SEBORRHEIC DERMATITIS                                                                       

Seborrheic dermatitis, also known as Dandruff or Seborrheic eczema is a skin condition characterized by loose, greasy or dry, white to yellowish scales, with or without associated reddened skin. Cradle cap is the term used when seborrheic dermatitis affects the scalp of infants.

Seborrheic dermatitis is a non-contagious condition that causes flaking and redness of the skin. It occurs when there is inflammation in areas of the skin where sebaceous (skin oil) glands are concentrated. It usually affects the scalp, but can also affect other parts of the body, such as eyebrows, eyelids, the folds of the nose, lips, behind or inside the ears, in the external ear, the forehead and the chin and the skin of the trunk, particularly around the navel, in the skin folds under the arms, in the groin, or under the breasts.

Seborrheic dermatitis appears to run in families. Stress, fatigue, weather extremes, oily skin, infrequent shampoos or skin cleaning, use of lotions that contain alcohol, or skin disorders such as acne or obesity may increase the risk. Neurological conditions, including Parkinson's disease, head injury, and stroke can also be associated with seborrheic dermatitis. Human immunodeficiency virus (HIV) is also associated with higher incidence.

Seborrheic dermatitis can be unpleasant and uncomfortable, and is usually unattractive. It can disappear spontaneously and suddenly reappear, for no known reason. Or it can stubbornly linger, resisting treatment. But as frustrating as it can be, it is readily diagnosed and is treatable.

Seborrheic dermatitis begins gradually, with dry or greasy scaling of the scalp. The affected areas are oily and red, and may or may not be itchy.

Every month, our skin replaces its cells. As these skin cells rise to the surface, they shed. They generally go unnoticed, but if they stick together in clumps, the dry scalp flakes are easily seen. Dandruff is the result of these clumps of dead skin cells flaking off the scalp. It is so common that it is considered normal. Clinically, there is no inflammation (pain or redness) but at a microscopic level there is inflammation associated with dandruff, which is why people with this condition sometimes complain of an itchy scalp.

Dandruff appears as scaling on the scalp without redness. Seborrhea is oiliness of the skin, especially of the scalp and face, without redness or scaling. Patients with seborrhea may later get seborrheic dermatitis. Seborrheic dermatitis has both redness and scaling.

Symptoms:

• skin lesions

• plaque

• greasy, oily areas of skin

• skin scales, white and flaking or yellowish, oily, and adherent "dandruff"

• plaques may include the scalp, eyebrows, nose, forehead, or ears

• itching; may become more itchy if infected

• mild redness

• hair loss may also be associated with this disease

The diagnosis is based on the appearance and location of the skin lesions.

When lesions are on the scalp, seborrheic dermatitis and psoriasis may be almost indistinguishable from one another. In patients with a genetic predisposition to psoriasis, seborrheic dermatitis is believed to trigger psoriasis or evolve into psoriasis.

Seborrheic dermatitis is a common, chronic skin condition that shares some features with psoriasis:

• The lesions of seborrheic dermatitis and psoriasis can appear as light red to pink patches with scales over the face and ears

• Seborrheic dermatitis is believed to evolve into psoriasis in some patients.

This condition is most common in three age groups — infancy when it’s called "cradle cap," middle age, and the elderly. Cradle cap usually clears without treatment by age 8 to 12 months. This may be due to the gradual disappearance of hormones passed from the mother to the child before birth. In some infants, seborrheic dermatitis may develop only in the diaper area where it could be confused with other forms of diaper rash. When seborrheic dermatitis develops at other ages it can come and go.

The exact cause of Seborrheic dermatitis is unknown. Yeast called Pityrosporum ovale, may be a factor in the development of Seborrheic dermatitis. This member of the fungus group is quite common and is found on healthy skin. For people with Seborrheic dermatitis, when the skin retains oil and scales, this organism grows rapidly and can aggravate the skin condition. That’s why some people with Seborrheic respond well to treatment with soaps or shampoos containing antifungal agents.

Treatment varies, depending on the affected areas and the severity of the condition. Mild cases can be treated with medicated shampoos and application of over-the-counter products. For more stubborn cases, consult a physician who can confirm the diagnosis. Such cases may require consultation by a dermatologist.

Washing your face two or three times a day with a drying soap can help control facial oiliness. When Seborrheic dermatitis affects the scalp, the doctor may recommend shampooing daily with one of many non-prescription medicated shampoos.

Adult seborrheic dermatitis is a chronic condition. In its mildest form, adult seborrheic dermatitis is eczema-like in appearance—oily, scaling, mildly inflamed and reddened skin, and moderate to intense itching. Seborrheic scales flaking from the scalp can look like dandruff. In moderate to severe adult form, seborrheic dermatitis has characteristic thick, oily, yellowish-brown crusts, mild to severe skin inflammation and redness, and intense itching. The itching may be especially intense on the scalp, ears and eyelids.

Shampooing Tips-Scalp:

• Look for a shampoo that contains one of four important ingredients: coal tar, zinc pyrithione, selenium sulfide, or salicylic acid.

• Shampoo as often as every day, or as occasionally as two to three times per week.

After applying the shampoo, leave it on your hair and scalp for at least five minutes to make sure that the medication reaches the scalp.

Cradle cap appears as thick, crusty, yellow or brown scales over the child's scalp. Similar scales may also be found on the eyelids, ear, around the nose, and in the groin. Cradle cap may be seen in newborns and small children up to the age of 3 years, and is a harmless, temporary condition caused by decreased function of a particular enzyme, resulting in a state similar to dandruff in adults.

Cradle cap is not contagious, nor is it caused by poor hygiene. It is not an allergy, and it is not dangerous. Cradle cap may or may not itch. If it itches, excessive scratching of the area may cause additional inflammation and breaks in skin may cause mild infections or bleeding.

Treating Cradle cap in infants:

• Massage your baby's scalp gently with your fingers or a soft brush to loosen the scales and improve scalp circulation.

• Give your child daily; gentle shampoos with a mild soap while scales are present. After scales have disappeared, you may reduce shampoos to twice weekly.

• Be sure to rinse off all soap.

• Brush your child's hair with a clean, soft brush after each shampoo and several times during the day.

• If scales do not easily loosen and wash off, apply some mineral oil to the baby's scalp and wrap warm, wet cloths around his head for up to an hour before shampooing. Then shampoo as directed above. Remember that your baby loses a lot of heat through his scalp. If you use warm, wet cloths with the mineral oil, check frequently to be sure that the cloths have not become cold. Cold, wet cloths could drastically reduce your baby's temperature. If the scales continue to be a problem or concern, or if your child seems uncomfortable or scratches his scalp, contact your physician.

Contact your medical practitioner if patches of seborrheic dermatitis drain fluid or pus, form crusts, or become very red or painful.

There is no way to prevent Seborrheic dermatitis. While it can be treated and controlled, it cannot be permanently cured. Treating Seborrheic dermatitis often requires patience — treatment can last many months until the scaling subsides.

The condition can be kept under control so that the embarrassing scaling is minimized. It is not known whether emotional stress, diet or food allergies trigger the condition. To control it, a treatment program should be developed and followed.