Seborrheic dermatitis: Difference between revisions

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{{SI}}
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{{CMG}}; {{AE}} {{JH}}; {{AA}}
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{{SK}} Seborrheic eczema
{{SK}} Seborrheic eczema; Seborrhea; Cradle cap


==Overview==
==Overview==
Seborrhoeic [[eczema]] (also known as Seborrheic dermatitis [[American English|AmE]], '''seborrhea''') is a skin disorder affecting the scalp, face, and trunk. Seborrhoeic dermatitis causes flaky, itchy, red skin and temporary hair loss. It particularly affects the [[sebum]]-gland rich areas of skin. Causes of seborrhoeic dermatitis include ''[[Malassezia furfur]]'' (formerly known as Pityrosporum ovale), as well as genetic, environmental, hormonal, and immune-system factors. Medical therapy for seborrhoeic dermatitis includes [[antifungal]] agents, [[corticosteroids]], and lithium salts.
Seborrheic [[eczema]] (also known as [[Seborrheic dermatitis]], '''[[seborrhea]]''') is a [[skin]] disorder affecting the [[scalp]], [[face]], and [[trunk]]. [[Seborrheic dermatitis]] causes flaky, itchy, red skin and temporary [[hair loss]]. It particularly affects the [[sebum]]-gland rich areas of skin. Causes of seborrheic dermatitis include ''[[Malassezia furfur]]'' (formerly known as ''[[Pityrosporum ovale]]'') as well as genetic, environmental, hormonal, and immune-related factors. Medical therapy for seborrheic dermatitis includes [[antifungal]] agents, [[corticosteroids]], and [[lithium|lithium salts]].
 
==Historical Perspective==
==Historical Perspective==
*In 1887, [[seborrheic dermatitis]] was first described by Unna.
*In 1894, a hypothesis was made by Unna and Sabouraud that causative agents responsible for [[seborrheic dermatitis]] include [[yeast]] ''[[Malassezia]]'', [[bacteria]], or both as they were obtained in high quantities in cultures obtained from the affected patients.
*In 1984, Shuster discovered that [[seborrheic dermatitis]] can be treated with oral [[ketoconazole]].<ref name="pmid6235835">{{cite journal| author=Shuster S| title=The aetiology of dandruff and the mode of action of therapeutic agents. | journal=Br J Dermatol | year= 1984 | volume= 111 | issue= 2 | pages= 235-42 | pmid=6235835 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6235835  }} </ref>.<ref>Low, R. Cranston, and H. W. Barber. "Discussion on the etiology of seborrhoea and seborrhoeic dermatitis." The British Medical Journal (1922): 752-757.</ref>


==Classification==
==Classification==
There is no established classification system for [[seborrheic dermatitis]].However, seborrheic dermatitis can be classified on the basis of following factors:<ref name="pmid16848386">{{cite journal| author=Schwartz RA, Janusz CA, Janniger CK| title=Seborrheic dermatitis: an overview. | journal=Am Fam Physician | year= 2006 | volume= 74 | issue= 1 | pages= 125-30 | pmid=16848386 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16848386  }} </ref><ref name="pmid23806151">{{cite journal| author=Dessinioti C, Katsambas A| title=Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 343-51 | pmid=23806151 | doi=10.1016/j.clindermatol.2013.01.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806151  }} </ref><ref>Dessinioti, Clio, and Andreas Katsambas. "Seborrheic dermatitis: Etiology, risk factors, and treatments:: Facts and controversies." Clinics in dermatology 31.4 (2013): 343-351.</ref><ref>
There is no established classification system for [[seborrheic dermatitis]]. However, it may be classified according to the anatomical location, age group, symptoms, etiology and severity.<ref name="pmid23806151">{{cite journal| author=Dessinioti C, Katsambas A| title=Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 343-51 | pmid=23806151 | doi=10.1016/j.clindermatol.2013.01.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806151  }} </ref><ref>Dessinioti, Clio, and Andreas Katsambas. "Seborrheic dermatitis: Etiology, risk factors, and treatments:: Facts and controversies." Clinics in dermatology 31.4 (2013): 343-351.</ref><ref>
===Classification by Anatomical Location===Peyri, J., and M. Lleonart. "Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis." Actas Dermo-Sifiliográficas (English Edition) 98.7 (2007): 476-482.</ref><ref> name="pmid6220754">{{cite journal| author=Burton JL, Pye RJ| title=Seborrhoea is not a feature of seborrhoeic dermatitis. | journal=Br Med J (Clin Res Ed) | year= 1983 | volume= 286 | issue= 6372 | pages= 1169-70 | pmid=6220754 | doi= | pmc=1547390 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6220754  }} </ref><ref name="pmid: 18752620">{{cite journal| author=Thomas DS, Ingham E, Bojar RA, Holland KT| title=In vitro modulation of human keratinocyte pro- and anti-inflammatory cytokine production by the capsule of Malassezia species. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 54 | issue= 2 | pages= 203-14 | pmid=: 18752620 | doi=10.1111/j.1574-695X.2008.00468.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?</ref>
 
===Classification by Anatomy===
[[Seborrheic dermatitis]] may be classified on the basis of anatomical location into following types:<ref name="pmid16848386">{{cite journal| author=Schwartz RA, Janusz CA, Janniger CK| title=Seborrheic dermatitis: an overview. | journal=Am Fam Physician | year= 2006 | volume= 74 | issue= 1 | pages= 125-30 | pmid=16848386 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16848386  }} </ref><ref name="pmid23806151">{{cite journal| author=Dessinioti C, Katsambas A| title=Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. | journal=Clin Dermatol | year= 2013 | volume= 31 | issue= 4 | pages= 343-51 | pmid=23806151 | doi=10.1016/j.clindermatol.2013.01.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23806151  }} </ref><ref>Dessinioti, Clio, and Andreas Katsambas. "Seborrheic dermatitis: Etiology, risk factors, and treatments:: Facts and controversies." Clinics in dermatology 31.4 (2013): 343-351.</ref><ref>
===Classification by Anatomical Location===Peyri, J., and M. Lleonart. "Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis." Actas Dermo-Sifiliográficas (English Edition) 98.7 (2007): 476-482.</ref>
===Classification by Anatomical Location===Peyri, J., and M. Lleonart. "Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis." Actas Dermo-Sifiliográficas (English Edition) 98.7 (2007): 476-482.</ref>
* '''Localised'''
**'''[[Scalp]]''': In infants its called Cradle Cap. Its the most common presentation in infants and appear as red yellow [[plaques]] coated by thick greasy scales, commonly appearing in first three months of age.In adults, presentation of disease is mild [[desquamation]]to honey coloured crusts which can extend to involve forehead called [["corona seborrheica"]]
**'''Face''': It most commonly involves eyelids, eyebrows and [[nasolabial folds]]. Eyes are involved resulting in [[blephritis]].
**'''[[Retroauricular]]''': lt invloves crusting, oozing and fissuring in the affected area. It may also involve external ear resulting in [[otitis externa]].
**'''Body folds''': It usually affects [[axilla]], breast folds, inguinal area and genital area. May progress to fissuring and secondary infection.
**'''Upper Chest''': It is mostly seen in adults. Affected areas may present with one of the following presentation.
***'''[[Pityriasiform]]''': It is usually in the form oval macules and patches ranging from 5-15mm in size which tend to involve intertriginous areas.
***'''[[Petaloid type]]''': It appears as small papules with oily scales which enlarges to become patches giving it an appearance of petals of flower, hence the name.
**'''Trunk''': common in infants and most common site of involvement is lower abdomen.


* '''Generalized''': mostly seen in infants associated with [[leiner's disease]] and children with severe immunodeficiency. It usually is associated with diarrhea and failure to thrive and may resolve in few weeks.
*'''Localized'''
**'''''[[Scalp]]''''': Most common presentation in  infants known as [[cradle cap]]
**'''''[[Face]]''''': Most commonly involves eyelids, eyebrows, and [[nasolabial folds]]
**'''''Retroauricular'''''
**'''''Body folds''''': Commonly affects [[axilla]], breast folds, and [[inguinal]] area
**'''''[[Trunk]]''''': May be seen in severe cases and most common site of involvement is lower abdomen
**'''''Upper Chest''''': Most commonly seen in adults
***''Pityriasiform'': Oval [[macules]] and patches.
***''Petaloid type'': Small [[papules]] with oily scales may enlarge to become patches resembling petals of flower.
 
*'''Generalized''': Mostly seen in infants; it is associated with Leiner's disease and children with severe [[immunodeficiency]].<ref name="pmid3255962">{{cite journal| author=Hampshire J, Violaris N| title=Oral and oropharyngeal malignancies: the case for early detection. | journal=Practitioner | year= 1988 | volume= 232 | issue= 1452 | pages= 766 | pmid=3255962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3255962  }} </ref>


===Classification by Age===
===Classification by Age===
* '''Infantile''': seen in first three months of life. It is mostly a self limited disease in children.
* '''Infantile''': Occurs in first three months of life.  
* '''Adults''': occurs most commonly between 30-60 years of age. In adults, it usually appears as chronic relapsing condition invloving various parts of the body.
* '''Adults''': Occurs most commonly between 30-60 years of age.


===Classification by Symptomic Presentation===
===Classification by Symptomatic Presentation===
* '''[[Non pruritic]]''': This type is most commonly seen in infants.
* '''[[Non pruritic]]''': Most commonly occurs in infants
* '''[[Pruritic]]''': This type is seen in older children and adults. This type is common with scalp involvement.
* '''[[Pruritic]]''': Most commonly occurs in older children and adults


===Classification by Etiology===
===Classification by Etiology===
Exact cause of seborrheic dermatitis is unknown.However, following causes may be related to pathogenesis of seborrheic dermatitis.
* '''Idiopathic'''  
* '''Idiopathic''' : No known cause
* '''[[Infectious]]'''
* '''Infectious''': Caused by fungus named Malssezia based on its response to antifungal agents.
* '''[[Autoimmune]] / [[Inflammatory]]'''
* '''Autoimmune/Inflammatory''':One hypothesis suggests it as a primary inflammatory dermatoses resulting in increased [[apoptosis]], scaling and inflammation in [[epidermis]][[.


===Classification by Severity===
===Classification by Severity===
* '''Mild to moderate disease''': seen in immunocompetent individuals.
* '''Mild to moderate disease''': Occurs in [[immunocompetent]] individuals
* '''Severe disease''': Immunocomprised patients have more extensive disease which is mostly unresponsive to treatment.
* '''Severe disease''': Occurs in [[immunocompromised]] individuals


==Pathophysiology==
==Pathophysiology==
Complete pathogenesis of seborrheic dermatitis is not fully understood.However, studies have demonstrated strong correlation between presence of fungal yeast Malasezia and seborrheic dermatitis.<ref name="pmid25695430">{{cite journal| author=Soares RC, Zani MB, Arruda AC, Arruda LH, Paulino LC| title=Malassezia intra-specific diversity and potentially new species in the skin microbiota from Brazilian healthy subjects and seborrheic dermatitis patients. | journal=PLoS One | year= 2015 | volume= 10 | issue= 2 | pages= e0117921 | pmid=25695430 | doi=10.1371/journal.pone.0117921 | pmc=4335070 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25695430  }} </ref>
 
There are two species of Malasezia that predominantly related to
The exact pathophysiology of seborrheic dermatitis remains unclear. However, several mechanisms are hypothesized to play a role in pathogenesis of seborrheic dermatitis.<ref> name="pmid6220754">{{cite journal| author=Burton JL, Pye RJ| title=Seborrhoea is not a feature of seborrhoeic dermatitis. | journal=Br Med J (Clin Res Ed) | year= 1983 | volume= 286 | issue= 6372 | pages= 1169-70 | pmid=6220754 | doi= | pmc=1547390 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6220754  }} </ref> <ref name="pmid16094289">{{cite journal| author=Tajima M| title=[Malassezia species in patients with seborrheic dermatitis and atopic dermatitis]. | journal=Nihon Ishinkin Gakkai Zasshi | year= 2005 | volume= 46 | issue= 3 | pages= 163-7 | pmid=16094289 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?</ref><ref name="pmid11260013">{{cite journal| author=Faergemann J, Bergbrant IM, Dohsé M, Scott A, Westgate G| title=Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry. | journal=Br J Dermatol | year= 2001 | volume= 144 | issue= 3 | pages= 549-56 | pmid=11260013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11260013  }} </ref><ref name="pmid22960253">{{cite journal| author=Niemann C, Horsley V| title=Development and homeostasis of the sebaceous gland. | journal=Semin Cell Dev Biol | year= 2012 | volume= 23 | issue= 8 | pages= 928-36 | pmid=22960253 | doi=10.1016/j.semcdb.2012.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22960253  }} </ref><ref name="pmid3255962">{{cite journal| author=Hampshire J, Violaris N| title=Oral and oropharyngeal malignancies: the case for early detection. | journal=Practitioner | year= 1988 | volume= 232 | issue= 1452 | pages= 766 | pmid=3255962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3255962  }} </ref>
 
===Pathogenesis===
 
Hypotheses regarding the pathogenesis of seborrheic dermatitis include:
 
'''Hypotheses related to ''[[Malassezia furfur|Malassezia]] :'''''
 
*A strong correlation between presence of the fungal yeast ''[[Malassezia]]'' and response to [[antifungals]] in patients with seborrheic dermatitis.<ref name="pmid25695430">{{cite journal| author=Soares RC, Zani MB, Arruda AC, Arruda LH, Paulino LC| title=Malassezia intra-specific diversity and potentially new species in the skin microbiota from Brazilian healthy subjects and seborrheic dermatitis patients. | journal=PLoS One | year= 2015 | volume= 10 | issue= 2 | pages= e0117921 | pmid=25695430 | doi=10.1371/journal.pone.0117921 | pmc=4335070 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25695430  }} </ref>
 
*''[[Malassezia]]'' is a [[lipophilic]] [[yeast]] found  on the skin of both healthy individuals and seborrheic dermatitis patients. It is thought that host reaction to ''[[Malassezia]]'' or its metabolites causes an [[Inflammatory response|inflammatory reaction]] that may have a significant role in the process.<ref name="pmid16094289">{{cite journal| author=Tajima M| title=[Malassezia species in patients with seborrheic dermatitis and atopic dermatitis]. | journal=Nihon Ishinkin Gakkai Zasshi | year= 2005 | volume= 46 | issue= 3 | pages= 163-7 | pmid=16094289 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16094289  }} </ref>.
 
