Seborrheic dermatitis (SD) is a common chronic skin condition that typically affects the face, scalp & body areas. It has a papulosquamous shape. The disease’s bimodal incidence is reflected by the adult (ASD) & infantile (ISD) variants.
Seborrheic dermatitis often does not bother infants, but it can create great parental anxiety. It frequently manifests as solid, oily scales on the crown & frontal areas of the scalp.
It starts in the first 3 months of life, is usually moderate, self-limiting, & resolves on its own by the first birthday. ASD, on the contrary hand, is characterized by a recurrent & remitting type of illness and is placed third for its ability to reduce the life quality behind contact and atopic dermatitis.
Epidemiology
The frequency of seborrheic dermatitis is estimated to be 5% worldwide, but dandruff, its non-inflammatory variation, is possibly nearer to 50%. Every ethnic group, everywhere in the world, is impacted by SD. The frequency of SD is bimodal, peaking during the first 3 years of life and again after the fourth decade from adrenarche.
At 3 months, there were about 72 percent of pre-schoolers in Australia had SD; after that, there was a sharp decline, with an overall prevalence of 10 percent. The Rotterdam Research and data analysis also revealed that 14 percent of middle-aged & elderly persons had SD. However, in HIV-AIDS, 35 percent of people with early Human immunodeficiency virus (HIV have SD, and 85% of people with AIDS have the condition.
SD is at risk for developing because of the following factors:
Increased activity of the sebaceous glands
Men’s sex
Age
Immunodeficiency, such as
Transplanting a kidney
HIV/AIDS
Lymphoma
Psychological and neurological conditions, such as
Stroke
severe depression
Parkinson disorder
Impaired autonomic function
Low ambient temperatures or humidity
Anatomy
Pathophysiology
The following are some suggested pathophysiologic pathways for SD:
The bacterium on the skin is harmed.
A weakened immunological response to Malassezia species that is accompanied by a weaker T-cell reaction and complementactivation
Fats that are unsaturated are more prevalent on the skin’s surface
Peripheral neurotransmitter disruption
Abnormal keratinocyte shedding
Disruptions of the epidermis barrier linked to genetic causes
In addition to degrading sebum & consuming saturated fats, Malassezia species. also affect the lipid equilibrium on the skin’s surface. Malassezia species. involvement is further supported by their separation from SD lesions and the considerable improvement of SD following antifungal therapy
To prove a connection between ISD and the emergence of ASD, however, there seems to be insufficient data.
Management:
The method will change depending on the individual’s age, as well as the location & seriousness of the ailment. Treatments should target the underlying illness process as well as any secondary symptoms, particularly pruritus and the hyperkeratotic spectrum, Staphylococcal invasion, and related characteristics. The consensus of a Danish group of experts was that topical antifungals should be used as the first line of treatment and that topical calcineurin inhibitors & corticosteroids should only be used in the event of severe symptoms or flare-ups.
In ISD, it’s crucial to take the scale-crust on the cradle cap and parental anxiousness into account. To soften and remove the cradle cap scales, use a soft brush and sorbolene lotion or cream. In contrast hand, itching & pain in ASD must be treated immediately. Antipruritics, anti-inflammatories, antifungals, and keratolytics should all be present in a standard formulary. Facts support the use of topical 1% zinc pyrithione. 1% – 2% ketoconazole, 1% hydrocortisone, and 1% ciclopirox for the treatment of scalp & non-scalp SD.
While a powerful corticosteroid may be required for short-term therapy of scalp ASD, intermittent usage of modest topical corticosteroids plus the antifungal imidazole is convenient, and it can be very successful. Combinations of ingredients like pine or coal tar (keratolytic/antipruritic), salicylic acid (keratolytic), sulfur (antimicrobial/keratolytic), & sulfacetamide (antibacterial/anti-inflammatory) are frequently found in shampoos. These can be applied to the patient’s scalp & non-scalp areas and removed with water after five to ten minutes.
Topical 1% pimecrolimus or other formulations with site-appropriate therapeutic potential should be used on occasion to reduce the side effects of topical corticosteroids. The standard of care employs the antifungal & anti-inflammatory characteristics of itraconazole (evaluated for CYP450 drug reaction, which could even deteriorate cardiovascular disease), ketoconazole (regulate liver health; Black Box warning), & fluconazole (calculate the dose according to kidney function). Oral therapy should be considered for refractory or generalized diseases.
