Medical symptom checker - Butterfly rash on face - Seborrheic dermatitis treatment
Seborrheic dermatitis treatment
Seborrheic dermatitis is a skin condition . It is a chronic, superficial inflammatory disorder that affects the hairy region of the body such as the face, scalp and eyebrows.
In terms of prevalence and incidence seborrheic dermatitis is common. It is more common in male than female and in infancy, adolescent as well as adult.
In term of risk factors seborrheic dermatitis is common in HIV patient. The severity of the disease depends on the progression of deficiency of the immune system, Emotional stress and Parkinson diseases are among the risk factors, Positive family history of seborrheic dermatitis is common.
It is scaly in appearance . It begins from infancy up to elderly and the characteristic
of this chronic inflammatory disease varies with different age groups.
Pityrosporum ovale, a skin surface yeasts may be contributing factors. Environmental stress or illness may leads to flares.
In infants, during the first months of life may present with greasy scaling scalp ( cradle cap ) which may be sometimes associated with mild erythema. Axillary and diaper rash may also present. It will resolves by 8 months to 12 months.
In adults, seborrheic dermatitis mostly present in areas which is hairy and rich in sebaceous gland such as nasolabial folds, eyebrows, scalp margins, scalps , presternal areas, mid upper back and ear or retorauricular fold. The lesions are bilateral and symmetrical with pruritus that is minimal. It appears to be glazed, red and smooth in the skin folds and scale, greasy and red patches and plaques with indistinct margins in most location .
On examination , patient may present with posterior cervical adenopathy and scaly red, greasy skin of the scalp.
The diagnostic procedure includes biopsy of the lesion which is performed when all the treatment for seborrheic dermatitis are fails, if alopecia or purpura are present and histiocytosis x is suspected.
The differential diagnosis of seborrheic dermatitis include psoriasis. The difference of psoriasis and seborrheic dermatitis is the scalp psoriasis tends to be more crusted,, sharply demarcated rather than mild erythema and scaling. The nails, knees and elbow are more likely to be involved in psoriasis rather than seborrheic dermatitis. Atopic dermatitis is also one of the diagnosis which is difficult to differentiate in infants. Candida or fungal infection such as Tinea capitis and Tinea cruris is also one of the diagnosis . Loss of hair and treatment failure justify the present of candida, Rosacea, Histiocytosis X, discoid lupus erythematosus and eczema of otitis externa and auricle are also the other differential diagnosis along with dandruff which is non inflammatory and affect the scalp.
Initially the patient is managed under the outpatient care. The general treatment include increase frequency of shampooing and consider moderate intakes of sunlight. In case of children who suffer fro cradle cap consider an increase frequency of shampooing with non medicated shampoo . Apply warm olive oil and mineral oil on the scalp, wash off with a soap , toothbrush or washcloth are then used to remove the thick scale.
In case of adults, the affected areas are washed with anti seborrheic dermatitis shampoo such as Tegrin, Selsun Blue or OTC brands before increasing to a more potent product which contains salicylic acid , coal tar, selenium and sulfur when no improvement is noted. 10% of liquor carbonic detergents that presents on the Nieva oil is used in case of dense scalp scaling at bedtime. Patient is advised to cover the head with shower cap. Performs nightly for 1- 3 weeks.
In adult, the first line of drug includes Nizoral or ketoconazoles creams then steroids to improve the inflammation. The steroids begins with the least potent that is 1 % hydrocortisone which later advance to fluorinated steroid which is more potent if no response with mild steroid. Patient is advised not to use the potent steroid continously as it may leads to systemic absorption , skin atrophy or hypopigmentation mostly in children and infant, Twice weekly 1% of ciclopirox shampoo is applied. If the symptoms are under controlled, remission is maintained with low potency steroid cream, selenium lotion and zinc soaps. If seborrheic dermatitis present on the trunk, benzoyl peroxides wash are helpful.
Atrophy or striae on the face or skin striae may present with high concentration of hydrocortisone ( 2. 5% ) or fluorinated corticosteroid.
The second line of drugs include 0.1- 0.3 mg/kg/d of isotretinoin in case of seborrheic dermatitis which is unresponsive to topical therapy.
In adult, seborrheic dermatitis is an unpredictable and chronic disorder which present with remission and exacerbations. Treatment with steroids that are controlled and the usage of shampoo are useful.
In infants 6-8 months remission periods from seborrheic dermatitis is noted.
The complication of seborrheic dermatitis include formation of glaucoma or striae or skin atrophy when fluorinated corticosteroids are used around the eyes or on the face. Tars may leads to photosensitivity occasionally and eyelid steroids may lead to formation of herpes simplex and herpes keratitis as one of the complication of herpes simplex.
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