents and adults, seborrhoeic dermatitis usually presents as scalp scaling similar to dandruff or as mild to marked erythema of the nasolabial fold.

Contents

Causes

Acute form of seborrhoeic dermatitis on scalp

Seborrhoeic dermatitis is caused by seborrhea, a pathologic overproduction of sebum, and subsequent infection and inflammation.

Fungal

Seborrhoeic dermatitis may involve an inflammatory reaction to a proliferation of a form of the yeast Malassezia,[3][4] though this has not been proven.[5]

The main species found in the scalp is Malassezia globosa, others being Malassezia furfur (formerly known as Pityrosporum ovale) and Malassezia restricta. The yeast produces toxic substances that irritate and inflame the skin. Patients with seborrhoeic dermatitis appear to have a reduced resistance to the yeast.[citation needed] However, the colonization rate of affected skin may be lower than that of unaffected skin.[6]

Only saturated fatty acids (FAs) have been shown to support Malassezia growth. It has also been shown that while number density of M. globosa and M. restricta do not directly correlate to dandruff presence or severity, removal correlates directly with amelioration of flaking. Furthermore, in dandruff-susceptible individuals pure oleic acid, an unsaturated FA and Malassezia metabolite, induces flaking in the absence of Malassezia by direct effects on the host skin barrier. These findings support the following hypothesis:

Malassezia hydrolyze human sebum releasing a mixture of saturated and unsaturated fatty acids. They take up the required saturated FAs, leaving behind unsaturated FAs. The unsaturated FAs penetrate the stratum corneum and because of their non-uniform structure breach the skin's barrier function. This barrier breach induces an irritation response, leading to dandruff and seborrheic dermatitis.[7][unreliable source?]

Other

Genetic, environmental, hormonal, and immune-system factors have been shown to be involved in the manifestation of seborrhoeic dermatitis.[8][9]

Seborrhoeic dermatitis may be aggravated by illness, psychological stress, fatigue, sleep deprivation, change of season and reduced general health.[10]

In children, excessive vitamin A intake can cause seborrhoeic dermatitis.[11] Lack of biotin,[10] pyridoxine (vitamin B6)[10][12] and riboflavin (vitamin B2)[10] may also be a cause.

Those with immunodeficiency (especially infection with HIV) and with neurological disorders such as Parkinson's disease (for which the condition is an autonomic sign) and stroke are particularly prone to it.[13]

Symptoms

Seborrhoeic dermatitis on scalp

Seborrhoeic dermatitis' symptoms appear gradually and usually the first signs are flaky skin and scalp.[14] Symptoms occur most commonly anywhere on the skin of the face, behind the ears and in areas where the skin folds. Flakes may be yellow, white or grayish.[15] Redness and flaking may also occur on the skin near the eyelashes, on the forehead, around the sides of the nose, and the chest and upper back.

In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[16]

Commonly, patients experience mild redness, scaly skin lesions and in some cases hair loss.[17] Other symptoms include patchy scaling or thick crusts on the scalp, red, greasy skin covered with flaky white or yellow scales, itching, soreness and yellow or white scales that may attach to the hair shaft.[18]

Seborrheic dermatitis can occur in infants younger than three months and it causes a thick, oily, yellowish crust around the hairline and on the scalp. Itching is not common among infants. Frequently, a stubborn diaper rash accompanies the scalp rash.[16] Usually, when it occurs in infants the condition resolves itself within days and with no treatment.

In adults, symptoms of seborrheic dermatitis may last from few weeks to years. Many patients experience alternating periods of inflammation. The condition is referred to a specialist when self-care has proven unsuccessful.

Hair loss

It is unclear if seborrheic dermatitis causes permanent hair loss, although the inflammation involves the hair follicles.[19] Hair loss can result from many factors individually and combined, including excess oil production from hormonal imbalance, stress, extreme hot or cold weather, weakened immune system, Parkinson's disease, certain neurological conditions and poor scalp hygiene.