A Typical Formulary Might Contain:
Topical Creams, Lotions, creams, and Ointments:
2% ketoconazole cream
5% sulfur lotion + 10% sulfacetamide lotion
2% sulfur + 2% salicylic acid + in emulsified ointment and sorbolene creams
The onset of SD is to be connected to the interaction of regular microscopic skin flora, particularly Malassezia subsp., the constituents of lipids on the surface of the skin, & genetic susceptibility.
Seborrheic dermatitis is a condition where the skin becomes inflamed and produces sebum. Both the quantity of yeast and the amount of sebum produced doesn’t seem to be important variables.
Genetics
Prognostic Factors
While ASD exhibits a chronic skin disease pattern marked by relapses & remissions, ISD often affects the scalp and is moderate & self-limiting. Although relatively controlled, ASD cannot be cured.
Clinical History
Clinical History
Burn, scaling, & itching are the symptoms of seborrheic dermatitis’ intermittent active and inactive stages, which alternate. Winter and the early spring are the busiest seasons, with the summer months typically seeing remissions. The intertriginous areas may become infected subsequent to the primary infection during the active periods of seborrheic dermatitis.
Infantile napkin dermatitis frequently involves candida spp overgrowth. These kids may have psoriasis or a diaper rashes type of seborrheic dermatitis. Rarely occurs extensive seborrheic erythroderma. Congestive cardiac failure, Parkinson’s disease, AIDS & immunodeficiency in preterm infants are among the conditions it occurs more frequently.
Physical Examination
Physical Examination
Seborrheic dermatitis can cause anything from moderate, spotty scaling to extensive, thick, adhering crusts on the scalp. Plaques are uncommon. Similar to psoriasis, seborrheic dermatitis can progress from the scalp to the forehead, the back of the neck, as well as the postauricular area. A lesion caused by seborrheic dermatitis appears as branny and greasy scales over red, swollen skin. Dark-skinned people frequently exhibit hypopigmentation.
Oozing & crusting from infected eczematoid dermatitis indicates subsequent infection. Independently developing seborrheic blepharitis is possible. The scalp, forehead, brows, lash line, nasolabial folds, beard, & postauricular area are among the oily & hair-bearing regions of the head & neck where the distribution is most noticeable. The skin on the submental region may extend.
Compared to nonscaling intertrigo of the axillae, umbilicus, inguinal & inframammary folds, perineum, and anogenital crease, which may also be involved, presternal and interscapular participation is more frequent. There are occasionally two separate truncal types of seborrheic dermatitis. The most typical petaloid scale is an annular and geographic one. On the trunk & neck, an uncommon pityriasiform variation can be found with peripheral scales around ovoid areas that resemble pityriasis rosea.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Tinea Versicolor
Tinea Cruris
Tinea Corporis
Tinea Capitis
Rosacea
Pityriasis Rosea
Perioral Dermatitis
Pemphigus foliaceus
Pemphigus Erythematosus
Pediatric Atopic Dermatitis
Omenn Syndrome
Nummular Dermatitis
Lichen Simplex Chronicus
Langerhans Cell Histiocytosis
Irritant Contact Dermatitis
Intertrigo
Extramammary Paget Disease
Erythrasma
Drug-Induced Photosensitivity
Drug Eruptions
Dermatologic Manifestations of Glucagonoma Syndrome
Cutaneous Candidiasis
Allergic Contact Dermatitis
Acute Cutaneous Lupus Erythematosus
Asteatotic Eczema
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The method will change depending on the individual’s age, as well as the location & seriousness of the ailment. Treatments should target the underlying illness process as well as any secondary symptoms, particularly pruritus and the hyperkeratotic spectrum, Staphylococcal invasion, and related characteristics. The consensus of a Danish group of experts was that topical antifungals should be used as the first line of treatment and that topical calcineurin inhibitors & corticosteroids should only be used in the event of severe symptoms or flare-ups.
In ISD, it’s crucial to take the scale-crust on the cradle cap and parental anxiousness into account. To soften and remove the cradle cap scales, use a soft brush and sorbolene lotion or cream. In contrast hand, itching & pain in ASD must be treated immediately. Antipruritics, anti-inflammatories, antifungals, and keratolytics should all be present in a standard formulary.
Facts support the use of topical 1% zinc pyrithione. 1% – 2% ketoconazole, 1% hydrocortisone, and 1% ciclopirox for the treatment of scalp & non-scalp SD. While a powerful corticosteroid may be required for short-term therapy of scalp ASD, intermittent usage of modest topical corticosteroids plus the antifungal imidazole is convenient, and it can be very successful.