* Another proposed mechanism for seborrheic dermatitis suggests that a disrupted lipid layer of ''[[Malassezia]]'' leads to an increased production of [[cytokines|pro inflammatory cytokines]] such as [[IL-6]] and [[IL-7]], and decreased production of [[IL-10]]. <ref name="pmid: 18752620">{{cite journal| author=Thomas DS, Ingham E, Bojar RA, Holland KT| title=In vitro modulation of human keratinocyte pro- and anti-inflammatory cytokine production by the capsule of Malassezia species. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 54 | issue= 2 | pages= 203-14 | pmid=: 18752620 | doi=10.1111/j.1574-695X.2008.00468.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18752620  }} </ref>
 
*''[[Malassezia]]'' is seen to have [[lipase]] activity, which acts on cutaneous [[triglycerides]] causing a release of unsaturated [[fatty acids]] such as [[arachidonic acid]]. These metabolites may cause abnormal proliferation and differentiation of the [[stratum corneum]] leading to signs and symptoms of seborrheic dermatitis.<ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref><ref name="pmid9767239">{{cite journal| author=Parry ME, Sharpe GR| title=Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast. | journal=Br J Dermatol | year= 1998 | volume= 139 | issue= 2 | pages= 254-63 | pmid=9767239 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9767239  }} </ref><ref> author=Faergemann J, Bergbrant IM, Dohsé M, Scott A, Westgate G| title=Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry. | journal=Br J Dermatol | year= 2001 | volume= 144 | issue= 3 | pages= 549-56 | pmid=11260013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11260013  }} </ref>
 
'''Other Hypotheses'''
 
*'''[[Sebaceous gland]] activity'''
:[[Sebaceous gland|Sebum gland]] activity may correlate with seborrheic dermatitis.<ref name="pmid22960253">{{cite journal| author=Niemann C, Horsley V| title=Development and homeostasis of the sebaceous gland. | journal=Semin Cell Dev Biol | year= 2012 | volume= 23 | issue= 8 | pages= 928-36 | pmid=22960253 | doi=10.1016/j.semcdb.2012.08.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22960253  }} </ref><ref name="pmid6220754">{{cite journal| author=Burton JL, Pye RJ| title=Seborrhoea is not a feature of seborrhoeic dermatitis. | journal=Br Med J (Clin Res Ed) | year= 1983 | volume= 286 | issue= 6372 | pages= 1169-70 | pmid=6220754 | doi= | pmc=1547390 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6220754  }} </ref>
 
*'''[[Immune response]]'''
:Elevated levels of [[HLA|HLA-AW30]], [[HLA|HLA-AW31]], [[HLA|HLA-A32]], [[HLA|HLA-B12]] and [[HLA|HLA-B18]] and increased levels of total serum [[IgA]] and [[IgG|IgG antibodies]] have been detected in seborrheic dermatitis patients. This implies an [[Immune responses|immune mediated pathological mechanism]].<ref name="pmid11260013">{{cite journal| author=Faergemann J, Bergbrant IM, Dohsé M, Scott A, Westgate G| title=Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry. | journal=Br J Dermatol | year= 2001 | volume= 144 | issue= 3 | pages= 549-56 | pmid=11260013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11260013  }} </ref><ref name="pmid22281892">{{cite journal| author=Sampaio AL, Mameri AC, Vargas TJ, Ramos-e-Silva M, Nunes AP, Carneiro SC| title=Seborrheic dermatitis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 6 | pages= 1061-71; quiz 1072-4 | pmid=22281892 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22281892  }} </ref><ref name="pmid4193751">{{cite journal| author=Burton JL, Shuster S| title=Effect of L-dopa on seborrhoea of parkinsonism. | journal=Lancet | year= 1970 | volume= 2 | issue= 7662 | pages= 19-20 | pmid=4193751 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4193751  }} </ref>
 
*'''Epidermal barrier dysfunction'''
:Abnormalities in [[stratum corneum]] that may be associated with seborrheic dermatitis include:
:*Corneocyte shape
:* Corneodesmosomes
:*Disrupted [[lipid]] lamellar structure <ref name="pmid18460028">{{cite journal| author=Simon M, Tazi-Ahnini R, Jonca N, Caubet C, Cork MJ, Serre G| title=Alterations in the desquamation-related proteolytic cleavage of corneodesmosin and other corneodesmosomal proteins in psoriatic lesional epidermis. | journal=Br J Dermatol | year= 2008 | volume= 159 | issue= 1 | pages= 77-85 | pmid=18460028 | doi=10.1111/j.1365-2133.2008.08578.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18460028  }} </ref>
   
*'''Neurogenic and other factors'''
 
:Patients with [[parkinsonism]] may have increase levels of [[Melanocyte stimulating hormone|α-melanocyte stimulating hormone (α-MSH)]] levels and seborrheic dermatitis in these patients respond to [[L-dopa]] treatment<ref name="pmid4193751">{{cite journal| author=Burton JL, Shuster S| title=Effect of L-dopa on seborrhoea of parkinsonism. | journal=Lancet | year= 1970 | volume= 2 | issue= 7662 | pages= 19-20 | pmid=4193751 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4193751  }} </ref>
 
===Genetics===
 
There is no specific genetic cause for seborrheic dermatitis.<ref name="pmid2888552">{{cite journal| author=Dill FJ, Schertzer M, Sandercock J, Tischler B, Wood S| title=Inverted tandem duplication generates a duplication deficiency of chromosome 8p. | journal=Clin Genet | year= 1987 | volume= 32 | issue= 2 | pages= 109-13 | pmid=2888552 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2888552  }} </ref>.<ref name="pmid16751772">{{cite journal| author=Birnbaum RY, Zvulunov A, Hallel-Halevy D, Cagnano E, Finer G, Ofir R et al.| title=Seborrhea-like dermatitis with psoriasiform elements caused by a mutation in ZNF750, encoding a putative C2H2 zinc finger protein. | journal=Nat Genet | year= 2006 | volume= 38 | issue= 7 | pages= 749-51 | pmid=16751772 | doi=10.1038/ng1813 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16751772  }} </ref>
 
===Associated conditions===
*[[Parkinsonism]]
*[[Epilepsy]]
*[[Depression|Depressive mood disorder]]
*[[Traumatic brain injury]]
*[[Spinal cord injury]]
*[[HIV]]
*[[Lymphoma]]
*[[Downs syndrome]]
 
===Gross Pathology===
 
Superficial flaking and redness are characteristic findings of seborrheic dermatitis.<ref>Warner, Ronald R., et al. "Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo." Journal of the American Academy of Dermatology 45.6 (2001): 897-903.</ref>
<gallery>
Image:800px-Seborrhoeic dermatitis highres.jpg|Seborrheic dermatitis showing erythema on face. - By Roymishali - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27267929
Image:Body folds.jpg|Upper chest showing redness and crusting. - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>
</gallery>
 
===Microscopic Histopathology===
 
Histopathological findings of seborrheic dermatitis may be categorized into the following stages: <ref name="pmid22281892">{{cite journal| author=Sampaio AL, Mameri AC, Vargas TJ, Ramos-e-Silva M, Nunes AP, Carneiro SC| title=Seborrheic dermatitis.pmid22281892">{{cite journal| author=Sampaio AL, Mameri AC, Vargas TJ, Ramos-e-Silva M, Nunes AP, Carneiro SC| title=Seborrheic dermatitis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 6 | pages= 1061-71; quiz 1072-4 | pmid=22281892 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22281892  }} </ref><ref name="pmid4318061">{{cite journal| author=Druet P, Burtin P| title=[On the detection in renal cancers of an antigen not found in normal human kidney]. | journal=Eur J Cancer | year= 1967 | volume= 3 | issue= 3 | pages= 237-8 | pmid=4318061 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4318061  }} </ref> 
*'''Acute'''
:*Focal mild spongiosis with superficial crust containing [[neutrophils]].
:*Edema of [[Dermis|papillary dermis]].
:*Dilatation of [[Blood vessel|blood vessels]] in superficial vascular plexus with  infiltration of [[lymphocytes]], [[histiocytes]].
*'''Subacute'''
:*Psoriasiform [[hyperplasia]].
:*[[Keratin]] showing presence of [[Yeast|yeasts]].
*'''Chronic'''
:*Extensive psoriasiform [[hyperplasia]]
:*Minimal spongiosis
:*Follicular crusting


==Causes==
==Causes==
The 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,<ref>{{cite journal |author=Hay R, Graham-Brown R |title=Dandruff and seborrheic dermatitis: causes and management |journal=Clin Exp Dermatol |volume=22 |issue=1 |pages=3-6 |year=1997 |pmid=9330043 |doi=10.1046/j.1365-2230.1997.d01-231.x}}</ref><ref>{{cite journal |author=Nowicki R |title=[Modern management of dandruff] |journal=Pol Merkur Lekarski |volume=20 |issue=115 |pages=121-4 |year=2006 |pmid=16617752}}</ref> as well as genetic, environmental, hormonal, and immune-system factors.<ref>Am Fam Physician 2000;61:2703-10,2713-4</ref><ref>{{cite journal |author=Janniger C, Schwartz R |title=Seborrheic dermatitis |journal=Am Fam Physician |volume=52 |issue=1 |pages=149-55, 159-60 |year=1995 |pmid=7604759}}</ref> A suggestion that seborrhoeic dermatitis is an inflammatory response to this yeast has yet to be proven.<ref>{{cite journal |author=Parry M, Sharpe G |title=Seborrheic dermatitis is not caused by an altered immune response to Malassezia yeast |journal=Br J Dermatol |volume=139 |issue=2 |pages=254-63 |year=1998 |pmid=9767239 |doi=10.1046/j.1365-2133.1998.02362.x}}</ref> Those afflicted with seborrhoeic dermatitis have an unfavourable epidermic response to the infection, with the skin becoming inflamed and flaking.
The cause of seborrheic dermatitis remains unknown; however, the following factors may have been implicated:
 
*''[[Malassezia furfur]]'' (formerly known as ''[[Pityrosporum ovale]]'')<ref>{{cite journal |author=Hay R, Graham-Brown R |title=Dandruff and seborrheic dermatitis: causes and management |journal=Clin Exp Dermatol |volume=22 |issue=1 |pages=3-6 |year=1997 |pmid=9330043 |doi=10.1046/j.1365-2230.1997.d01-231.x}}</ref><ref>{{cite journal |author=Nowicki R |title=[Modern management of dandruff] |journal=Pol Merkur Lekarski |volume=20 |issue=115 |pages=121-4 |year=2006 |pmid=16617752}}</ref>.<ref>Am Fam Physician 2000;61:2703-10,2713-4</ref><ref>{{cite journal |author=Janniger C, Schwartz R |title=Seborrheic dermatitis |journal=Am Fam Physician |volume=52 |issue=1 |pages=149-55, 159-60 |year=1995 |pmid=7604759}}</ref><ref>{{cite journal |author=Parry M, Sharpe G |title=Seborrheic dermatitis is not caused by an altered immune response to Malassezia yeast |journal=Br J Dermatol |volume=139 |issue=2 |pages=254-63 |year=1998 |pmid=9767239 |doi=10.1046/j.1365-2133.1998.02362.x}}</ref>
In children, excessive [[vitamin A]] intake can cause seborrhoeic dermatitis.<ref>
*Excessive [[vitamin A]]<ref>
{{cite web
{{cite web
|url=http://www.nlm.nih.gov/medlineplus/ency/article/000350.htm
|url=http://www.nlm.nih.gov/medlineplus/ency/article/000350.htm
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</ref> Lack of [[biotin]],<ref name="aafp">
</ref>  
*Lack of [[biotin]],<ref name="aafp">
{{cite web
{{cite web
|url=http://www.aafp.org/afp/20060701/125.html
|url=http://www.aafp.org/afp/20060701/125.html
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|first=
|first=
}}
}}
</ref> [[pyridoxine]] (vitamin B6)<ref name="aafp"/><ref name="emedicine">
</ref>  
*[[pyridoxine]] (vitamin B6)<ref name="aafp"/><ref name="emedicine">
{{cite web
{{cite web
|url=http://www.emedicine.com/NEURO/topic278.htm
|url=http://www.emedicine.com/NEURO/topic278.htm
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|first=
|first=
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}}
</ref> and [[riboflavin]] (vitamin B2)<ref name="aafp"/> may also be a cause.
</ref>
*[[riboflavin]] (vitamin B2)<ref name="aafp"/>