Treatments

Proper scalp hygiene is primary in treating seborrheic dermatitis. Dermatologists recommend topical treatments such as shampoos, cleansers or creams/lotions that contain antifungal, anti-inflammatory, sebo-suppressive or keratolytic ingredients:

One combination approach combines a dandruff shampoo, antifungal agent and topical steroid. If a class III steroid is unsuccessful, short-term "pulse fashion" use of a more potent topical steroid in combination with a dandruff shampoo and antifungal agent may put some resistant patients into remission and actually decrease total steroid exposure. Therapeutic choices include a nonfluorinated class III steroid such as mometasone furoate (Elocon) or an extra-potent class I or class II topical steroid such as clobetasol propionate (Temovate) or fluocinonide (Lidex). The more potent agents may be applied once or twice per day, even on the face, but must be stopped after two weeks because of the increased frequency of side effects. If the patient responds before the two-week limit, the agent should be stopped immediately. Some prescription creams such as topical cortisone may be effective in minimizing inflammation and itchiness. Antihistamines are used primarily to reduce itching, if present. However, research studies suggest that some antihistamines have anti-inflammatory properties.[20]

Antifungals

Over-the-counter
Prescription

Antihistamines

Other medications

Phototherapy

Some dermatologists recommend photodynamic therapy using UV-A and UV-B laser or red and blue LED light to inhibit the growth of Malassezia fungus and reduce seborrhoeic inflammation.[30][31][32]

Natural treatments

Supplements

Diet

There is evidence of a relationship between seborrheic dermatitis and intestinal yeast, such as candida.[58] An antifungal diet consisting of the elimination of sugar and increasing vegetable intake should reduce seborrheic dermatitis.[59][60]

Prevention

A clean scalp is essential to preventing a flare-up of seborrhoeic dermatitis. Daily use of an over-the-counter or prescription anti-fungal shampoo is recommended.[61]

Both natural and artificial UV radiation curbs the growth of Malassezia yeast.[62] Low humidity also inhibits yeast growth. A short hair cut allows air and sun to readily reach affected areas of the scalp.