Combinations of ingredients like pine or coal tar (keratolytic/antipruritic), salicylic acid (keratolytic), sulfur (antimicrobial/keratolytic), & sulfacetamide (antibacterial/anti-inflammatory) are frequently found in shampoos. These can be applied to the patient’s scalp & non-scalp areas and removed with water after five to ten minutes. Topical 1% pimecrolimus or other formulations with site-appropriate therapeutic potential should be used on occasion to reduce the side effects of topical corticosteroids.
The standard of care employs the antifungal & anti-inflammatory characteristics of itraconazole (evaluated for CYP450 drug reaction, which could even deteriorate cardiovascular disease), ketoconazole (regulate liver health; Black Box warning), & fluconazole (calculate the dose according to kidney function). Oral therapy should be considered for refractory or generalized diseases.
A Typical Formulary Might Contain:
Topical Creams, Lotions, creams, and Ointments:
2% ketoconazole cream
5% sulfur lotion + 10% sulfacetamide lotion
2% sulfur + 2% salicylic acid + in emulsified ointment and sorbolene creams
Indicated for the seborrheic dermatitis of the scalp
Apply the gel onto the affected area twice daily for 4 weeks; diagnose again
Apply 5 ml or 1 teaspoonful of shampoo onto wet hair, prepare lather, and leave it for 3 minutes before rinsing
For longer hair, 10 ml of shampoo can be used
Repeat the process twice weekly for 4 weeks
Keep a minimum interval of 3 days before two applications
Cream: Administer the cream in a thin layer, with a frequency ranging from once daily to up to three times daily, based on individual needs
Foam: Cleanse the affected area thoroughly and massage the foam into it once daily to twice daily If required, rinse off the foam after 1-2 minutes
Cleanser: Wet your skin and gently massage the cleanser onto it once daily to twice daily
Cleansing Pads: Take a wet pad and apply it to wet skin, working it into a rich lather for 10-20 seconds while avoiding the eye area
To minimize the possibility of dryness, begin with one application daily, then gradually increase to 2-3 times daily as needed
Spread the medication to the affected regions twice daily for a duration of 8 to 10 days
Cleanse the impacted areas twice daily using the medication for a period of 8 to 10 days
Wet your hair and rub the shampoo into your scalp with a vigorous massage; rinse thoroughly and utilize a minimum of twice per week
Increase the time between applications to once or twice a week
Administration
Eliminate contact with mucous membranes and eyes.
indicated for Seborrheic Dermatitis/Psoriasis
Cream (2.5%)-apply the cream to the affected area every 6-8 hours, and, by the specific product requirement, it can be retained overnight
Shampoo (1.8-3%)- Gently apply the product to damp hair or the specific area that requires attention, allowing it to remain for some time afterwards, ensure thorough rinsing
It is advised to utilize this treatment two or three times per week, following the guidance of a healthcare professional
Depending on the specific product, leaving it in overnight may also be an option
Ointment (3%)-Use this product on plaques or scales present on the skin every six hours, not suitable for application on the scalp or face
Foam- apply every 12 hours by gently rubbing it onto the skin until complete absorption is achieved
Cream- apply every 12 hours for a duration of 4 weeks until clear
Shampoo-use the shampoo twice a week over a period of 4 weeks
maintain gap of at least three days between each application
Foam- apply every 12 hours to the affected area for a duration of 4 weeks
Gel-Apply once daily to the affected area for a duration of two weeks
Safety and efficacy not determined in less than twelve years
≥12 years
Spread the medication to the affected regions twice daily for a duration of 8 to 10 days
Cleanse the impacted areas twice daily using the medication for a period of 8 to 10 days
Wet your hair and rub the shampoo into your scalp with a vigorous massage; rinse thoroughly and utilize a minimum of twice per week
Increase the time between applications to once or twice a week
Administration
Eliminate contact with mucous membranes and eyes
Age ≥12 years (foam/cream)- apply foam/cream to the affected area every 12 hours for a duration of four weeks
Age ≥12 years (gel)- apply gel one time daily to the affected area for a duration of two weeks
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References
https://www.ncbi.nlm.nih.gov/books/NBK551707/
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Seborrheic dermatitis (SD) is a common chronic skin condition that typically affects the face, scalp & body areas. It has a papulosquamous shape. The disease’s bimodal incidence is reflected by the adult (ASD) & infantile (ISD) variants.
Seborrheic dermatitis often does not bother infants, but it can create great parental anxiety. It frequently manifests as solid, oily scales on the crown & frontal areas of the scalp.
It starts in the first 3 months of life, is usually moderate, self-limiting, & resolves on its own by the first birthday. ASD, on the contrary hand, is characterized by a recurrent & remitting type of illness and is placed third for its ability to reduce the life quality behind contact and atopic dermatitis.
