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Seborrhoeic dermatitis (also Seborrheic dermatitis AmE, seborrhea) (also known as "Seborrheic eczema"[1]) is a skin disorder affecting the scalp, face, and trunk causing scaly, flaky, itchy, red skin. It particularly affects the sebum-gland rich areas of skin.
[edit] CausesThe cause of seborrhoeic dermatitis remains unknown, although many factors have been implicated. The widely present yeast, Malassezia furfur (formerly known as Pityrosporum ovale), is involved,[2][3] as well as genetic, environmental, hormonal, and immune-system factors.[4][5] The claim that seborrhoeic dermatitis is an inflammatory response to the yeast has not been proven.[6] Those afflicted with seborrhoeic dermatitis have an unfavourable epidermic response to the infection, with the skin becoming inflamed and flaking.    In children, excessive vitamin A intake can cause seborrhoeic dermatitis.[7] Lack of biotin,[8] pyridoxine (vitamin B6)[8][9] and riboflavin (vitamin B2)[8] may also be a cause. In adolescents and adults, seborrhoeic dermatitis usually presents as scalp scaling (dandruff) or as mild to marked erythema of the nasolabial fold during times of stress or sleep deprivation.[8] [edit] Hair loss
Side effects to inflammation may include temporary hair loss. If severe outbreaks are untreated for extended intervals, permanent hair loss may result, because of damage to hair follicles. [edit] TreatmentsAmong dermatologist-recommended treatments are shampoos, cleansers or any topical containing coal tar, salicylic acid, sulfur, ciclopiroxolamine, ketoconazole, selenium sulfide, or zinc pyrithione.[8] For severe disease, keratolytics such as salicylic acid or coal tar preparations may be used to remove dense scale. Topical terbinafine solution (1%) has also been shown to be effective in the treatment of scalp seborrhoea,[10] as may lotions containing alpha hydroxy acids or corticosteroids (such as fluocinolone acetonide). Pimecrolimus topical lotion is also sometimes prescribed. Topical application of a water-soluble ointment containing 50 mg of Vitamin B6 per gram of ointment has been used as an effective treatment.[11] Several nutritional supplements are recommended including: 3 mg twice per day of biotin, [11] vitamin B complex,[11] 20-30 mg per day of zinc,[11] and 1 tbsp per day of flaxseed oil.[11] Chronic treatment with topical corticosteroids may lead to permanent skin changes, such as atrophy and telangiectasia.[12][13] UV-A and UV-B light inhibit the growth of M. furfur,[14] although caution should be taken to avoid sun damage. Also used to reduce itching: daily use of isopropyl rubbing alcohol and hydrogen peroxide. Other suggested treatments include using an air humidifier, as well as a gentle moisturizer.[citation needed] Applying milk of magnesia may help clear up seborrheic dermatitis; one may apply on the face while showering and rinse off at the end of the shower.[15] As a last resort in refractory disease, sebosuppressive agents such as isotretinoin (Accutane) may be used to reduce sebaceous gland activity. However, isotretinoin has potentially serious side effects and few patients with seborrhea are appropriate candidates for therapy. The most devastating side effect is teratogenicity, but other serious side effects include hyperlipidemia, neutropenia, anemia and hepatitis. Mucocutaneous adverse effects include cheilitis, xerosis, conjunctivitis, urethritis and hair loss. Long-term use has been associated with the development of diffuse idiopathic skeletal hyperostosis (DISH). This agent must be used cautiously and only by physicians who are well versed in all of its adverse effects. A more practical approach to the refractory patient may be to first try different combinations of the usual agents: a dandruff shampoo, an antifungal agent and a topical steroid. If this fails, short-term use of a more potent topical steroid in a "pulse fashion" may put some refractory patients into remission and actually decrease the total steroid exposure. Therapeutic choices for pulse therapy may 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 class III topical steroid should be tried first, but if the condition remains unresponsive, the clinician may then choose to use a class I agent. These 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. Adjuvant therapy including use of a dandruff shampoo, an antifungal agent, or both, is essential during the "pulse" period and should be continued as maintenance therapy after each pulse. Most corticosteroids are available as solutions, lotions, creams and ointments. Which vehicle to use is often determined by the patient and the treatment site. Lotions and creams are frequently used on all areas of the face and body, whereas solutions and ointments are more commonly used on the scalp. In general, application of a scalp solution is preferred by white and Asian patients but may be too drying for black patients. Ointments may be a better option. The vehicle affects the potency of a topical steroid. In most circumstances, the same steroid in an ointment is more potent than the steroid in a cream, which, in turn, is more potent than the same chemical in a lotion.[4] [edit] Plant-based treatmentsMain article: phytotherapy The World Health Organization mentions Aloe vera gel as a yet to be scientifically proven traditional medicine treatment for Seborrhoeic dermatitis.[16] [edit] See also[edit] References
[edit] External links
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