See also

References

  1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  2. ^ "seborrheic dermatitis" at Dorland's Medical Dictionary
  3. ^ Hay, R.J.; Graham-Brown, R.A.C. (1997). "Dandruff and seborrhoeic dermatitis: causes and management". Clinical and Experimental Dermatology 22 (1): 3–6. doi:10.1046/j.1365-2230.1997.d01-231.x. PMID 9330043. 
  4. ^ Nowicki R (January 2006). "[Modern management of dandruff]" (in Polish). Polski Merkuriusz Lekarski 20 (115): 121–4. PMID 16617752. 
  5. ^ Parry, ME; Sharpe, GR (1998). "Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast". British Journal of Dermatology 139 (2): 254–63. doi:10.1046/j.1365-2133.1998.02362.x. PMID 9767239. 
  6. ^ "Treatment of Seborrheic Dermatitis". http://www.aafp.org/afp/20000501/2703.html. Retrieved September 10, 2010. 
  7. ^ http://www.pgbeautygroomingscience.com/role-of-lipid-metabolism-in-seborrheic-dermatitis-dandruff.php
  8. ^ Johnson, Betty Anne; Nunley, Julia R. (May 2000). "Treatment of seborrheic dermatitis". American Family Physician 61 (9): 2703–10, 2713–4. PMID 10821151. http://www.aafp.org/afp/20000501/2703.html. 
  9. ^ Janniger CK, Schwartz RA (July 1995). "Seborrheic dermatitis". American Family Physician 52 (1): 149–55, 159–60. PMID 7604759. 
  10. ^ a b c d Schwartz, Robert A.; Janusz, Christopher A.; Janniger, Camila K. (July 2006). "Seborrheic dermatitis: an overview". American Family Physician 74 (1): 125–30. PMID 16848386. http://www.aafp.org/link_out?pmid=16848386. 
  11. ^ MedlinePlus Encyclopedia Hypervitaminosis A
  12. ^ Nutritional Neuropathy at eMedicine
  13. ^ "Seborrhoeic dermatitis and dandruff (seborrheic eczema). DermNet NZ". . DermNet NZ. 2012-03-20. http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html. Retrieved 2012-06-10. 
  14. ^ "Dermatitis Seborrheic Treatment". http://www.dermatitisseborrheic.net/. Retrieved June 11, 2010. 
  15. ^ "Seborrheic Dermatitis". http://www.hmc.psu.edu/healthinfo/s/seborrheicdermatitis.htm. Retrieved June 11, 2010. 
  16. ^ a b "Dermatitis". http://www.merckmanuals.com/home/skin_disorders/itching_and_noninfectious_rashes/dermatitis.html. Retrieved June 11, 2010. 
  17. ^ "What is Seborrheic Dermatitis?". http://www.mamashealth.com/skin/seb.asp. Retrieved June 11, 2010. 
  18. ^ "Symptoms". http://www.mayoclinic.com/health/seborrheic-dermatitis/ds00984/dsection=symptoms. Retrieved June 11, 2010. 
  19. ^ "Seborrheic Dermatitis and Dandruff". http://www.reddingdermatology.com/seborrheic-dermatitis.html. Retrieved June 11, 2010. [dead link]
  20. ^ Grob, JJ; Castelain, M.; Richard, MA; Bonniol, JP; Beraud, V.; Adhoute, H.; Guillou, N.; Bonerandi, JJ (1998). "Antiinflammatory properties of cetirizine in a human contact dermatitis model. Clinical evaluation of patch tests is not hampered by antihistamines.". Acta Dermato-Venereologica 78(3): 194–7. 
  21. ^ Faergemann, J.; Jones, T.C.; Hettler, O.; Loria, Y. (1996). "Pityrosporum ovale(Malassezia furfur)as the causative agent of seborrhoeic dermatitis: new treatment options". British Journal of Dermatology 134: 12–5: discussion 38. doi:10.1111/j.1365-2133.1996.tb15652.x. PMID 8763461. 
  22. ^ Shemer, A; Kaplan, B; Nathansohn, N; Grunwald, MH; Amichai, B; Trau, H (2008). "Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study". The Israel Medical Association journal 10 (6): 417–8. PMID 18669136. 
  23. ^ Roelofzen JH, Aben KK, Oldenhof UT, et al. (April 2010). "No increased risk of cancer after coal tar treatment in patients with psoriasis or eczema". J. Invest. Dermatol. 130 (4): 953–61. doi:10.1038/jid.2009.389. PMID 20016499. 
  24. ^ "European Journal of Dermatology". John-libbey-eurotext.fr. http://www.john-libbey-eurotext.fr/fr/revues/medecine/ejd/e-docs/00/01/87/5E/article.md. Retrieved 2012-06-10. 