==Differentiating {{PAGENAME}} from Other Diseases==
==Differentiating {{PAGENAME}} from Other Diseases==
Differential diagnosis of seborrheic dermatitis can be classified into two types by age group
Symptoms of seborrheic dermatitis may overlap with other skin conditions such as [[psoriasis]], [[candidiasis]], [[contact dermatitis]], and [[atopic dermatitis]]. Differential diagnosis of seborrheic dermatitis may be classified into two types by age group:<ref>Naldi, Luigi, and Alfredo Rebora. "Seborrheic dermatitis." New England Journal of Medicine 360.4 (2009): 387-396.</ref><ref name="pmid161301">{{cite journal| author=Braun-Falco O, Heilgemeir GP, Lincke-Plewig H| title=[Histological differential diagnosis of psoriasis vulgaris and seborrheic eczema of the scalp]. | journal=Hautarzt | year= 1979 | volume= 30 | issue= 9 | pages= 478-83 | pmid=161301 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=161301  }} </ref><ref name="pmid17191043">{{cite journal| author=Rosina P, Zamperetti MR, Giovannini A, Girolomoni G| title=Videocapillaroscopy in the differential diagnosis between psoriasis and seborrheic dermatitis of the scalp. | journal=Dermatology | year= 2007 | volume= 214 | issue= 1 | pages= 21-4 | pmid=17191043 | doi=10.1159/000096908 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17191043  }} </ref><ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref><ref>Schwartz, Robert A., Christopher A. Janusz, and Camila K. Janniger. "Seborrheic dermatitis: an overview." Am Fam Physician 74.1 (2006): 125-130.</ref><ref name="pmid25822272">{{cite journal| author=Clark GW, Pope SM, Jaboori KA| title=Diagnosis and treatment of seborrheic dermatitis. | journal=Am Fam Physician | year= 2015 | volume= 91 | issue= 3 | pages= 185-90 | pmid=25822272 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25822272  }} </ref><ref name="pmid4318061">{{cite journal| author=Druet P, Burtin P| title=[On the detection in renal cancers of an antigen not found in normal human kidney]. | journal=Eur J Cancer | year= 1967 | volume= 3 | issue= 3 | pages= 237-8 | pmid=4318061 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4318061  }} </ref>
===Differential diagnosis in infants===  
===Differential diagnosis in Infants===  
*[[Atopic dermatitis]]
*[[Atopic dermatitis]]
*[[Candidiasis]
*[[Candidiasis]]
*[[Dermatophytosis]]
*[[Dermatophytosis]]
*[[Diaper dermatitis]]
*[[Diaper rash|Diaper dermatitis]]
*[[Langerhans cell histiocytosis]]: It usually presents as refractory seborrheic dermatitis or diaper dermatitis in infants. Diagnosis is confirmed by skin biopsy.
*[[Langerhans cell histiocytosis]]
*[[Psoriasis]]
*[[Psoriasis]]
*[[Pityriasis amiantacea]]
*[[Pityriasis amiantacea]]
*[[Rosacea]]
*[[Rosacea]]
*[[Tinea capitis]]
*[[Tinea capitis]]
*[[zinc deficiency]]
*[[Zinc deficiency]]
*[[Vitamin B deficiency]]
*[[Vitamin B deficiency]]
===Differential diagnosis in Adults===
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Rash Characteristics
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Associated Conditions
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Images
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cutaneous T cell lymphoma]]/[[Mycosis fungoides]]<ref name="urlMycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/lymphoma/patient/mycosis-fungoides-treatment-pdq |title=Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
|
* '''Premycotic phase:''' A scaly, red [[rash]] in areas of the [[body]] that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
* '''Patch phase:''' Thin, [[erythematous]], [[eczema]]-like rash.
* '''[[Plaque]] phase:''' Small raised [[Bumps on skin|bumps]] ([[Papule|papules]]) or hardened [[lesions]] on the skin, which may be [[erythematous]].
* '''[[Tumor]] phase:''' Tumors form on the [[skin]]. [[Infection]] secondary to [[Ulcer|ulcers]].
|
* [[Epidermis (skin)|Epidermal]] [[atrophy]] or poikiloderma


==Epidemiology and Demographics==
* Generalized [[itching]] ([[pruritus]])
* [[Pain]] in the affected area of the skin
* [[Insomnia]]
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]
* Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease
* [[Weight loss]]
* [[Lymphadenopathy]]
* [[Malaise]] and [[fatigue]]
* [[Anemia]]
* May progress to [[Sezary syndrome]] (skin involvement plus hematogenous dissemination)
|
* [[Sezary syndrome]]
|
[[Image:Mycosis_fungoides.JPG|200px|thumb|By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=7139812]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
|
* Pink or salmon in color, which may be scaly; referred to as "herald patch"
* Oval shape
* Long axis oriented along the cleavage lines
* Distributed on the [[trunk]] and [[proximal extremities]]
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on  posterior trunk
* Secondary to [[viral infection]]<nowiki/>s
* Resolves spontaneously after 6-8 weeks
|
* Preceded by a prodrome of:
** [[Sore throat]]
** [[Gastrointestinal tract|Gastrointestinal]] disturbance
** [[Fever]]
** [[Arthralgia]]
|
* Infection by any of the following:<ref name="pmid19997691">{{cite journal |vauthors=Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A |title=Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea |journal=Acta Derm. Venereol. |volume=89 |issue=6 |pages=604–6 |year=2009 |pmid=19997691 |doi=10.2340/00015555-0703 |url=}}</ref>
** [[Human herpesvirus 6|HHV-6]]
** [[HHV-7]]
** [[HHV-8]]
|
[[Image:Pityriasisrosea.png|200px|thumb|By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis lichenoides chronica]]
|
* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
* Brownish red or orange-brown in color
* [[Lesions]] are capped by a single detachable, opaque, mica-like scale
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
|
* High [[fever]]
* [[Malaise]]
* [[Myalgias]]
* [[Paraesthesia]]
* [[Pruritis|Pruritus]]
|
* Infection by any of the following:<ref name="pmid9109005">{{cite journal |vauthors=Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF |title=Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR) |journal=Int. J. Dermatol. |volume=36 |issue=2 |pages=104–9 |year=1997 |pmid=9109005 |doi= |url=}}</ref>
** [[Epstein Barr virus|Epstein-Barr virus]] (EBV)
** ''[[Toxoplasma gondii]]''
** [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
|


==Risk Factors==
|-
Most common risk factors for Seborrheic dermatitis are<ref name="pmid3129121">{{cite journal| author=Hastings GB, Leathar DS, Scott AC| title=Scottish attitudes to AIDS. | journal=Br Med J (Clin Res Ed) | year= 1988 | volume= 296 | issue= 6627 | pages= 991-2 | pmid=3129121 | doi= | pmc=2545449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3129121  }} </ref><ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nummular dermatitis]]<ref name="pmid23517392">{{cite journal |vauthors=Jiamton S, Tangjaturonrusamee C, Kulthanan K |title=Clinical features and aggravating factors in nummular eczema in Thais |journal=Asian Pac. J. Allergy Immunol. |volume=31 |issue=1 |pages=36–42 |year=2013 |pmid=23517392 |doi= |url=}}</ref>
*[[Immunocompromised]] Patients such as organ transplant recipients, patients with [[HIV]], [[Hep C]], [[chronic alcoholic pancreatitis]] and various malignancies such as [[lymphoma]]<ref name="pmid14731170">{{cite journal| author=Dunic I, Vesic S, Jevtovic DJ| title=Oral candidiasis and seborrheic dermatitis in HIV-infected patients on highly active antiretroviral therapy. | journal=HIV Med | year= 2004 | volume= 5 | issue= 1 | pages= 50-4 | pmid=14731170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14731170  }} </ref><ref name="pmid4280471">{{cite journal| author=Soldatov IuN, Glushko AV| title=[Spontaneous rupture of the epigastric arteries simulating acute abdomen]. | journal=Klin Khir | year= 1974 | volume= | issue= 11 | pages= 61-2 | pmid=4280471 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4280471  }} </ref><ref name="pmid: 23991694">{{cite journal| author=Özcan D, Seçkin D, Ada S, Haberal M| title=Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case-control study. | journal=Clin Transplant | year= 2013 | volume= 27 | issue= 5 | pages= 742-8 | pmid=: 23991694 | doi=10.1111/ctr.12215 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23991694  }} </ref>
|
*Neurologic and psychiatric cases such as patients with [[Parkinsonism]], patients with [[Depressive mood disorde]]r, [[tardive dyskinesia]], traumatic brain injury, [[epilepsy]], [[facial nerve palsy]], spinal cord injury 
* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]  
*Genetic disorders such as patients with [[Downs syndrome]], [[Hailey Hailey disease]], [[Cardiofaciocutaneous syndrome]], mutation in (ZNF750) which codes for a [[zinc finger protein (C2H2)]] may be related to cause seborrhea like dermatitis
* Commonly affecting the [[extremities]] (lower>upper) and [[trunk]]
* May ooze [[fluid]] and become dry and crusty
|
* Often appears after a skin injury, such as a [[burn]], [[abrasion]] (from friction), or [[insect bite]]


Other risk factors include
* [[Lesions]] commonly relapse after occasional remission or may persist for long periods
*Stress<ref name="pmid18033062">{{cite journal| author=Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG et al.| title=[Stress and seborrheic dermatitis]. | journal=Ann Dermatol Venereol | year= 2007 | volume= 134 | issue= 11 | pages= 833-7 | pmid=18033062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18033062  }} </ref>
* [[Pruritis|Pruritus]]
*Patients treated with [[psoralene]] and ultravoilet light A for [[psoriasis]] are seen to have a predisposition for seborrheic dermatitis.
|
*Male population is more prone to develop seborrheic dermatitis as compared to females.<ref>Baran, Robert, and Howard Maibach, eds. Textbook of cosmetic dermatology. CRC Press, 2010.</ref>
* Associated with:
*[[Obesity]], [[Diabetes Mellitus]] and other endocrine disorders causing alteration in glucose metabolism.<ref>Dowlati, Bijan, et al. "Insulin quantification in patients with seborrheic dermatitis." Archives of dermatology 134.8 (1998): 1043-1045.</ref>
** Dry skin
*Seasonal changes such as low temperature and decreased humditiy  may have a significant role in seborrheic dermatitis flare ups<ref name="pmid20418977">{{cite journal| author=Banerjee S, Gangopadhyay DN, Jana S, Chanda M| title=Seasonal variation in pediatric dermatoses. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 44-6 | pmid=20418977 | doi=10.4103/0019-5154.60351 | pmc=2856373 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418977  }} </ref>
** Emotional stress
** [[Allergens]] (rubber chemicals, [[formaldehyde]], [[neomycin]], chrome, [[Mercury (element)|mercury]], and [[nickel]])
** [[Staphylococcus]] infection
** Seasonal variation
** [[Alcohol]]
** [[Drugs]]
** [[Atopy]]
|