The frequency of seborrheic dermatitis is estimated to be 5% worldwide, but dandruff, its non-inflammatory variation, is possibly nearer to 50%. Every ethnic group, everywhere in the world, is impacted by SD. The frequency of SD is bimodal, peaking during the first 3 years of life and again after the fourth decade from adrenarche.
At 3 months, there were about 72 percent of pre-schoolers in Australia had SD; after that, there was a sharp decline, with an overall prevalence of 10 percent. The Rotterdam Research and data analysis also revealed that 14 percent of middle-aged & elderly persons had SD. However, in HIV-AIDS, 35 percent of people with early Human immunodeficiency virus (HIV have SD, and 85% of people with AIDS have the condition.
SD is at risk for developing because of the following factors:
Increased activity of the sebaceous glands
Men’s sex
Age
Immunodeficiency, such as
Transplanting a kidney
HIV/AIDS
Lymphoma
Psychological and neurological conditions, such as
Stroke
severe depression
Parkinson disorder
Impaired autonomic function
Low ambient temperatures or humidity
The following are some suggested pathophysiologic pathways for SD:
The bacterium on the skin is harmed.
A weakened immunological response to Malassezia species that is accompanied by a weaker T-cell reaction and complementactivation
Fats that are unsaturated are more prevalent on the skin’s surface
Peripheral neurotransmitter disruption
Abnormal keratinocyte shedding
Disruptions of the epidermis barrier linked to genetic causes
In addition to degrading sebum & consuming saturated fats, Malassezia species. also affect the lipid equilibrium on the skin’s surface. Malassezia species. involvement is further supported by their separation from SD lesions and the considerable improvement of SD following antifungal therapy
To prove a connection between ISD and the emergence of ASD, however, there seems to be insufficient data.
Management:
The method will change depending on the individual’s age, as well as the location & seriousness of the ailment. Treatments should target the underlying illness process as well as any secondary symptoms, particularly pruritus and the hyperkeratotic spectrum, Staphylococcal invasion, and related characteristics. The consensus of a Danish group of experts was that topical antifungals should be used as the first line of treatment and that topical calcineurin inhibitors & corticosteroids should only be used in the event of severe symptoms or flare-ups.
In ISD, it’s crucial to take the scale-crust on the cradle cap and parental anxiousness into account. To soften and remove the cradle cap scales, use a soft brush and sorbolene lotion or cream. In contrast hand, itching & pain in ASD must be treated immediately. Antipruritics, anti-inflammatories, antifungals, and keratolytics should all be present in a standard formulary. Facts support the use of topical 1% zinc pyrithione. 1% – 2% ketoconazole, 1% hydrocortisone, and 1% ciclopirox for the treatment of scalp & non-scalp SD.
While a powerful corticosteroid may be required for short-term therapy of scalp ASD, intermittent usage of modest topical corticosteroids plus the antifungal imidazole is convenient, and it can be very successful. Combinations of ingredients like pine or coal tar (keratolytic/antipruritic), salicylic acid (keratolytic), sulfur (antimicrobial/keratolytic), & sulfacetamide (antibacterial/anti-inflammatory) are frequently found in shampoos. These can be applied to the patient’s scalp & non-scalp areas and removed with water after five to ten minutes.
Topical 1% pimecrolimus or other formulations with site-appropriate therapeutic potential should be used on occasion to reduce the side effects of topical corticosteroids. The standard of care employs the antifungal & anti-inflammatory characteristics of itraconazole (evaluated for CYP450 drug reaction, which could even deteriorate cardiovascular disease), ketoconazole (regulate liver health; Black Box warning), & fluconazole (calculate the dose according to kidney function). Oral therapy should be considered for refractory or generalized diseases.
A Typical Formulary Might Contain:
Topical Creams, Lotions, creams, and Ointments:
2% ketoconazole cream
5% sulfur lotion + 10% sulfacetamide lotion
2% sulfur + 2% salicylic acid + in emulsified ointment and sorbolene creams
The onset of SD is to be connected to the interaction of regular microscopic skin flora, particularly Malassezia subsp., the constituents of lipids on the surface of the skin, & genetic susceptibility.
Seborrheic dermatitis is a condition where the skin becomes inflamed and produces sebum. Both the quantity of yeast and the amount of sebum produced doesn’t seem to be important variables.
While ASD exhibits a chronic skin disease pattern marked by relapses & remissions, ISD often affects the scalp and is moderate & self-limiting. Although relatively controlled, ASD cannot be cured.