  25. ^ Leeming JP (1993). "Use of topical lithium succinate in the treatment of seborrhoeic dermatitis". Dermatolog 187 (2): 149–50. doi:10.1159/000247228. PMID 8358107. 
  26. ^ Murray, Michael; Pizzorno, Joseph (1997). "Encyclopedia of Natural Medicine" (Revised 2nd Edition) Three Rivers Press. ISBN 0-7615-1157-1[page needed]
  27. ^ Smith, J. G.; Wehr, RF; Chalker, DK (1976). "Corticosteroid-induced cutaneous atrophy and telangiectasia. Experimental production associated with weight loss in rats". Archives of Dermatology 112 (8): 1115–7. doi:10.1001/archderm.112.8.1115. PMID 952530. 
  28. ^ Scheinfeld, Noah S. (2005). "Seborrheic Dermatitis". SKINmed 4 (1): 49–50. doi:10.1111/j.1540-9740.2005.03961.x. PMID 15654167. 
  29. ^ Firooz, A.; Solhpour, A; Gorouhi, F; Daneshpazhooh, M; Balighi, K; Farsinejad, K; Rashighi-Firoozabadi, M; Dowlati, Y (2006). "Pimecrolimus Cream, 1%, vs Hydrocortisone Acetate Cream, 1%, in the Treatment of Facial Seborrheic Dermatitis: A Randomized, Investigator-Blind, Clinical Trial". Archives of Dermatology 142 (8): 1066–1067. doi:10.1001/archderm.142.8.1066. PMID 16924062. 
  30. ^ Wikler JR, Janssen N, Bruynzeel DP, Nieboer C (1990). "The effect of UV-light on pityrosporum yeasts: ultrastructural changes and inhibition of growth". Acta Dermato-venereologica 70 (1): 69–71. PMID 1967880. 
  31. ^ Calzavara-Pinton PG, Venturini M, Sala R (2005). "A comprehensive overview of photodynamic therapy in the treatment of superficial fungal infections of the skin". Photochem Photobiol 78 (1): 1–6. doi:10.1016/j.jphotobiol.2004.06.006. PMID 15629243. 
  32. ^ Tim Maisch,a Rolf-Markus Szeimies,a Giulio Jori*b and Christoph Abels (2004 [1]). Antibacterial photodynamic therapy in dermatology. 
  33. ^ "WHO Monographs on Selected Medicinal Plants - Volume 1: Aloe Vera Gel". World Health Organization. http://apps.who.int/medicinedocs/en/d/Js2200e/6.html. Retrieved 2011-05-28. 
  34. ^ Feily A, Namazi MR (February 2009). "Aloe vera in dermatology: a brief review". Giornale Italiano Di Dermatologia E Venereologia 144 (1): 85–91. PMID 19218914. http://www.minervamedica.it/index2.t?show=R23Y2009N01A0085. 
  35. ^ "Coconut oil & seborrheic dermatitis". http://forum.lowcarber.org/archive/index.php/t-185246.html. Retrieved 2011-04-15. 
  36. ^ Gupta AK, Nicol K, Batra R (2004). "Role of antifungal agents in the treatment of seborrheic dermatitis". American Journal of Clinical Dermatology 5 (6): 417–22. doi:10.2165/00128071-200405060-00006. PMID 15663338. 
  37. ^ Satchell AC, Saurajen A, Bell C, Barnetson RS (December 2002). "Treatment of dandruff with 5% tea tree oil shampoo". Journal of the American Academy of Dermatology 47 (6): 852–5. doi:10.1067/mjd.2002.122734. PMID 12451368. 
  38. ^ "A Modern Herbal | Heartsease". Botanical.com. http://www.botanical.com/botanical/mgmh/h/hearts10.html. Retrieved 2012-06-10. 
  39. ^ Matthias Augustin: 6.46 Stiefmütterchen In: Phytotherapie bei Hauterkrankungen, S.226-227; Elsevier, Urban & Fischer 2004. ISBN 978-3-437-56120-7 Volltext
  40. ^ Meyer, S.; Vogt, T.; Landthaler, M.; Karrer, S. (2005). "Einsatz von Phytopharmaka in der Dermatologie". Der Hautarzt 56 (5): 483–99; quiz 500–1. doi:10.1007/s00105-005-0949-y. PMID 15830171. 
  41. ^ Al-Waili NS (July 2001). "Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff". European Journal of Medical Research 6 (7): 306–8. PMID 11485891. 
  42. ^ Donnarumma, G; Buommino, E; Baroni, A; Auricchio, L; De Filippis, A; Cozza, V; Msika, P; Piccardi, N et al. (2007). "Effects of AV119, a natural sugar from avocado, on Malassezia furfur invasiveness and on the expression of HBD-2 and cytokines in human keratinocytes". Experimental Dermatology 16 (11): 912–9. doi:10.1111/j.1600-0625.2007.00613.x. PMID 17927574. 
  43. ^ Piccardi N, Piccirilli A, Choulot JC, Chadoutaud B, Msika P; Pharmacological and Clinical Activities of 5-Alpha Avocuta : Application for the Management of Androgenic Disorders [2]