==Screening==
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Secondary syphilis]]<ref name="urlSTD Facts - Syphilis">{{cite web |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm |title=STD Facts - Syphilis |format= |work= |accessdate=}}</ref>
|
* Round, coppery, red colored [[lesions]] on palms and soles
* [[Papule|Papules]] with collarette of scales
|
* [[Fever]]
* [[Lymphadenopathy|Generalized lymphadenopathy]]
* [[Sore throat]]
* [[Hair loss|Patchy hair loss]]
* [[Headaches|Headache]]
* [[Weight loss]]
* [[Myalgia]]
* [[Fatigue]]
|
* Associated with:
** [[Condyloma latum|Condylomata lata]]
** Corona verinata
** Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] test
|
[[Image:Secondary_Syphilis.jpg|200px|thumb|By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
|
* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]
* Well-defined margins
|
* [[Pruritis|Pruritus]]
* [[Pain]]
* Bleeding [[lesions]]
|
* Associated with:<ref name="pmid25201325">{{cite journal |vauthors=Murao K, Yoshioka R, Kubo Y |title=Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease |journal=J. Dermatol. |volume=41 |issue=10 |pages=878–84 |year=2014 |pmid=25201325 |doi=10.1111/1346-8138.12613 |url=}}</ref>
** [[Erythroplasia of Queyrat]] ([[Bowen's disease]] of the [[penis]])
** [[Squamous cell carcinoma]]
** Solar radiation and [[ultraviolet]] (UV) exposure
** [[Radiation therapy|Radiotherapy]]
** [[Immunosuppression]]
** [[Arsenic]] exposure
** [[Human papillomavirus|Human papilloma virus]] (HPV) type 16
** [[Polyomavirus|Merkel cell polyomavirus]]
** [[Sjögren's syndrome|Sjögren’s syndrome]]
|
[[Image:Bowen.jpg|200px|thumb|By Klaus D. Peter, Gummersbach, Germany - Own work (own photograph), CC BY 3.0 de, https://commons.wikimedia.org/w/index.php?curid=6839115]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Exanthematous pustulosis]]<ref name="pmid26354880">{{cite journal |vauthors=Szatkowski J, Schwartz RA |title=Acute generalized exanthematous pustulosis (AGEP): A review and update |journal=J. Am. Acad. Dermatol. |volume=73 |issue=5 |pages=843–8 |year=2015 |pmid=26354880 |doi=10.1016/j.jaad.2015.07.017 |url=}}</ref>
|
* Numerous small, primarily non-follicular, sterile [[pustules]], arising within large areas of [[Edema|edematous]] [[erythema]]
|
* [[Fever]]
* [[Leukocytosis]]
* Intracorneal, subcorneal, and/or intraepidermal [[pustules]] with [[papillary]] [[dermal]] [[edema]] containing [[neutrophils]] and [[eosinophils]]
|
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
** [[Antibiotics]] ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** [[Carbamazepine]]
** [[Calcium channel blocker|Calcium channel blockers]] ([[Diltiazem]])
** [[Hydroxychloroquine]]
|
[[Image:Acute_generalized_exanthematous_pustulosis.jpg|200px|thumb|By See below - (2010). "Acute generalized exanthematous pustulosis: an unusual side effect of meropenem". Indian J Dermatol 55 (2): 176–7. DOI:10.4103/0019-5154.62759. PMID 20606889. PMC: 2887524., CC BY 1.0, https://commons.wikimedia.org/w/index.php?curid=52979729]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lichen planus|Hypertrophic lichen planus]]<ref name="pmid27222766">{{cite journal |vauthors=Ankad BS, Beergouder SL |title=Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective |journal=Dermatol Pract Concept |volume=6 |issue=2 |pages=9–15 |year=2016 |pmid=27222766 |pmc=4866621 |doi=10.5826/dpc.0602a03 |url=}}</ref>
|
* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
* [[Lesions]] may transform into [[Hyperkeratosis|hyperkeratotic]] thickened, elevated, purplish or reddish [[Plaque|plaques]] and [[nodules]]
|
* Chronic [[pruritis|pruritus]]
* Scaling
* May be [[asymptomatic]]
|
* Associated with [[Hepatitis C virus]] infection<ref name="pmid19770446">{{cite journal |vauthors=Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W |title=Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis |journal=Arch Dermatol |volume=145 |issue=9 |pages=1040–7 |year=2009 |pmid=19770446 |doi=10.1001/archdermatol.2009.200 |url=}}</ref>
|
[[Image:Lichen_planus2.JPG|200px|thumb|Di James Heilman, MD - Opera propria, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11509003]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sneddon–Wilkinson disease<ref name="pmid9564592">{{cite journal |vauthors=Lutz ME, Daoud MS, McEvoy MT, Gibson LE |title=Subcorneal pustular dermatosis: a clinical study of ten patients |journal=Cutis |volume=61 |issue=4 |pages=203–8 |year=1998 |pmid=9564592 |doi= |url=}}</ref>
|
* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
* Annular configuration
|
* [[Pruritis|Pruritus]]
* May be asymptomatic
|
* Associated with:
** [[Monoclonal gammopathy]], usually an [[IgA]] paraproteinemia<ref name="pmid3056995">{{cite journal |vauthors=Kasha EE, Epinette WW |title=Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature |journal=J. Am. Acad. Dermatol. |volume=19 |issue=5 Pt 1 |pages=854–8 |year=1988 |pmid=3056995 |doi= |url=}}</ref>
** [[Crohn's disease]]<ref name="pmid1357895">{{cite journal |vauthors=Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H |title=Subcorneal pustular dermatosis in a patient with Crohn's disease |journal=Acta Derm. Venereol. |volume=72 |issue=4 |pages=301–2 |year=1992 |pmid=1357895 |doi= |url=}}</ref>
** [[Osteomyelitis]]
** [[Adalimumab]]<ref name="pmid23489057">{{cite journal |vauthors=Sauder MB, Glassman SJ |title=Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis |journal=Int. J. Dermatol. |volume=52 |issue=5 |pages=624–8 |year=2013 |pmid=23489057 |doi=10.1111/j.1365-4632.2012.05707.x |url=}}</ref>
|


==Natural History, Complications, and Prognosis==
|-
===Natural History===
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
|
* [[Erythematous]] [[plaques]] with fine scaly surface
* May present with elongated, finger-like patches
* Symmetrical distribution on the flanks
* Known as digitate dermatosis
|
* [[Lesions]] may be [[asymptomatic]]
* May be mildly [[Itch|pruritic]]
* May fade or disappear after sun exposure during the summer season, but typically recur during the winter
|
* May progress to [[mycosis fungoides]]<ref name="pmid16191852">{{cite journal |vauthors=Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A |title=A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides |journal=Acta Derm. Venereol. |volume=85 |issue=4 |pages=318–23 |year=2005 |pmid=16191852 |doi=10.1080/00015550510030087 |url=}}</ref>
|


===Complications===
|-
Side effects to inflammation may include temporary hair loss. If severe outbreaks go untreated for long periods of time, permanent hair loss may result due to damaged hair follicles.  
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intertrigo]]<ref name="pmid16156342">{{cite journal |vauthors=Janniger CK, Schwartz RA, Szepietowski JC, Reich A |title=Intertrigo and common secondary skin infections |journal=Am Fam Physician |volume=72 |issue=5 |pages=833–8 |year=2005 |pmid=16156342 |doi= |url=}}</ref>
===Prognosis===
|
* Red and fleshy looking [[lesion]] in [[skin]] folds
* [[Itching]]
* Oozing
* May be sore
|
* [[Pruritis|Pruritus]]
* Musty odor
|
* Associated with:
** [[Infections]] (Fungal, bacterial, viral)
** [[Allergies]]
** [[Diabetes Mellitus|Diabetes]]
** [[Obesity]]
|
[[Image:Axillary_intertrigo.png|200px|thumb|Source: https://www.cdc.gov/]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
|
* Scaling and crusting of [[scalp]]
|
* Pathological fractures<ref name="pmid1636041">{{cite journal |vauthors=Stull MA, Kransdorf MJ, Devaney KO |title=Langerhans cell histiocytosis of bone |journal=Radiographics |volume=12 |issue=4 |pages=801–23 |year=1992 |pmid=1636041 |doi=10.1148/radiographics.12.4.1636041 |url=}}</ref>
* Visceromegaly ([[hepatomegaly]], [[spleenomegaly]])
* [[Chronic cough, severe cold|Chronic cough]]
* [[Dyspnea]]<ref name="pmid17527085">{{cite journal |vauthors=Sholl LM, Hornick JL, Pinkus JL, Pinkus GS, Padera RF |title=Immunohistochemical analysis of langerin in langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases |journal=Am. J. Surg. Pathol. |volume=31 |issue=6 |pages=947–52 |year=2007 |pmid=17527085 |doi=10.1097/01.pas.0000249443.82971.bb |url=}}</ref>
* [[Lymphadenopathy]]
|
* Associated with:
** [[Diabetes insipidus]]<ref name="pmid16047354">{{cite journal |vauthors=Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H |title=Risk factors for diabetes insipidus in langerhans cell histiocytosis |journal=Pediatr Blood Cancer |volume=46 |issue=2 |pages=228–33 |year=2006 |pmid=16047354 |doi=10.1002/pbc.20425 |url=}}</ref>
** [[Pancytopenia]]
|


==Diagnosis==
|-
===Diagnostic Criteria===
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tinea manuum]]/pedum/capitis<ref name="pmid15050029">{{cite journal |vauthors=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal=Clin Mol Allergy |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |pmc=419368 |doi=10.1186/1476-7961-2-5 |url=}}</ref>
|
* Scaling, flaking, and sometimes blistering of the affected areas
* Hair loss with a black dot on scalp in case of [[tinea capitis]]
|
* [[Pruritis|Pruritus]]
* [[KOH]] preparation of the [[lesions]] confirms [[fungal infection]]
|
* Associated with:
** [[Diabetes mellitus|Diabetes]]
** [[Immunosupression]]
** Intimate contact with infected person
** May lead to [[asthma]] exacerbation
|


===History and Symptoms===
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
|
* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
|
* [[Pruritus]]
|
* Associated with:<ref name="pmid16848386">{{cite journal |vauthors=Schwartz RA, Janusz CA, Janniger CK |title=Seborrheic dermatitis: an overview |journal=Am Fam Physician |volume=74 |issue=1 |pages=125–30 |year=2006 |pmid=16848386 |doi= |url=}}</ref>
** [[AIDS]]
** [[Stress]]<ref name="pmid18033062">{{cite journal |vauthors=Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM |title=[Stress and seborrheic dermatitis] |language=French |journal=Ann Dermatol Venereol |volume=134 |issue=11 |pages=833–7 |year=2007 |pmid=18033062 |doi= |url=}}</ref>
** [[Fungal infection]]
** [[Fatigue]]
** [[Sleep deprivation]]
** Change of season
** [[Parkinson's disease|Parkinson's]] disease
** [[Biotin]] deficiency
|
[[Image:Seborrhoeic_dermatitisnew.jpg|thumb|200px|By Roymishali - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27267929]]
|}


===Physical Examination===
===Differential diagnosis in Adults===
====Head====
*[[Systemic lupus erythematosus]]
*[[Candidiasis]]
*[[Erythrasma]]
*[[Contact dermatitis]]
*[[Psoriasis]]
*[[Tinea versicolor]]
*[[Tinea corporis]]
*[[Secondary syphilis]]
*[[Pemphigus foliaceus]]
*[[Rosacea]]


<gallery>
==Epidemiology and Demographics==
===Epidemiology===
Worldwide, the [[prevalence]] of seborrheic dermatitis is estimated to be 11000 cases per 100,000.<ref name="pmid2888552">{{cite journal| author=Dill FJ, Schertzer M, Sandercock J, Tischler B, Wood S| title=Inverted tandem duplication generates a duplication deficiency of chromosome 8p. | journal=Clin Genet | year= 1987 | volume= 32 | issue= 2 | pages= 109-13 | pmid=2888552 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2888552  }} </ref> [[Prevalence]] of seborrheic varies among individuals based on the following factors:
:* Higher reporting of mild cases
:* Higher in patients with [[HIV]] with 35000 per 100,000 in early diagnosis and 85000 per 100,000 with full blown [[AIDS]]<ref name="pmid14678527">{{cite journal| author=Gupta AK, Bluhm R| title=Seborrheic dermatitis. | journal=J Eur Acad Dermatol Venereol | year= 2004 | volume= 18 | issue= 1 | pages= 13-26; quiz 19-20 | pmid=14678527 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14678527  }} </ref>
:*Higher [[prevalence]] seen among those directly exposed to UV radiation<ref name="pmid11053918">{{cite journal| author=Moehrle M, Dennenmoser B, Schlagenhauff B, Thomma S, Garbe C| title=High prevalence of seborrhoeic dermatitis on the face and scalp in mountain guides. | journal=Dermatology | year= 2000 | volume= 201 | issue= 2 | pages= 146-7 | pmid=11053918 | doi=18458 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11053918  }} </ref>
*The exact [[incidence]] of seborrheic dermatitis is unknown<ref>Naldi, Luigi, and Alfredo Rebora. "Seborrheic dermatitis." New England Journal of Medicine 360.4 (2009): 387-396</ref><ref>Denton, C. P., et al. "Scleroderma (systemic sclerosis)." Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York, NY: McGraw-Hill Medical Publishing Division (2008): 1553-1562</ref><ref name="pmid14678527">{{cite journal| author=Gupta AK, Bluhm R| title=Seborrheic dermatitis. | journal=J Eur Acad Dermatol Venereol | year= 2004 | volume= 18 | issue= 1 | pages= 13-26; quiz 19-20 | pmid=14678527 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14678527  }} </ref><ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109  }} </ref>


Image: Seborrhoeic_dermatitis_01.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
===Demographics===
====Age====
Seborrheic dermatitis demonstrates a tri-modal age distribution as follows:<ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109  }} </ref><ref name="pmid17656992">{{cite journal| author=Sachdeva M, Kaur S, Nagpal M, Dewan SP| title=Cutaneous lesions in new born. | journal=Indian J Dermatol Venereol Leprol | year= 2002 | volume= 68 | issue= 6 | pages= 334-7 | pmid=17656992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17656992  }} </ref><ref name="pmid22281892">{{cite journal| author=Sampaio AL, Mameri AC, Vargas TJ, Ramos-e-Silva M, Nunes AP, Carneiro SC| title=Seborrheic dermatitis. | journal=An Bras Dermatol | year= 2011 | volume= 86 | issue= 6 | pages= 1061-71; quiz 1072-4 | pmid=22281892 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22281892  }} </ref>
*The first [[incidence]] peak is seen in infants around three to four months of age, which usually resolves within 12 months
*The second [[incidence]] peak is seen around puberty.  
*The third [[incidence]] peak is seen after age 50 with the highest [[prevalence]] seen among ages 33-44 years.<ref>Naldi, Luigi, and Alfredo Rebora. "Seborrheic dermatitis." New England Journal of Medicine 360.4 (2009): 387-396.</ref>
*Age groups showing lowest [[prevalence]] of clinical disease is seen in individuals younger than 12 years.<ref>Naldi, Luigi, and Alfredo Rebora. "Seborrheic dermatitis." New England Journal of Medicine 360.4 (2009): 387-396.</ref>
====Gender====
Males are more commonly affected with seborrheic dermatitis than females.<ref> name="pmid12956195">{{cite journal| author=Gupta AK, Bluhm R, Cooper EA, Summerbell RC, Batra R| title=Seborrheic dermatitis. | journal=Dermatol Clin | year= 2003 | volume= 21 | issue= 3 | pages= 401-12 | pmid=12956195 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12956195  }} </ref>
====Race====
*Seborrheic dermatitis is rarely seen in African Americans.
*If seborrheic dermatitis is seen in this population, it leads to high suspicion of [[HIV]] in affected individuals.<ref>Mahé, Antoine, et al. "Predictive value of seborrheic dermatitis and other common dermatoses for HIV infection in Bamako, Mali." Journal of the American Academy of Dermatology 34.6 (1996):</ref>