Clinical History
Burn, scaling, & itching are the symptoms of seborrheic dermatitis’ intermittent active and inactive stages, which alternate. Winter and the early spring are the busiest seasons, with the summer months typically seeing remissions. The intertriginous areas may become infected subsequent to the primary infection during the active periods of seborrheic dermatitis.
Infantile napkin dermatitis frequently involves candida spp overgrowth. These kids may have psoriasis or a diaper rashes type of seborrheic dermatitis. Rarely occurs extensive seborrheic erythroderma. Congestive cardiac failure, Parkinson’s disease, AIDS & immunodeficiency in preterm infants are among the conditions it occurs more frequently.
Physical Examination
Seborrheic dermatitis can cause anything from moderate, spotty scaling to extensive, thick, adhering crusts on the scalp. Plaques are uncommon. Similar to psoriasis, seborrheic dermatitis can progress from the scalp to the forehead, the back of the neck, as well as the postauricular area. A lesion caused by seborrheic dermatitis appears as branny and greasy scales over red, swollen skin. Dark-skinned people frequently exhibit hypopigmentation.
Oozing & crusting from infected eczematoid dermatitis indicates subsequent infection. Independently developing seborrheic blepharitis is possible. The scalp, forehead, brows, lash line, nasolabial folds, beard, & postauricular area are among the oily & hair-bearing regions of the head & neck where the distribution is most noticeable. The skin on the submental region may extend.
Compared to nonscaling intertrigo of the axillae, umbilicus, inguinal & inframammary folds, perineum, and anogenital crease, which may also be involved, presternal and interscapular participation is more frequent. There are occasionally two separate truncal types of seborrheic dermatitis. The most typical petaloid scale is an annular and geographic one. On the trunk & neck, an uncommon pityriasiform variation can be found with peripheral scales around ovoid areas that resemble pityriasis rosea.
Differential Diagnoses
Tinea Versicolor
Tinea Cruris
Tinea Corporis
Tinea Capitis
Rosacea
Pityriasis Rosea
Perioral Dermatitis
Pemphigus foliaceus
Pemphigus Erythematosus
Pediatric Atopic Dermatitis
Omenn Syndrome
Nummular Dermatitis
Lichen Simplex Chronicus
Langerhans Cell Histiocytosis
Irritant Contact Dermatitis
Intertrigo
Extramammary Paget Disease
Erythrasma
Drug-Induced Photosensitivity
Drug Eruptions
Dermatologic Manifestations of Glucagonoma Syndrome
Cutaneous Candidiasis
Allergic Contact Dermatitis
Acute Cutaneous Lupus Erythematosus
Asteatotic Eczema
The method will change depending on the individual’s age, as well as the location & seriousness of the ailment. Treatments should target the underlying illness process as well as any secondary symptoms, particularly pruritus and the hyperkeratotic spectrum, Staphylococcal invasion, and related characteristics. The consensus of a Danish group of experts was that topical antifungals should be used as the first line of treatment and that topical calcineurin inhibitors & corticosteroids should only be used in the event of severe symptoms or flare-ups.
In ISD, it’s crucial to take the scale-crust on the cradle cap and parental anxiousness into account. To soften and remove the cradle cap scales, use a soft brush and sorbolene lotion or cream. In contrast hand, itching & pain in ASD must be treated immediately. Antipruritics, anti-inflammatories, antifungals, and keratolytics should all be present in a standard formulary.
Facts support the use of topical 1% zinc pyrithione. 1% – 2% ketoconazole, 1% hydrocortisone, and 1% ciclopirox for the treatment of scalp & non-scalp SD. While a powerful corticosteroid may be required for short-term therapy of scalp ASD, intermittent usage of modest topical corticosteroids plus the antifungal imidazole is convenient, and it can be very successful.
Combinations of ingredients like pine or coal tar (keratolytic/antipruritic), salicylic acid (keratolytic), sulfur (antimicrobial/keratolytic), & sulfacetamide (antibacterial/anti-inflammatory) are frequently found in shampoos. These can be applied to the patient’s scalp & non-scalp areas and removed with water after five to ten minutes. Topical 1% pimecrolimus or other formulations with site-appropriate therapeutic potential should be used on occasion to reduce the side effects of topical corticosteroids.
The standard of care employs the antifungal & anti-inflammatory characteristics of itraconazole (evaluated for CYP450 drug reaction, which could even deteriorate cardiovascular disease), ketoconazole (regulate liver health; Black Box warning), & fluconazole (calculate the dose according to kidney function). Oral therapy should be considered for refractory or generalized diseases.