  44. ^ Zhilyakova, ET; Novikov, OO; Naumenko, EN; Krichkovskaya, LV; Kiseleva, TS; Timoshenko, EY; Novikova, MY; Litvinov, SA (2009). "Study of Monarda fistulosa essential oil as a prospective antiseborrheic agent". Bulletin of experimental biology and medicine 148 (4): 612–4. doi:10.1007/s10517-010-0777-7. PMID 20396753. 
  45. ^ Ji, GE (2009). "Probiotics in primary prevention of atopic dermatitis". Forum of nutrition. Forum of Nutrition 61: 117–28. doi:10.1159/000212744. ISBN 978-3-8055-9097-6. PMID 19367116. 
  46. ^ A.G. Gueniche , D. Philippe , P. Bastien , E. Buyukpamukcu , P. Reygagne , I. Castiel(Clichy; France)Oral supplementation with probiotic Lactobacillus paracasei ST improves dandruff condition [3] [4][verification needed]
  47. ^ Kiratli H, Irkeç M, Orhan M (2000). "Tear lactoferrin levels in chronic meibomitis associated with acne rosacea". European Journal of Ophthalmology 10 (1): 11–4. PMID 10744199. 
  48. ^ Dreno, B; Moyse, D; Alirezai, M; Amblard, P; Auffret, N; Beylot, C; Bodokh, I; Chivot, M et al. (2001). "Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris". Dermatology (Basel, Switzerland) 203 (2): 135–40. doi:10.1159/000051728. PMID 11586012. 
  49. ^ Basset-Séguin, N; Sotto, A; Guillot, B; Jourdan, J; Guilhou, JJ (1998). "Zinc status in HIV-infected patients: relation to the presence or absence of seborrheic dermatitis". Journal of the American Academy of Dermatology 38 (2 Pt 1): 276–8. doi:10.1016/S0190-9622(98)70250-6. PMID 9486690. 
  50. ^ Guillard, O; Fauconneau, B; Piriou, A; Pineau, A (1997). "In vitro study of the antiseborrheic activity of zinc L-cysteate, a novel zinc compound, on rat preputial gland". Pharmacology 55 (1): 54–8. doi:10.1159/000139512. PMID 9309801. 
  51. ^ Olivi, O; Balli, F; Olivi, F (1986). "A new and original therapy for seborrheic dermatitis". La Pediatria medica e chirurgica 8 (3): 407–9. PMID 2947051. 
  52. ^ Klevay, LM (1979). "Diets deficient in copper and zinc?". Medical hypotheses 5 (12): 1323–6. doi:10.1016/0306-9877(79)90101-4. PMID 161345. 
  53. ^ Abou-Mourad, NN; Farah, FS; Steel, D (1979). "Dermopathic changes in hypozincemia". Archives of dermatology 115 (8): 956–8. doi:10.1001/archderm.115.8.956. PMID 111624. 
  54. ^ "Blackcurrant properties". http://www.liveandfeel.com/medicinalplants/black_currant.html. 
  55. ^ Graedon, Joe; Graedon, Teresa (2008-04-17). "The People's Pharmacy". Atlanta Journal Constitution Evening Edge (Atlanta Journal Constitution): p. 15. 
  56. ^ Ammon, HP; Safayhi, H.; Mack, T.; Sabieraj, J. (1993). "Mechanism of antiinflammatory actions of curcumine and boswellic acids.". J Ethnopharmacol 38(2-3): 113–9. 
  57. ^ Banno, N.; Akihisa, T.; Yasukawa, K.; Tokuda, H.; Tabata, K.; Nakamura, Y.; Nishimura, R.; Kimura, Y. et al. (2006). "Anti-inflammatory activities of the triterpene acids from the resin of Boswellia carteri". J Ethnopharmacol 107 (2): 249–53. doi:10.1016/j.jep.2006.03.006. PMID 16621377. 
  58. ^ Buslau, M; Hänel, H; Holzmann, H (1989). "The significance of yeasts in seborrheic eczema". Der Hautarzt; Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 40 (10): 611–3. PMID 2533189. 
  59. ^ Putzier, E (1989). "Dermatomycoses and an antifungal diet". Wiener medizinische Wochenschrift (1946) 139 (15–16): 379–80. PMID 2556862. 
  60. ^ Menzel, I; Holzmann, H (1986). "Reflections on seborrheic scalp eczema and psoriasis capillitii in relation to intestinal mycoses". Zeitschrift fur Hautkrankheiten 61 (7): 451–4. PMID 2939630. 
  61. ^ , April 1, 2012 
  62. ^ Wikler, JR.; Janssen N., Bruynzeel DP., Nieboer C. (1990). "The effect of UV-light on pityrosporum yeasts: ultrastructural changes and inhibition of growth". Acta dermato-venereologica (Stockholm) 70 (1): 69–71. PMID 1967880. 

External links