Image: Seborrhoeic_dermatitis_04.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
==Risk Factors==
The most common risk factors for seborrheic dermatitis include:<ref name="pmid3129121">{{cite journal| author=Hastings GB, Leathar DS, Scott AC| title=Scottish attitudes to AIDS. | journal=Br Med J (Clin Res Ed) | year= 1988 | volume= 296 | issue= 6627 | pages= 991-2 | pmid=3129121 | doi= | pmc=2545449 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3129121 }} </ref><ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref>


Image: Seborrhoeic_dermatitis_05.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
'''[[Immunosuppression]]'''
*[[Organ transplant]] recipients
*[[HIV/AIDS]]
*[[Malignancies]] such as [[lymphoma]]<ref name="pmid14731170">{{cite journal| author=Dunic I, Vesic S, Jevtovic DJ| title=Oral candidiasis and seborrheic dermatitis in HIV-infected patients on highly active antiretroviral therapy. | journal=HIV Med | year= 2004 | volume= 5 | issue= 1 | pages= 50-4 | pmid=14731170 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14731170  }} </ref><ref name="pmid4280471">{{cite journal| author=Soldatov IuN, Glushko AV| title=[Spontaneous rupture of the epigastric arteries simulating acute abdomen]. | journal=Klin Khir | year= 1974 | volume=  | issue= 11 | pages= 61-2 | pmid=4280471 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4280471 }} </ref><ref name="pmid: 23991694">{{cite journal| author=Özcan D, Seçkin D, Ada S, Haberal M| title=Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case-control study. | journal=Clin Transplant | year= 2013 | volume= 27 | issue= 5 | pages= 742-8 | pmid=: 23991694 | doi=10.1111/ctr.12215 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23991694  }} </ref>


Image: Seborrhoeic_dermatitis_06.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
'''Neurologic and psychiatric cases'''
*[[Parkinsonism]]
*[[Depression]]
*[[Tardive dyskinesia]]
*[[Traumatic brain injury]]
*[[Epilepsy]]
*[[Facial nerve palsy]]
*[[Spinal cord injury]]
   
'''Genetic disorders'''


Image: Seborrhoeic_dermatitis_07.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
*[[Downs syndrome]]
*[[Hailey-Hailey Disease]]
*[[Cardiofaciocutaneous syndrome]]
*[[Mutation]] in (ZNF750) coding a [[zinc finger protein]] (C2H2)


Image: Seborrhoeic_dermatitis_09.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
'''Other risk factors'''


Image: Seborrhoeic_dermatitis_10.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
*Stress<ref name="pmid18033062">{{cite journal| author=Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG et al.| title=[Stress and seborrheic dermatitis]. | journal=Ann Dermatol Venereol | year= 2007 | volume= 134 | issue= 11 | pages= 833-7 | pmid=18033062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18033062 }} </ref>
*Treatment with psoralene and [[UV-A]]
*Male gender <ref>Baran, Robert, and Howard Maibach, eds. Textbook of cosmetic dermatology. CRC Press, 2010.</ref>
*[[Obesity]]
*[[Diabetes mellitus]]<ref>Dowlati, Bijan, et al. "Insulin quantification in patients with seborrheic dermatitis." Archives of dermatology 134.8 (1998): 1043-1045.</ref>
*Seasonal changes such as low temperature and decreased humditiy<ref name="pmid20418977">{{cite journal| author=Banerjee S, Gangopadhyay DN, Jana S, Chanda M| title=Seasonal variation in pediatric dermatoses. | journal=Indian J Dermatol | year= 2010 | volume= 55 | issue= 1 | pages= 44-6 | pmid=20418977 | doi=10.4103/0019-5154.60351 | pmc=2856373 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20418977  }} </ref>
*Drugs such as [[Haloperidol|haloperidol deconate]], [[lithium]] and [[chlorpromazine]]


Image: Seborrhoeic_dermatitis_13.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
==Screening==
There are no screening guidelines for seborrheic dermatitis.<ref name=Screening-seborrheic-dermatitis>US preventive service task force.seborrheic dermatitis. http://www.uspreventiveservicestaskforce.org/accessed on August16, 2016</ref>


Image: Seborrhoeic_dermatitis_15.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
==Natural History, Complications, and Prognosis==
===Natural History===
*The symptoms of seborrheic dermatitis usually develop in the first three months in infants. It may resolve without treatment in most cases in few months and rarely presents after 12 months.<ref name="pmid2528704">{{cite journal| author=Tedder JM| title=New Zealand Society of Physiotherapists, court of appeal and ACC. | journal=N Z Med J | year= 1989 | volume= 102 | issue= 875 | pages= 483 | pmid=2528704 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2528704 }} </ref>
*In adults, symptoms of seborrheic dermatitis usually develop in the second and third decade of life, and start with symptoms such as [[redness]], scaling and crusting on affected areas. However, occurrence of seborrheic dermatitis is highly variable and it may present after 50 years of age.
*The course of disease is highly variable among individuals despite treatment. Some cases present with more frequent [[relapses]] than others.<ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109  }} </ref>


Image: Seborrhoeic_dermatitis_19.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
===Complications===
Common complications of seborrheic dermatitis include:<ref name="pmid16172323">{{cite journal| author=Gorman CR, White SW| title=Rosaceiform dermatitis as a complication of treatment of facial seborrheic dermatitis with 1% pimecrolimus cream. | journal=Arch Dermatol | year= 2005 | volume= 141 | issue= 9 | pages= 1168 | pmid=16172323 | doi=10.1001/archderm.141.9.1168 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16172323  }} </ref><ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109 }} </ref><ref name="pmid15128319">{{cite journal| author=Guin JD| title=Eyelid dermatitis: a report of 215 patients. | journal=Contact Dermatitis | year= 2004 | volume= 50 | issue= 2 | pages= 87-90 | pmid=15128319 | doi=10.1111/j.0105-1873.2004.00311.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15128319  }} </ref><ref name="pmid24689165">{{cite journal| author=Ooi ET, Tidman MJ| title=Improving the management of seborrhoeic dermatitis. | journal=Practitioner | year= 2014 | volume= 258 | issue= 1768 | pages= 23-6, 3 | pmid=24689165 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24689165  }} </ref><ref>Ross, Elizabeth K., Colombina Vincenzi, and Antonella Tosti. "Videodermoscopy in the evaluation of hair and scalp disorders." Journal of the American Academy of Dermatology 55.5 (2006): 799-806.</ref><ref name="pmid3255962">{{cite journal| author=Hampshire J, Violaris N| title=Oral and oropharyngeal malignancies: the case for early detection. | journal=Practitioner | year= 1988 | volume= 232 | issue= 1452 | pages= 766 | pmid=3255962 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3255962  }} </ref>
*Temporary or permanent [[hair loss]]
*Secondary [[bacterial infection]]
*[[Blepharitis]]
*[[Abscess]] of [[meibomian glands]]
*[[Otitis externa]]
*Extensive involvement of body


Image: Seborrhoeic_dermatitis_20.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
===Prognosis===
*The prognosis of seborrheic dermatitis is excellent in infants; it is a self limited disease and usually resolves within few months after birth.
*In adults, it is a recurrent condition with no permanent cure.<ref name="pmid12622623">{{cite journal| author=Foley P, Zuo Y, Plunkett A, Merlin K, Marks R| title=The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap). | journal=Arch Dermatol | year= 2003 | volume= 139 | issue= 3 | pages= 318-22 | pmid=12622623 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12622623 }} </ref><ref name="pmid27013615">{{cite journal| author=Forrestel AK, Kovarik CL, Mosam A, Gupta D, Maurer TA, Micheletti RG| title=Diffuse HIV-associated seborrheic dermatitis - a case series. | journal=Int J STD AIDS | year= 2016 | volume=  | issue=  | pages=  | pmid=27013615 | doi=10.1177/0956462416641816 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27013615  }} </ref>


</gallery>
==Diagnosis==
There is no definitive diagnostic criteria for seborrheic dermatitis. Diagnosis of seborrheic dermatitis is primarily clinical; it is based on history and physical examination findings.<ref>Schwartz, Robert A., Christopher A. Janusz, and Camila K. Janniger. "Seborrheic dermatitis: an overview." Am Fam Physician 74.1 (2006): 125-130</ref>


====Ear====
==History==
Obtaining complete  history is important in making diagnosis of seborrheic dermatitis as it will give an insight into cause and associated risk factors for the disease. In addition to symptoms of seborrheic dermatitis, patients may present with symptoms of one of the following associated conditions:<ref name="pmid3995588">{{cite journal| author=Tsao BP, Aldo-Benson MA| title=Macrophage-derived soluble factors mediate suppression induced by 2,4-dinitrophenyl-conjugated mouse IgG in hybridoma cells. | journal=Cell Immunol | year= 1985 | volume= 91 | issue= 2 | pages= 362-74 | pmid=3995588 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3995588  }} </ref><ref name="pmid2861228">{{cite journal| author=Rola-Pleszczynski M| title=Differential effects of leukotriene B4 on T4+ and T8+ lymphocyte phenotype and immunoregulatory functions. | journal=J Immunol | year= 1985 | volume= 135 | issue= 2 | pages= 1357-60 | pmid=2861228 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2861228  }} </ref><ref>Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. Journal of clinical and investigative dermatology. 2015;3(2):10.13188/2373-1044.1000019.</ref><ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref> <ref name="pmid9764146">{{cite journal| author=Muñoz-Pérez MA, Rodriguez-Pichardo A, Camacho F, Colmenero MA| title=Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse. | journal=Br J Dermatol | year= 1998 | volume= 139 | issue= 1 | pages= 33-9 | pmid=9764146 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9764146  }} </ref><ref name="pmid22303799">{{cite journal| author=Bilgili SG, Akdeniz N, Karadag AS, Akbayram S, Calka O, Ozkol HU| title=Mucocutaneous disorders in children with down syndrome: case-controlled study. | journal=Genet Couns | year= 2011 | volume= 22 | issue= 4 | pages= 385-92 | pmid=22303799 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22303799  }} </ref><ref name="pmid27511489">{{cite journal| author=Baş Y, Seçkin HY, Kalkan G, Takci Z, Çitil R, Önder Y et al.| title=Prevalence and related factors of psoriasis and seborrheic dermatitis: a community-based study. | journal=Turk J Med Sci | year= 2016 | volume= 46 | issue= 2 | pages= 303-9 | pmid=27511489 | doi=10.3906/sag-1406-51 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27511489  }} </ref>
*[[Parkinsonism]]
*[[Epilepsy]]
*[[Depression|Depressive mood disorder]]
*[[Traumatic brain injury]]
*[[Spinal cord injury]]
*[[HIV]]
*[[Lymphoma]]
*[[Downs syndrome]]
*[[Hailey-Hailey Disease]]
*[[Diabetes mellitus]]


<gallery>
==Symptoms==


Image: Seborrhoeic_dermatitis_08.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
Symptoms of seborrheic dermatitis may be categorized according to age as follows:<ref name="pmid2888552">{{cite journal| author=Dill FJ, Schertzer M, Sandercock J, Tischler B, Wood S| title=Inverted tandem duplication generates a duplication deficiency of chromosome 8p. | journal=Clin Genet | year= 1987 | volume= 32 | issue= 2 | pages= 109-13 | pmid=2888552 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2888552 }} </ref><ref name="pmid20657113">{{cite journal| author=Sarkar R, Garg VK| title=Erythroderma in children. | journal=Indian J Dermatol Venereol Leprol | year= 2010 | volume= 76 | issue= 4 | pages= 341-7 | pmid=20657113 | doi=10.4103/0378-6323.66576 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20657113  }} </ref>


Image: Seborrhoeic_dermatitis_21.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
===Infants===


Image: Seborrhoeic_dermatitis_22.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
Infants usually present in the first few months of life. Symptoms can be divided into following types depending on extent of involvement.


</gallery>
*'''Localized'''
**Redness and flaking
**[[Pruritis]]
**Most common sites involved are scalp and face
**Other sites involved include retroauricular area, [[nasolabial folds]], cheeks, eyebrows and eyelids
**Napkin or diaper area involvement


====Neck====
*'''Generalized'''
**Few cases may present with generalized involvement such as lower abdomen, [[groin]] and [[pubic]] area.