A Typical Formulary Might Contain:
Topical Creams, Lotions, creams, and Ointments:
2% ketoconazole cream
5% sulfur lotion + 10% sulfacetamide lotion
2% sulfur + 2% salicylic acid + in emulsified ointment and sorbolene creams
Indicated for the seborrheic dermatitis of the scalp
Apply the gel onto the affected area twice daily for 4 weeks; diagnose again
Apply 5 ml or 1 teaspoonful of shampoo onto wet hair, prepare lather, and leave it for 3 minutes before rinsing
For longer hair, 10 ml of shampoo can be used
Repeat the process twice weekly for 4 weeks
Keep a minimum interval of 3 days before two applications
Cream: Administer the cream in a thin layer, with a frequency ranging from once daily to up to three times daily, based on individual needs
Foam: Cleanse the affected area thoroughly and massage the foam into it once daily to twice daily If required, rinse off the foam after 1-2 minutes
Cleanser: Wet your skin and gently massage the cleanser onto it once daily to twice daily
Cleansing Pads: Take a wet pad and apply it to wet skin, working it into a rich lather for 10-20 seconds while avoiding the eye area
To minimize the possibility of dryness, begin with one application daily, then gradually increase to 2-3 times daily as needed
Spread the medication to the affected regions twice daily for a duration of 8 to 10 days
Cleanse the impacted areas twice daily using the medication for a period of 8 to 10 days
Wet your hair and rub the shampoo into your scalp with a vigorous massage; rinse thoroughly and utilize a minimum of twice per week
Increase the time between applications to once or twice a week
Administration
Eliminate contact with mucous membranes and eyes.
indicated for Seborrheic Dermatitis/Psoriasis
Cream (2.5%)-apply the cream to the affected area every 6-8 hours, and, by the specific product requirement, it can be retained overnight
Shampoo (1.8-3%)- Gently apply the product to damp hair or the specific area that requires attention, allowing it to remain for some time afterwards, ensure thorough rinsing
It is advised to utilize this treatment two or three times per week, following the guidance of a healthcare professional
Depending on the specific product, leaving it in overnight may also be an option
Ointment (3%)-Use this product on plaques or scales present on the skin every six hours, not suitable for application on the scalp or face
Foam- apply every 12 hours by gently rubbing it onto the skin until complete absorption is achieved
Cream- apply every 12 hours for a duration of 4 weeks until clear
Shampoo-use the shampoo twice a week over a period of 4 weeks
maintain gap of at least three days between each application
Foam- apply every 12 hours to the affected area for a duration of 4 weeks
Gel-Apply once daily to the affected area for a duration of two weeks
Safety and efficacy not determined in less than twelve years
≥12 years
Spread the medication to the affected regions twice daily for a duration of 8 to 10 days
Cleanse the impacted areas twice daily using the medication for a period of 8 to 10 days
Wet your hair and rub the shampoo into your scalp with a vigorous massage; rinse thoroughly and utilize a minimum of twice per week
Increase the time between applications to once or twice a week
Administration
Eliminate contact with mucous membranes and eyes
Age ≥12 years (foam/cream)- apply foam/cream to the affected area every 12 hours for a duration of four weeks
Age ≥12 years (gel)- apply gel one time daily to the affected area for a duration of two weeks
https://www.ncbi.nlm.nih.gov/books/NBK551707/
medtigo
Seborrheic Dermatitis
Updated :
September 4, 2023
Seborrheic dermatitis (SD) is a common chronic skin condition that typically affects the face, scalp & body areas. It has a papulosquamous shape. The disease’s bimodal incidence is reflected by the adult (ASD) & infantile (ISD) variants.
Seborrheic dermatitis often does not bother infants, but it can create great parental anxiety. It frequently manifests as solid, oily scales on the crown & frontal areas of the scalp.
It starts in the first 3 months of life, is usually moderate, self-limiting, & resolves on its own by the first birthday. ASD, on the contrary hand, is characterized by a recurrent & remitting type of illness and is placed third for its ability to reduce the life quality behind contact and atopic dermatitis.
The frequency of seborrheic dermatitis is estimated to be 5% worldwide, but dandruff, its non-inflammatory variation, is possibly nearer to 50%. Every ethnic group, everywhere in the world, is impacted by SD. The frequency of SD is bimodal, peaking during the first 3 years of life and again after the fourth decade from adrenarche.
At 3 months, there were about 72 percent of pre-schoolers in Australia had SD; after that, there was a sharp decline, with an overall prevalence of 10 percent. The Rotterdam Research and data analysis also revealed that 14 percent of middle-aged & elderly persons had SD. However, in HIV-AIDS, 35 percent of people with early Human immunodeficiency virus (HIV have SD, and 85% of people with AIDS have the condition.
