SEBORRHOEIC DERMATITIS

INTRODUCTION

• Chronic Papulo-Squamous Dermatitis with Yellowish, Waxy, Branny Scaling

• Syn : SEBORRHOEIC ECZEMA

• Associated with SEBORRHOEA

• Along distribution of Sebaceous Glands (Primarily Scalp / Face / Trunk)

ETYMOLOGY

Seborrhoeic (Latin : ‘Sebum’ – Oil/Wax + ‘Orrhoea’ – Flow)

Dermatitis(Greek: ‘Derma’ – Skin + ‘itis’ – Inflammation)

HISTORY

• Described in 16th Century by Greek Physician Paulus Aeginata ( Paul of Aegina)

• Pityriasis Spectrum • Implication of ‘Furfur fungus’

• Medica Operi (Published in 1542)

EPIDEMIOLOGY

• Bimodal Age Incidence0-3 Months of life4th – 7th Decade of life

• Common in HIV/AIDS & PARKINSONISM

• Men > Women

• 03 – 05 % Prevalence

ETIOPATHOGENESIS

• EXACT CAUSE UNKNOWN

• SEBORRHOEA No Sebaceous Gland Pathology

Sebum Production Infancy Puberty Retention of Skin Surface Lipids (Eczema Flanneraire)

ETIOPATHOGENESIS

• Sebum = CHOLESTEROL / TRIGs

SQUALENE / WAX ESTERS / FFAs

Thought to be an Aberration in EPIDERMAL PROFILERATION

ETIOPATHOGENESIS

• MICROBIAL EFFECTS

• Candida Albicans • Staphylococcus Aureus

Previously• Propionibacterium Acne

ETIOPATHOGENESIS

• Malassezia Furfur (erst Pityrosporum Ovale)

• Lipophilic Yeast / 665,000 Org per sq cm (500,000 in Normal Skin)

• Aggravating > Causative

• T-Cell Activation +/- Complement Activation

ETIOPATHOGENESIS

• DRUGS (Gold / Arsenic / Methyl DOPA)

• SEASONAL PREDILECTION (Winters)

• EMOTIONAL LABILITY / STRESS

• NUTRITIONAL DEFICIENCY (Zn / BIOTIN)

• ??GENETIC

CLINICAL PATTERNS : INFANTS

CRADLE CAP

TRUNCAL LESIONS

LENIER’S DISEASE (FAM / NON-FAM)

CLINICAL PATTERN : ADULTS

• SCALP• FACE• TRUNK

PETALOID / PITYRIASIFORM / FLEXURAL EZCEMATOUS PLAQUES / FOLLICULAR

• GENERALIZED

SEBACOUS GLANDS : DISTRIBUTION

INFANTILE SEB DERM

• SCALP

Initially Sparse Inflammatory Yellowish, Oily Flakes

Thick Crusted, Grayish-Yellow Scales over an Erythematous Plaque (Extn beyond Hairline) without Alopecia - Crusta Lactea / Cradle Cap

INFANTILE SEB DERM

INFANTILE SEB DERM

INFANTILE SEB DERM

• S

INFANTILE SEB DERM

INFANTILE SEB DERM

LEINER’S DISEASE

• Syn : Erythroderma Desquamativum Dermatitis Seborrhoides Infantum Discovered by Leiner in 1908

Complication of Infantile Seb Derm with Confluent Scaly Erythema > 90 % BSA + GI Manifest + Anemia

C5 Deficiency (Familial)

LENIER’S DISEASE

LENIER’S DISEASE

DIFFERENTIALS : INF SEB DERM

• ATOPIC DERMATITIS

• PSORIASIS

• SCABIES

TREATMENT

• SCALP

WARM OIL COMPRESSES 3 % SALICYLIC ACID SHAMPOO / OIL DESONIDE LOT 0.05 %

HYDROCORTISONE CREAM 1 % IMIDAZOLE SHAMPOOS

TREATMENT

• BODY/ INTERTIGO

CLIOQUINOL 0.2 – 0.5% IN Zn OIL KETOCONAZOLE 2% CREAM /

SOFTPASTE DESONIDE LOT 0.05%

ADULT SEB DERM

SCALP IN SEB DERM

• PITYRIASIS SICCA

• PATCHY SEB DERM + CORONA SEBORRHEICA

• PITYRIASIS AMIANTACEA

PITYRIASIS SICCA (DANDRUFF)

SEB DERM : SCALP

• Perifollicular, Erythematous Plaques with Branny Gray-Yellow, Greasy Scales

• CORONA SEBORRHOEICA

• May cause reversible Alopecia

SEB DERM : SCALP

• s

SEB DERM : SCALP

SEB DERM : SCALP

• A

PITYRIASIS AMIANTACEA

• Syn : Tinea Amiantacea / Asbestos Scalp

• Heavy Micaceous, Crusted Scaling extending to Follicle

• Binding of Proximal Portions of Hair

• Assoc with Strep / AD / LS / PSOR

PITYRIASIS AMIANTACEA

ADULT SEB DERM

• Wide Spectrum

• SEBORRHOEIC ECZEMATID

Erythema NASOLABIAL / RETROAURICULAR Seborrhoea PRESTERNAL / SHOULDER BLADES White, Fluffy Scaly Scalp - Pityriasis Sicca

(Dandruff)

SEBORRHOEIC ECZEMATID

SEB DERM : FACE

• PRURITIC ERYTHEMATOUS PLAQUES, POWDERY to GREASY SCALES seen over

GLABELLAEYEBROWS

NASOLABIAL / PARANASAL FOLDRETROAURICULAR FOLDBEARD REGION

Assoc with BLEPHARITIS / OTITIS EXTERNA

SEB DERM : FACE

SEB DERM : FACE

SEBORRHOEIC BLEPHARITIS

SEBORRHOEIC BLEPHARITIS

SEBORRHOEIC OTITIS EXTERNA

SEB DERM : TRUNK

SEB DERM : TRUNK

SEBORRHOEIC ERYTHRODERMA

• Confluent Erythema• Yellowish – Gray Scaling + Exfoliation

• Covering > 90 % BSA

• Differential Diagnoses

SEBORRHOEIC ERYTHRODERMA

DIFFERENTIALS : SEB DERM

TREATMENT

• TOPICALS

SELENIUM SULFIDE SHAMPOO 1 – 2.5%

COAL TAR 1-5% OINT / SHAMPOO

MILD – MODERATE CORTICOSTEROIDSDESONIDE LOT 0.05% LOTMOMETASONE 0.1 % CRFLUCINOLONE ACET 0.01% SH

TREATMENT : TOPICALS

ANTIFUNGALS ZPTO 1-2% SHAMPOOKETOCONAZOLE 2 % SHAMPOO/ CREAMCICLOPIROX OLAMINE 1% SH / CRTERBINAFINE 1% CREAM / SOLUTIONMETRONIDAZOLE 1% GEL

KERATOLYTICS (SALICYLIC ACID 5-6% OINT)

TREATMENT : TOPICALS

• IMMUNOMODULATORS

TACROLIMUS OINT 0.1 %

PIMECROLIMUS OINT 1%

OTHERS - BENZOYL PEROXIDE 2.5 – 5%

TREAMENT

• SYSTEMIC

KETOCONAZOLE 200MG / DAY X 07D

ITRACONZAOLE 200 MG / DAY X 07D

TERBINAFINE 250 MG OD X 28 D

ISOTRETINOIN

THANK YOU