<gallery>
===Adults===


Image: Seborrhoeic_dermatitis_14.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
The most common symptoms of seborrheic dermatitis may be divided into two types based on extent of involvement:<ref name="pmid2888552">{{cite journal| author=Dill FJ, Schertzer M, Sandercock J, Tischler B, Wood S| title=Inverted tandem duplication generates a duplication deficiency of chromosome 8p. | journal=Clin Genet | year= 1987 | volume= 32 | issue= 2 | pages= 109-13 | pmid=2888552 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2888552  }} </ref>
*'''Localized'''
**[[Macules]], thin [[plaques]], or red patches(scalp, face, nasolabial folds, anterior hairline, eyebrows, [[glabella]] region of the forehead, melolabial folds, ears, central chest, and genital region)
**[[Pruritis]]
**Fine scaling (mild cases)
**Redness and yellow to white crusting or scaling (severe disease)
**Redness, itching and yellow crusting of eye lashes ([[Blepharitis]]).
**Repeated itching of ear causing secondary [[bacterial infection]] resulting in [[fever]] and ear pain.


</gallery>
*'''Generalized'''
**Patients with [[HIV]] or other [[Immunosupression|immunosupressive]] conditions such as [[malignancies]] usually present with more severe disease involving unusual sites such as extremities.<ref name="pmid2936776">{{cite journal| author=Soeprono FF, Schinella RA, Cockerell CJ, Comite SL| title=Seborrheic-like dermatitis of acquired immunodeficiency syndrome. A clinicopathologic study. | journal=J Am Acad Dermatol | year= 1986 | volume= 14 | issue= 2 Pt 1 | pages= 242-8 | pmid=2936776 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2936776  }} </ref><ref name="pmid2934444">{{cite journal| author=Mathes BM, Douglass MC| title=Seborrheic dermatitis in patients with acquired immunodeficiency syndrome. | journal=J Am Acad Dermatol | year= 1985 | volume= 13 | issue= 6 | pages= 947-51 | pmid=2934444 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2934444  }} </ref>


====Trunk====
==Physical Examination==


<gallery>
Physical examination may be divided into two types according to age group:


Image: Seborrhoeic_dermatitis_01.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
{| class="wikitable"
! Age
! Site involved
! colspan="2" style="width: 400px;" | Local Examination
! Image<ref name=Seborrheicdermatitis>Dermatology Atlas. Seborrheic dermatitis(2016) http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424 Accessed on Aug22, 2016</ref>
|-
| rowspan="6" | Infants
| General Appearance
| colspan="2" style="width: 400px;" | Infants often looks healthy with a good appetite and sleep habits.
| [[File:Infant GA.jpg|100px]]
|-
| Scalp
| style="width: 400px;" colspan="2" | Fine scaling in mild cases. Thick greasy scales with [[erythema]] in severe cases.<ref>Borda, Luis J., and Tongyu C. Wikramanayake. "Seborrheic Dermatitis and Dandruff: A Comprehensive Review." Journal of clinical and investigative dermatology 3.2 (2015).</ref>
| [[File:Infant Scalp.jpg|100px]]
|-
| Face
| colspan="2" | Face may present with scaly salmon colored scales.
| [[File:Chest SD A.jpg|100px]]
|-
| Neck, Axillae and Body Folds
| colspan="2" | Non-scaly moist glistening appearance of lesions which tend to appear confluent.<ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref>
| [[File:Chest SD.jpg|100px]]
|-
| Trunk
| colspan="2" style="width: 400px;" | Trunk involvement is seen in severe cases. However, the diaper area iscommonly involved which presents with [[erythema]] and [[maceration]] of skin with edema of surrounding skin. Secondary [[Bacterial infection|bacterial]] and [[candida|candidal]] infections are common in these cases.<ref name="pmid26051065">{{cite journal| author=Tüzün Y, Wolf R, Bağlam S, Engin B| title=Diaper (napkin) dermatitis: A fold (intertriginous) dermatosis. | journal=Clin Dermatol | year= 2015 | volume= 33 | issue= 4 | pages= 477-82 | pmid=26051065 | doi=10.1016/j.clindermatol.2015.04.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26051065  }} </ref>
| [[File:Seborrhoeic dermatitis 17.jpeg|100px]]
|-
| Generalized
| colspan="2" style="width: 400px;" | Most commonly seen in Leiner's disease, which is an [[immunosuppressive]] condition. It may involve unusual sites such as extremities and trunk with scaling and [[erythematous]] patches. Scaling and crusting usually spreads to involve other parts of the body with extensive peeling of skin.<ref name="pmid1544726">{{cite journal| author=Fischer HG, Hartmann U, Becker R, Kommans B, Mader A, Hollmann W| title=The excretion of 17-ketosteroids and 17-hydroxycorticosteroids in night urine of elite rowers during altitude training. | journal=Int J Sports Med | year= 1992 | volume= 13 | issue= 1 | pages= 15-20 | pmid=1544726 | doi=10.1055/s-2007-1021227 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1544726  }} </ref><ref name="pmid2958789">{{cite journal| author=Sonea MJ, Moroz BE, Reece ER| title=Leiner's disease associated with diminished third component of complement. | journal=Pediatr Dermatol | year= 1987 | volume= 4 | issue= 2 | pages= 105-7 | pmid=2958789 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2958789  }} </ref><ref name="pmid144462">{{cite journal| author=Evans DI, Holzel A, MacFarlane H| title=Yeast opsonization defect and immunoglobulin deficiency in severe infantile dermatitis (Leiner's disease). | journal=Arch Dis Child | year= 1977 | volume= 52 | issue= 9 | pages= 691-5 | pmid=144462 | doi= | pmc=1544726 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=144462  }} </ref>
| [[File:Seborrhoeic_dermatitis_18.jpeg|100px]]
|-
| rowspan="5" | Adults
| General appearance
| colspan="2" style="width: 400px;" | Adults may present with a healthy general appearance in mild cases or may present in considerable distress due to widespread involvement especially. Patients may appear ill in cases with underlying diseases associated with seborrheic dermatitis such as [[HIV]], [[malignancy]], or [[parkinsonism]].<ref name="pmid14731170">{{cite journal| author=Dunic I, Vesic S, Jevtovic DJ| title=Oral candidiasis and seborrheic dermatitis in HIV-infected patients on highly active antiretroviral therapy. | journal=HIV Med | year= 2004 | volume= 5 | issue= 1 | pages= 50-4 | pmid=14731170 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14731170  }} </ref>
| [[File:800px-Seborrhoeic dermatitis highres.jpg|100px]]
|-
| Scalp
| colspan="2" style="width: 400px;" | Mild [[desquamation]] to honey coloured crusting of the scalp causing [[alopecia]].
| [[File:Seborrhoeic dermatitis 05.jpeg|100px]]
|-
| Face/Retroauricular
areas
| colspan="2" style="width: 400px;" | May present as a "butterfly rash". [[Malar]] erythema and scaling in a symmetrical pattern . Yellowish scaling between eyelashes and eyelids causing [[blepharitis]] with honey colored crusting on free margins.<ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109 }} </ref>
| [[File:Seborrhoeic dermatitis 10.jpeg|100px]]
|-
| Upper Chest
| colspan="2"  style="width: 400px;" | SD presents as petalloid or pityriasiform.
'''Petalloid''': Small reddish  follicular or perifollicular papules that may coalesce forming patches resembling petals of flower.
<br>'''Pityriasiform''': Common on skin tension lines and intertriginous areas and presents as oval scaly [[macules]] and patches. This type involves extensive involvement of the body.<ref name="pmid2936776">{{cite journal| author=Soeprono FF, Schinella RA, Cockerell CJ, Comite SL| title=Seborrheic-like dermatitis of acquired immunodeficiency syndrome. A clinicopathologic study. | journal=J Am Acad Dermatol | year= 1986 | volume= 14 | issue= 2 Pt 1 | pages= 242-8 | pmid=2936776 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2936776  }} </ref>
| [[File:Seborrhoeic_dermatitis_11.jpeg|100px]]
|-
| Body Folds
| colspan="2" style="width: 400px;" | Lesions usually present as moist, [[Maceration|macerated]], and [[erythematous]] lesions. May lead to fissuring and [[secondary infection]].<ref name="pmid4852869">{{cite journal| author=Lewak N| title=Letter: Mythology and SIDS. | journal=N Engl J Med | year= 1974 | volume= 291 | issue= 14 | pages= 740-1 | pmid=4852869 | doi=10.1056/NEJM197410032911423 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4852869  }} </ref>
|[[File:Body folds.jpg|100px]]
|-
| SD of
[[Immunosuppression]]
|
| colspan="2" style="width: 400px;" | It may present as extensive scaling and [[erythema]] involving unusual sites such as extremities and is refractory to  treatment. It is usually seen in children and adults with [[immunosuppression]] such as [[HIV/AIDS]].<ref>Bukvić, Mokos Z., et al. "Seborrheic dermatitis: an update." Acta dermatovenerologica Croatica: ADC 20.2 (2011): 98-104.</ref><ref>Mathes, Barbara M., and Margaret C. Douglass. "Seborrheic dermatitis in patients with acquired immunodeficiency syndrome." Journal of the American Academy of Dermatology 13.6 (1985): 947-951.</ref>
| [[File:Seborrhoeic dermatitis 03.jpeg|100px]]
|}


Image: Seborrhoeic_dermatitis_03.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>


Image: Seborrhoeic_dermatitis_11.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>


Image: Seborrhoeic_dermatitis_12.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
===Imaging Findings===
There are no imaging findings associated with seborrheic dermatitis.<ref name="pmid25822272">{{cite journal| author=Clark GW, Pope SM, Jaboori KA| title=Diagnosis and treatment of seborrheic dermatitis. | journal=Am Fam Physician | year= 2015 | volume= 91 | issue= 3 | pages= 185-90 | pmid=25822272 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25822272  }} </ref>


</gallery>
===Other Diagnostic Studies===
There are no other diagnostic studies for seborrheic dermatitis.


====Extremities====
==Treatment==


<gallery>
The mainstay of treatment for seborrheic dermatitis is medical therapy. Depending on age and severity of symptoms the treatment may be categorized as follows:
 
Image: Seborrhoeic_dermatitis_18.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
 