SD is at risk for developing because of the following factors:
Increased activity of the sebaceous glands
Men’s sex
Age
Immunodeficiency, such as
Transplanting a kidney
HIV/AIDS
Lymphoma
Psychological and neurological conditions, such as
Stroke
severe depression
Parkinson disorder
Impaired autonomic function
Low ambient temperatures or humidity
The following are some suggested pathophysiologic pathways for SD:
The bacterium on the skin is harmed.
A weakened immunological response to Malassezia species that is accompanied by a weaker T-cell reaction and complementactivation
Fats that are unsaturated are more prevalent on the skin’s surface
Peripheral neurotransmitter disruption
Abnormal keratinocyte shedding
Disruptions of the epidermis barrier linked to genetic causes
In addition to degrading sebum & consuming saturated fats, Malassezia species. also affect the lipid equilibrium on the skin’s surface. Malassezia species. involvement is further supported by their separation from SD lesions and the considerable improvement of SD following antifungal therapy
To prove a connection between ISD and the emergence of ASD, however, there seems to be insufficient data.
Management:
The method will change depending on the individual’s age, as well as the location & seriousness of the ailment. Treatments should target the underlying illness process as well as any secondary symptoms, particularly pruritus and the hyperkeratotic spectrum, Staphylococcal invasion, and related characteristics. The consensus of a Danish group of experts was that topical antifungals should be used as the first line of treatment and that topical calcineurin inhibitors & corticosteroids should only be used in the event of severe symptoms or flare-ups.
In ISD, it’s crucial to take the scale-crust on the cradle cap and parental anxiousness into account. To soften and remove the cradle cap scales, use a soft brush and sorbolene lotion or cream. In contrast hand, itching & pain in ASD must be treated immediately. Antipruritics, anti-inflammatories, antifungals, and keratolytics should all be present in a standard formulary. Facts support the use of topical 1% zinc pyrithione. 1% – 2% ketoconazole, 1% hydrocortisone, and 1% ciclopirox for the treatment of scalp & non-scalp SD.
While a powerful corticosteroid may be required for short-term therapy of scalp ASD, intermittent usage of modest topical corticosteroids plus the antifungal imidazole is convenient, and it can be very successful. Combinations of ingredients like pine or coal tar (keratolytic/antipruritic), salicylic acid (keratolytic), sulfur (antimicrobial/keratolytic), & sulfacetamide (antibacterial/anti-inflammatory) are frequently found in shampoos. These can be applied to the patient’s scalp & non-scalp areas and removed with water after five to ten minutes.
Topical 1% pimecrolimus or other formulations with site-appropriate therapeutic potential should be used on occasion to reduce the side effects of topical corticosteroids. The standard of care employs the antifungal & anti-inflammatory characteristics of itraconazole (evaluated for CYP450 drug reaction, which could even deteriorate cardiovascular disease), ketoconazole (regulate liver health; Black Box warning), & fluconazole (calculate the dose according to kidney function). Oral therapy should be considered for refractory or generalized diseases.
A Typical Formulary Might Contain:
Topical Creams, Lotions, creams, and Ointments:
2% ketoconazole cream
5% sulfur lotion + 10% sulfacetamide lotion
2% sulfur + 2% salicylic acid + in emulsified ointment and sorbolene creams
The onset of SD is to be connected to the interaction of regular microscopic skin flora, particularly Malassezia subsp., the constituents of lipids on the surface of the skin, & genetic susceptibility.
Seborrheic dermatitis is a condition where the skin becomes inflamed and produces sebum. Both the quantity of yeast and the amount of sebum produced doesn’t seem to be important variables.
While ASD exhibits a chronic skin disease pattern marked by relapses & remissions, ISD often affects the scalp and is moderate & self-limiting. Although relatively controlled, ASD cannot be cured.
Clinical History
Burn, scaling, & itching are the symptoms of seborrheic dermatitis’ intermittent active and inactive stages, which alternate. Winter and the early spring are the busiest seasons, with the summer months typically seeing remissions. The intertriginous areas may become infected subsequent to the primary infection during the active periods of seborrheic dermatitis.
Infantile napkin dermatitis frequently involves candida spp overgrowth. These kids may have psoriasis or a diaper rashes type of seborrheic dermatitis. Rarely occurs extensive seborrheic erythroderma. Congestive cardiac failure, Parkinson’s disease, AIDS & immunodeficiency in preterm infants are among the conditions it occurs more frequently.
Physical Examination
Seborrheic dermatitis can cause anything from moderate, spotty scaling to extensive, thick, adhering crusts on the scalp. Plaques are uncommon. Similar to psoriasis, seborrheic dermatitis can progress from the scalp to the forehead, the back of the neck, as well as the postauricular area. A lesion caused by seborrheic dermatitis appears as branny and greasy scales over red, swollen skin. Dark-skinned people frequently exhibit hypopigmentation.
Oozing & crusting from infected eczematoid dermatitis indicates subsequent infection. Independently developing seborrheic blepharitis is possible. The scalp, forehead, brows, lash line, nasolabial folds, beard, & postauricular area are among the oily & hair-bearing regions of the head & neck where the distribution is most noticeable. The skin on the submental region may extend.
Compared to nonscaling intertrigo of the axillae, umbilicus, inguinal & inframammary folds, perineum, and anogenital crease, which may also be involved, presternal and interscapular participation is more frequent. There are occasionally two separate truncal types of seborrheic dermatitis. The most typical petaloid scale is an annular and geographic one. On the trunk & neck, an uncommon pityriasiform variation can be found with peripheral scales around ovoid areas that resemble pityriasis rosea.
Differential Diagnoses
Tinea Versicolor
Tinea Cruris
Tinea Corporis
Tinea Capitis
Rosacea
Pityriasis Rosea
Perioral Dermatitis
Pemphigus foliaceus
Pemphigus Erythematosus
Pediatric Atopic Dermatitis
Omenn Syndrome
Nummular Dermatitis
Lichen Simplex Chronicus
Langerhans Cell Histiocytosis
Irritant Contact Dermatitis
Intertrigo
Extramammary Paget Disease
Erythrasma
Drug-Induced Photosensitivity
Drug Eruptions
Dermatologic Manifestations of Glucagonoma Syndrome
Cutaneous Candidiasis
Allergic Contact Dermatitis
Acute Cutaneous Lupus Erythematosus
Asteatotic Eczema
The method will change depending on the individual’s age, as well as the location & seriousness of the ailment. Treatments should target the underlying illness process as well as any secondary symptoms, particularly pruritus and the hyperkeratotic spectrum, Staphylococcal invasion, and related characteristics. The consensus of a Danish group of experts was that topical antifungals should be used as the first line of treatment and that topical calcineurin inhibitors & corticosteroids should only be used in the event of severe symptoms or flare-ups.
In ISD, it’s crucial to take the scale-crust on the cradle cap and parental anxiousness into account. To soften and remove the cradle cap scales, use a soft brush and sorbolene lotion or cream. In contrast hand, itching & pain in ASD must be treated immediately. Antipruritics, anti-inflammatories, antifungals, and keratolytics should all be present in a standard formulary.
Facts support the use of topical 1% zinc pyrithione. 1% – 2% ketoconazole, 1% hydrocortisone, and 1% ciclopirox for the treatment of scalp & non-scalp SD. While a powerful corticosteroid may be required for short-term therapy of scalp ASD, intermittent usage of modest topical corticosteroids plus the antifungal imidazole is convenient, and it can be very successful.
Combinations of ingredients like pine or coal tar (keratolytic/antipruritic), salicylic acid (keratolytic), sulfur (antimicrobial/keratolytic), & sulfacetamide (antibacterial/anti-inflammatory) are frequently found in shampoos. These can be applied to the patient’s scalp & non-scalp areas and removed with water after five to ten minutes. Topical 1% pimecrolimus or other formulations with site-appropriate therapeutic potential should be used on occasion to reduce the side effects of topical corticosteroids.
The standard of care employs the antifungal & anti-inflammatory characteristics of itraconazole (evaluated for CYP450 drug reaction, which could even deteriorate cardiovascular disease), ketoconazole (regulate liver health; Black Box warning), & fluconazole (calculate the dose according to kidney function). Oral therapy should be considered for refractory or generalized diseases.
A Typical Formulary Might Contain:
Topical Creams, Lotions, creams, and Ointments:
2% ketoconazole cream
5% sulfur lotion + 10% sulfacetamide lotion
2% sulfur + 2% salicylic acid + in emulsified ointment and sorbolene creams
1% hydrocortisone + 1% clotrimazole cream
Oral therapy
Fluconazole
Itraconazole
Terbinafine
Shampoos
1% ciclopirox
1% zinc pyrithione
0.1% & 0.03% tacrolimus
2% ketoconazole
https://www.ncbi.nlm.nih.gov/books/NBK551707/
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