</gallery>
 
====Genitals====
 
<gallery>


Image: Seborrhoeic_dermatitis_17.jpeg| Seborrheic dermatitis. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=424>
{| class="wikitable"
! colspan="1" rowspan="1" style="text-align: center;" |
! colspan="1" rowspan="1" style="text-allign: center;" | Severity
! colspan="1" | Acute Therapy
! Maintainence Therapy
|-
! rowspan="2" colspan="1" style="text-align: center;" | Infants
| rowspan="1" colspan="1" style="text-align: center;" | Mild
| rowspan="1" valign=top |
*Education and reassurance of parents.<ref>Foley, Peter, et al. "The frequency of common skin conditions in preschool-age children in Australia: atopic dermatitis." Archives of dermatology 137.3 (2001): 293-300.</ref>
*Application of [[emollients]] such as baby oil or [[mineral oil]].
*Frequent shampooing using [[Shampoo|non-medicated shampoos]].
*Removal of scales.
| rowspan="1" valign=top |  
*Self limited, resolves in few months
|-
| rowspan="1" colspan="1" style="text-align: center;" | Moderate to Severe
| rowspan="1" valign=top |
*Use of Topical [[corticosteroids]] (1% [[hydrocortisone]]) and [[antifungal agent]] (2% [[ketoconazole]])<ref name="pmid1719824">{{cite journal| author=Yasuda G, Sun L, Umemura S, Pettinger WA, Jeffries WB| title=Characterization of prazosin-sensitive alpha 2 B-adrenoceptors expressed by cultured rat IMCD cells. | journal=Am J Physiol | year= 1991 | volume= 261 | issue= 5 Pt 2 | pages= F760-6 | pmid=1719824 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1719824  }} </ref><ref name="pmid16083165">{{cite journal| author=Wannanukul S, Chiabunkana J| title=Comparative study of 2% [[ketoconazole]] cream and 1% hydrocortisone cream in the treatment of infantile seborrheic dermatitis. | journal=J Med Assoc Thai | year= 2004 | volume= 87 Suppl 2 | issue=  | pages= S68-71 | pmid=16083165 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16083165  }} </ref>
| rowspan="1" valign=top |
*Topical [[corticosteroids]] and [[antifungal agent]].
*Look for alternative diagnosis.
|-
! rowspan="2" colspan="1" style="text-align: center;" | Adults
| colspan="1" style="text-align: center;" | Mild
| rowspan="1" valign=top |
*No curative treatment.
*Topical [[antifungals]] such as [[azoles]], [[zinc pyrithione]], [[selenium sulfide]] (1%–2.5%), imidazoles (1%–2% [[ketoconazole]] shampoo, creams, lotions, or foams), [[ciclopirox]] (cream, gel, and shampoo), [[salicylic acid]] (shampoos, creams), [[coal tar]] (creams, shampoos)
*[[Azoles|Topical azoles]] such as [[ketoconazole]], [[Miconazole|miconazle]]<ref name="pmid17569404">{{cite journal| author=Reygagne P, Poncet M, Sidou F, Soto P| title=Clobetasol propionate shampoo 0.05% in the treatment of seborrheic dermatitis of the scalp: results of a pilot study. | journal=Cutis | year= 2007 | volume= 79 | issue= 5 | pages= 397-403 | pmid=17569404 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17569404  }} </ref><ref name="pmid7718463">{{cite journal| author=Peter RU, Richarz-Barthauer U| title=Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial. | journal=Br J Dermatol | year= 1995 | volume= 132 | issue= 3 | pages= 441-5 | pmid=7718463 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7718463  }} </ref><ref name="pmid15655141">{{cite journal| author=Shuster S, Meynadier J, Kerl H, Nolting S| title=Treatment and prophylaxis of seborrheic dermatitis of the scalp with antipityrosporal 1% ciclopirox shampoo. | journal=Arch Dermatol | year= 2005 | volume= 141 | issue= 1 | pages= 47-52 | pmid=15655141 | doi=10.1001/archderm.141.1.47 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15655141  }} </ref>
*Topical use of (low, moderate and high potency) [[corticosteroids]]<ref name="pmid24838779">{{cite journal| author=Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkkä J et al.| title=Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 5 | pages= CD009446 | pmid=24838779 | doi=10.1002/14651858.CD009446.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24838779  }} </ref> 
*[[Keratolytic|Keratolytic agents]]: Lipohydroxy acid, [[propylene glycol]].
*[[Coconut oil]] compound (ointment combination of [[coal tar]], [[salicylic acid]] and [[sulfur]]).
| rowspan="1" valign=top |
*Using of 1% [[ciclopirox]] shampoo once or twice weekly for 4 weeks.
*Using 2% [[ketoconazole]] such as once a week or twice a week.
*[[Aluminium acetate]] solution (seborrheic dermatitis externa).
|-
| rowspan="1" colspan="1" style="text-align: center;" | Moderate to Severe
| rowspan="1" valign=top |
*[[Azoles|Topical azoles]] such as [[ketoconazole]], [[miconazole]] (Scalp)<ref>Faergemann, J. "Pharmacology and Treatment Seborrhoeic dermatitis and Pityrosporumorbiculare: treatment of seborrhoeic dermatitis of the scalp with miconazole‐hydrocortisone (Daktacort), miconazole and hydrocortisone." British journal of dermatology 114.6 (1986): 695-700.</ref>
*Short courses of low potency [[Corticosteroids|topical corticosteroids]] (face, trunk and ears)<ref name="pmid24838779">{{cite journal| author=Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkkä J et al.| title=Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. | journal=Cochrane Database Syst Rev | year= 2014 | volume=  | issue= 5 | pages= CD009446 | pmid=24838779 | doi=10.1002/14651858.CD009446.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24838779  }} </ref>  
*[[Lithium succinate]] or [[gluconate]]] topical preparations (Non scalp SD)<ref name="pmid18330588">{{cite journal| author=Ballanger F, Tenaud I, Volteau C, Khammari A, Dréno B| title=Anti-inflammatory effects of lithium gluconate on keratinocytes: a possible explanation for efficiency in seborrhoeic dermatitis. | journal=Arch Dermatol Res | year= 2008 | volume= 300 | issue= 5 | pages= 215-23 | pmid=18330588 | doi=10.1007/s00403-007-0824-z | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18330588  }} </ref><ref name="pmid12459525">{{cite journal| author=Dreno B, Moyse D| title=Lithium gluconate in the treatment of seborrhoeic dermatitis: a multicenter, randomised, double-blind study versus placebo. | journal=Eur J Dermatol | year= 2002 | volume= 12 | issue= 6 | pages= 549-52 | pmid=12459525 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12459525 }} </ref><ref name="pmid1532964">{{cite journal| author=| title=A double-blind, placebo-controlled, multicenter trial of lithium succinate ointment in the treatment of seborrheic dermatitis. Efalith Multicenter Trial Group. | journal=J Am Acad Dermatol | year= 1992 | volume= 26 | issue= 3 Pt 2 | pages= 452-7 | pmid=1532964 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1532964  }} </ref>
*[[Fluconazole]] ([[Seborrheic blepharitis]])<ref name="pmid19957565">{{cite journal| author=Zisova LG| title=Treatment of Malassezia species associated seborrheic blepharitis with fluconazole. | journal=Folia Med (Plovdiv) | year= 2009 | volume= 51 | issue= 3 | pages= 57-9 | pmid=19957565 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19957565  }} </ref>
*Oral [[antifungals]] and oral [[terbinafine]] ( refractory cases)<ref>Young Jr, A. W. "Seborrhea in the geriatric patient: incidence, implication, management." Geriatrics 24.3 (1969): 144-150.</ref><ref>Gupta, Aditya K., Karyn Nicol, and Roma Batra. "Role of antifungal agents in the treatment of seborrheic dermatitis." American journal of clinical dermatology 5.6 (2004): 417-422.</ref>
*[[Calcineurin inhibitor|Calcineurin inhibitors]] suh as [[tacrolimus]] ( non scalp SD)<ref>Shin, Hyoseung, et al. "Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: a comparative study." The Journal of dermatology 36.3 (2009): 131-137.</ref>
| rowspan="1" |
*0.1% [[tacrolimus]] ointment twice daily for up to 4 weeks.<ref name="pmid12828755">{{cite journal| author=Braza TJ, DiCarlo JB, Soon SL, McCall CO| title=Tacrolimus 0.1% ointment for seborrhoeic dermatitis: an open-label pilot study. | journal=Br J Dermatol | year= 2003 | volume= 148 | issue= 6 | pages= 1242-4 | pmid=12828755 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12828755  }} </ref>
*[[Isotretinoin]] in low doses for 3-5 months and phototherapy with narrowband [[Ultraviolet|ultraviolet B]] or [[psoralen]] plus [[Ultraviolet|ultraviolet A]](refractory cases).<ref>Collins, Chris D., and Chad Hivnor. "Seborrheic dermatitis." management 41 (1988): 182-186.</ref><ref>Geißler, Sabine E., Silke Michelsen, and Gerd Plewig. "Very low dose isotretinoin is effective in controlling seborrhea." JDDG: Journal der Deutschen Dermatologischen Gesellschaft 1.12 (2003): 952-958.</ref>
*Systemic use of [[glucocorticoids]] ([[prednisolone]] 0.5 mg/kg body weight/day) for 7 days (severe).
|}


</gallery>
The following are the preferred treatment regimens for seborrheic dermatitis:<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>


===Medical Therapy===
:* 1. '''[[Antifungal drug|Antifungal agents]]'''
* Seborrheic dermatitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
:* 1. '''Antifungal agents'''
::* Preferred regimen (1): [[Ketoconazole]] 2% in shampoo, foam, gel, or cream  
::* Preferred regimen (1): [[Ketoconazole]] 2% in shampoo, foam, gel, or cream  
:::* Scalp: Twice/week for clearance {{then}} once/week or every other week for maintenance
:::* Scalp: Twice/week for clearance {{then}} once/week or every other week for maintenance
Line 211: Line 718:
:::* Scalp: 3 times/week for clearance
:::* Scalp: 3 times/week for clearance
:::* Other areas: qd for clearance
:::* Other areas: qd for clearance
::* Preferred regimen (3): [[Ciclopirox olamine]] (also called ciclopirox) 1.0% or 1.5% in shampoo or cream  
::* Preferred regimen (3): [[Ciclopirox|Ciclopirox olamine]] (also called ciclopirox) 1.0% or 1.5% in shampoo or cream  
:::* Scalp: Twice to 3 times/week for clearance {{then}} once/week or every 2 week for maintenance  
:::* Scalp: Twice to 3 times/week for clearance {{then}} once/week or every 2 week for maintenance  
:::* Other areas: Twice daily for clearance {{then}} qd for maintenance
:::* Other areas: Twice daily for clearance {{then}} qd for maintenance


:* 2. '''Corticosteroids'''  
:* 2. '''[[Corticosteroids]]'''  
::* Preferred regimen (1): [[Hydrocortisone]] 1% in cream areas other than scalp qd or bid
::* Preferred regimen (1): [[Hydrocortisone]] 1% in cream areas other than scalp qd or bid
::* Preferred regimen (2): [[Betamethasone dipropionate]] 0.05% in lotion scalp and other areas qd or bid
::* Preferred regimen (2): [[Betamethasone dipropionate]] 0.05% in lotion scalp and other areas qd or bid
Line 223: Line 730:
::* Preferred regimen (5): [[Desonide]] 0.05% lotion bid on scalp and other areas
::* Preferred regimen (5): [[Desonide]] 0.05% lotion bid on scalp and other areas


:* 3. '''Lithium salts'''
:* 3. '''[[Lithium salts]]'''
::* Preferred regimen: [[Lithium succinate]] {{and}} [[Zinc sulfate]] Ointment containing 8% [[Lithium succinate]] {{and}} 0.05% [[Zinc sulfate]]
::* Preferred regimen: [[Lithium succinate]] {{and}} [[Zinc sulfate]] Oin
::* Preferred regimen: [[Lithium|Lithium gluconate]] 8% in gel bid on areas other than scalp
[[Category: Infectious Disease Project]]


===Plant-based treatments===
===Plant-based treatments===
{{main article|phytotherapy}}
{{main article|Phytotherapy}}
The [[World Health Organization]] mentions ''[[Aloe vera]]'' gel as a yet to be scientifically proven [[traditional medicine]] treatment for Seborrhoeic dermatitis.<ref>
The [[World Health Organization]] mentions ''[[Aloe vera]]'' gel as a yet to be scientifically proven [[traditional medicine]] treatment for Seborrhoeic dermatitis.<ref>
{{cite web
{{cite web
Line 241: Line 746:
</ref>
</ref>


*''[[Arctium lappa]]'' (Burdock) oil<ref name="green">
*''[[Arctium lappa]]'' ([[Burdock]]) oil<ref name="green">
{{cite web
{{cite web
|url=http://books.google.com/books?id=N-Uus_kjkNUC&pg=PA154&lpg=PA154&dq=plants+for+treating+seborrhea&source=web&ots=u4fzYOLFsb&sig=cpWVYu2MB5a3dqNC17QRX7qYhcw&hl=en#PPA154,M1
|url=http://books.google.com/books?id=N-Uus_kjkNUC&pg=PA154&lpg=PA154&dq=plants+for+treating+seborrhea&source=web&ots=u4fzYOLFsb&sig=cpWVYu2MB5a3dqNC17QRX7qYhcw&hl=en#PPA154,M1
Line 251: Line 756:
}}
}}
</ref>
</ref>
*''[[Chelidonium majus]]'' (Celandine)<ref name="green"/>
*''[[Chelidonium|Chelidonium majus]]'' ([[Greater celandine|Celandine]])<ref name="green"/>
*''[[Glycyrrhiza glabra]]'' (Licorice)<ref name="green"/>
*''[[Glycyrrhiza glabra]]'' ([[Licorice]])<ref name="green"/>
*''[[Melaleuca]]'' (Tea tree) species<ref name="green"/>
*''[[Melaleuca (company)|Melaleuca]]'' (Tea tree) species<ref name="green"/>
*''[[Plantago]]'' (Plantain) species<ref name="green"/>
*''[[Plantago]]'' (Plantain) species<ref name="green"/>
*''Symphytum officinale'' ([[Comfrey]])<ref name="green"/>
*''[[Comfrey|Symphytum officinale]]'' [[Comfrey|(Comfrey)]]<ref name="green"/>
*''[[Zingiber officinale]]'' (Ginger) root juice<ref name="green"/>
*''[[Ginger|Zingiber officinale]]'' [[Ginger|(Ginger)]] root juice<ref name="green"/>treatment containing 8% [[Lithium succinate]] {{and}} 0.05% [[Zinc sulfate]]
 
:* Preferred regimen: [[Lithium|Lithium gluconate]] 8% in gel bid on areas other than scalp
===Imaging Findings===
 
===Other Diagnostic Studies===
 
==Treatment==
===Medical Therapy===


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of seborrrheic dermatitis.


===Prevention===
===Prevention===
====[[Primary Prevention Guidelines Recommendations|Primary Prevention]]====
There is no established method for prevention of seborrheic dermatitis.<ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109  }} </ref>


==Related Chapter==
====[[Secondary Prevention]]====
*''[[Echinopsis peruviana]]''
Secondary prevention strategies following seborrheic dermatitis include:
 
*Using of 1% [[ciclopirox]] shampoo once or twice weekly for 4 weeks. Shampooing once weekly or once every two weeks decreases the [[relapse]] rate of seborrheic dermatitis.<ref name="pmid15655141">{{cite journal| author=Shuster S, Meynadier J, Kerl H, Nolting S| title=Treatment and prophylaxis of seborrheic dermatitis of the scalp with [[antipityrosporal]] 1% [[ciclopirox]] shampoo. | journal=Arch Dermatol | year= 2005 | volume= 141 | issue= 1 | pages= 47-52 | pmid=15655141 | doi=10.1001/archderm.141.1.47 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15655141  }} </ref>
==External Links==
*Using 2% [[ketoconazole]] such as once a week or twice a week may decrease relapse of seborrheic dermatitis.<ref name="pmid11306850">{{cite journal| author=Piérard-Franchimont C, Piérard GE, Arrese JE, De Doncker P| title=Effect of ketoconazole 1% and 2% shampoos on severe dandruff and seborrhoeic dermatitis: clinical, squamometric and mycological assessments. | journal=Dermatology | year= 2001 | volume= 202 | issue= 2 | pages= 171-6 | pmid=11306850 | doi=51628 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11306850  }} </ref>
* [http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html Seborrhoeic Dermatitis at DermNet]
*[[Ketoconazole]] 2% shampoo may have greater prophylactic effect against [[relapse]] than [[selenium sulfide]].<ref name="pmid3100109">{{cite journal| author=Okochi T, Seike H, Saeki K, Sumikawa K, Yamamoto T, Higashino K| title=A novel alkaline phosphatase isozyme in human adipose tissue. | journal=Clin Chim Acta | year= 1987 | volume= 162 | issue= 1 | pages= 19-27 | pmid=3100109 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3100109  }} </ref>
*[http://www.aafp.org/afp/20060701/125.html Seborrheic Dermatitis: An Overview - July 1, 2006 -- American Family Physician]


==References==
==References==
Line 280: Line 781:




{{Diseases of the skin and subcutaneous tissue}}
 
{{WH}}
{{WS}}


[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Primary care]]
[[Category:Disease]]
[[Category:Up-To-Date]]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]; Aysha Aslam, M.B.B.S[3]

Synonyms and keywords: Seborrheic eczema; Seborrhea; Cradle cap

Overview

Seborrheic eczema (also known as Seborrheic dermatitis, seborrhea) is a skin disorder affecting the scalp, face, and trunk. Seborrheic dermatitis causes flaky, itchy, red skin and temporary hair loss. It particularly affects the sebum-gland rich areas of skin. Causes of seborrheic dermatitis include Malassezia furfur (formerly known as Pityrosporum ovale) as well as genetic, environmental, hormonal, and immune-related factors. Medical therapy for seborrheic dermatitis includes antifungal agents, corticosteroids, and lithium salts.

Historical Perspective

Classification

There is no established classification system for seborrheic dermatitis. However, it may be classified according to the anatomical location, age group, symptoms, etiology and severity.[3][4][5][6][7]

Classification by Anatomy

Seborrheic dermatitis may be classified on the basis of anatomical location into following types:[8][3][9][10]

  • Localized
    • Scalp: Most common presentation in infants known as cradle cap
    • Face: Most commonly involves eyelids, eyebrows, and nasolabial folds
    • Retroauricular
    • Body folds: Commonly affects axilla, breast folds, and inguinal area
    • Trunk: May be seen in severe cases and most common site of involvement is lower abdomen
    • Upper Chest: Most commonly seen in adults
      • Pityriasiform: Oval macules and patches.
      • Petaloid type: Small papules with oily scales may enlarge to become patches resembling petals of flower.
  • Generalized: Mostly seen in infants; it is associated with Leiner's disease and children with severe immunodeficiency.[11]

Classification by Age

  • Infantile: Occurs in first three months of life.
  • Adults: Occurs most commonly between 30-60 years of age.

Classification by Symptomatic Presentation

  • Non pruritic: Most commonly occurs in infants
  • Pruritic: Most commonly occurs in older children and adults

Classification by Etiology

Classification by Severity

Pathophysiology

The exact pathophysiology of seborrheic dermatitis remains unclear. However, several mechanisms are hypothesized to play a role in pathogenesis of seborrheic dermatitis.[12] [13][14][15][11]

Pathogenesis

Hypotheses regarding the pathogenesis of seborrheic dermatitis include:

Hypotheses related to Malassezia :

  • A strong correlation between presence of the fungal yeast Malassezia and response to antifungals in patients with seborrheic dermatitis.[16]

Other Hypotheses

Sebum gland activity may correlate with seborrheic dermatitis.[15][20]
Elevated levels of HLA-AW30, HLA-AW31, HLA-A32, HLA-B12 and HLA-B18 and increased levels of total serum IgA and IgG antibodies have been detected in seborrheic dermatitis patients. This implies an immune mediated pathological mechanism.[14][21][22]
  • Epidermal barrier dysfunction
Abnormalities in stratum corneum that may be associated with seborrheic dermatitis include:
  • Corneocyte shape
  • Corneodesmosomes
  • Disrupted lipid lamellar structure [23]
  • Neurogenic and other factors
Patients with parkinsonism may have increase levels of α-melanocyte stimulating hormone (α-MSH) levels and seborrheic dermatitis in these patients respond to L-dopa treatment[22]

Genetics

There is no specific genetic cause for seborrheic dermatitis.[24].[25]

Associated conditions

Gross Pathology

Superficial flaking and redness are characteristic findings of seborrheic dermatitis.[26]

Microscopic Histopathology

Histopathological findings of seborrheic dermatitis may be categorized into the following stages: [21][28]

  • Acute
  • Subacute
  • Chronic
  • Extensive psoriasiform hyperplasia
  • Minimal spongiosis
  • Follicular crusting

Causes

The cause of seborrheic dermatitis remains unknown; however, the following factors may have been implicated:

Differentiating Seborrheic dermatitis from Other Diseases

Symptoms of seborrheic dermatitis may overlap with other skin conditions such as psoriasis, candidiasis, contact dermatitis, and atopic dermatitis. Differential diagnosis of seborrheic dermatitis may be classified into two types by age group:[37][38][39][17][40][41][28]

Differential diagnosis in Infants

Disease Rash Characteristics Signs and Symptoms Associated Conditions Images
Cutaneous T cell lymphoma/Mycosis fungoides[42]
By Bobjgalindo - Own work, GFDL, https://commons.wikimedia.org/w/index.php?curid=7139812
Pityriasis rosea[43]
  • Pink or salmon in color, which may be scaly; referred to as "herald patch"
  • Oval shape
  • Long axis oriented along the cleavage lines
  • Distributed on the trunk and proximal extremities
  • Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on posterior trunk
  • Secondary to viral infections
  • Resolves spontaneously after 6-8 weeks
By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230
Pityriasis lichenoides chronica
  • Recurrent lesions are usually less evenly scattered than in cases of psoriasis
  • Brownish red or orange-brown in color
  • Lesions are capped by a single detachable, opaque, mica-like scale
  • Often leave hypopigmented macules
Nummular dermatitis[46]
  • Lesions commonly relapse after occasional remission or may persist for long periods
  • Pruritus
Secondary syphilis[47]
  • Round, coppery, red colored lesions on palms and soles
  • Papules with collarette of scales
By James Heilman,MD - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=16305230
Bowen’s disease[48]
  • Erythematous, small, scaly plaque, which enlarges erratically over time
  • Scale is usually yellow or white and it is easily detachable without any bleeding
  • Well-defined margins
By Klaus D. Peter, Gummersbach, Germany - Own work (own photograph), CC BY 3.0 de, https://commons.wikimedia.org/w/index.php?curid=6839115
Exanthematous pustulosis[50]
By See below - (2010). "Acute generalized exanthematous pustulosis: an unusual side effect of meropenem". Indian J Dermatol 55 (2): 176–7. DOI:10.4103/0019-5154.62759. PMID 20606889. PMC: 2887524., CC BY 1.0, https://commons.wikimedia.org/w/index.php?curid=52979729
Hypertrophic lichen planus[52]
Di James Heilman, MD - Opera propria, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11509003
Sneddon–Wilkinson disease[54]
  • Flaccid pustules that are often generalized and have a tendency to involve the flexural areas
  • Annular configuration
Small plaque parapsoriasis[58]
  • Erythematous plaques with fine scaly surface
  • May present with elongated, finger-like patches
  • Symmetrical distribution on the flanks
  • Known as digitate dermatosis
  • Lesions may be asymptomatic
  • May be mildly pruritic
  • May fade or disappear after sun exposure during the summer season, but typically recur during the winter
Intertrigo[60]
Source: https://www.cdc.gov/
Langerhans cell histiocytosis[61]
  • Scaling and crusting of scalp
Tinea manuum/pedum/capitis[65]
  • Scaling, flaking, and sometimes blistering of the affected areas
  • Hair loss with a black dot on scalp in case of tinea capitis
Seborrheic dermatitis
By Roymishali - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=27267929

Differential diagnosis in Adults

Epidemiology and Demographics

Epidemiology

Worldwide, the prevalence of seborrheic dermatitis is estimated to be 11000 cases per 100,000.[24] Prevalence of seborrheic varies among individuals based on the following factors:

  • Higher reporting of mild cases
  • Higher in patients with HIV with 35000 per 100,000 in early diagnosis and 85000 per 100,000 with full blown AIDS[67]
  • Higher prevalence seen among those directly exposed to UV radiation[68]

Demographics

Age

Seborrheic dermatitis demonstrates a tri-modal age distribution as follows:[71][72][21]

  • The first incidence peak is seen in infants around three to four months of age, which usually resolves within 12 months
  • The second incidence peak is seen around puberty.
  • The third incidence peak is seen after age 50 with the highest prevalence seen among ages 33-44 years.[73]
  • Age groups showing lowest prevalence of clinical disease is seen in individuals younger than 12 years.[74]

Gender

Males are more commonly affected with seborrheic dermatitis than females.[75]

Race

  • Seborrheic dermatitis is rarely seen in African Americans.
  • If seborrheic dermatitis is seen in this population, it leads to high suspicion of HIV in affected individuals.[76]

Risk Factors

The most common risk factors for seborrheic dermatitis include:[77][17]

Immunosuppression

Neurologic and psychiatric cases

Genetic disorders

Other risk factors

Screening

There are no screening guidelines for seborrheic dermatitis.[84]

Natural History, Complications, and Prognosis

Natural History

  • The symptoms of seborrheic dermatitis usually develop in the first three months in infants. It may resolve without treatment in most cases in few months and rarely presents after 12 months.[85]
  • In adults, symptoms of seborrheic dermatitis usually develop in the second and third decade of life, and start with symptoms such as redness, scaling and crusting on affected areas. However, occurrence of seborrheic dermatitis is highly variable and it may present after 50 years of age.
  • The course of disease is highly variable among individuals despite treatment. Some cases present with more frequent relapses than others.[71]

Complications

Common complications of seborrheic dermatitis include:[86][71][87][88][89][11]

Prognosis

  • The prognosis of seborrheic dermatitis is excellent in infants; it is a self limited disease and usually resolves within few months after birth.
  • In adults, it is a recurrent condition with no permanent cure.[90][91]

Diagnosis

There is no definitive diagnostic criteria for seborrheic dermatitis. Diagnosis of seborrheic dermatitis is primarily clinical; it is based on history and physical examination findings.[92]

History

Obtaining complete history is important in making diagnosis of seborrheic dermatitis as it will give an insight into cause and associated risk factors for the disease. In addition to symptoms of seborrheic dermatitis, patients may present with symptoms of one of the following associated conditions:[93][94][95][17] [96][97][98]

Symptoms

Symptoms of seborrheic dermatitis may be categorized according to age as follows:[24][99]

Infants

Infants usually present in the first few months of life. Symptoms can be divided into following types depending on extent of involvement.

  • Localized
    • Redness and flaking
    • Pruritis
    • Most common sites involved are scalp and face
    • Other sites involved include retroauricular area, nasolabial folds, cheeks, eyebrows and eyelids
    • Napkin or diaper area involvement
  • Generalized
    • Few cases may present with generalized involvement such as lower abdomen, groin and pubic area.

Adults

The most common symptoms of seborrheic dermatitis may be divided into two types based on extent of involvement:[24]

  • Localized
    • Macules, thin plaques, or red patches(scalp, face, nasolabial folds, anterior hairline, eyebrows, glabella region of the forehead, melolabial folds, ears, central chest, and genital region)
    • Pruritis
    • Fine scaling (mild cases)
    • Redness and yellow to white crusting or scaling (severe disease)
    • Redness, itching and yellow crusting of eye lashes (Blepharitis).
    • Repeated itching of ear causing secondary bacterial infection resulting in fever and ear pain.

Physical Examination

Physical examination may be divided into two types according to age group:

Age Site involved Local Examination Image[102]
Infants General Appearance Infants often looks healthy with a good appetite and sleep habits.
Scalp Fine scaling in mild cases. Thick greasy scales with erythema in severe cases.[103]
Face Face may present with scaly salmon colored scales.
Neck, Axillae and Body Folds Non-scaly moist glistening appearance of lesions which tend to appear confluent.[17]
Trunk Trunk involvement is seen in severe cases. However, the diaper area iscommonly involved which presents with erythema and maceration of skin with edema of surrounding skin. Secondary bacterial and candidal infections are common in these cases.[104]
Generalized Most commonly seen in Leiner's disease, which is an immunosuppressive condition. It may involve unusual sites such as extremities and trunk with scaling and erythematous patches. Scaling and crusting usually spreads to involve other parts of the body with extensive peeling of skin.[105][106][107]
Adults General appearance Adults may present with a healthy general appearance in mild cases or may present in considerable distress due to widespread involvement especially. Patients may appear ill in cases with underlying diseases associated with seborrheic dermatitis such as HIV, malignancy, or parkinsonism.[78]
Scalp Mild desquamation to honey coloured crusting of the scalp causing alopecia.
Face/Retroauricular

areas

May present as a "butterfly rash". Malar erythema and scaling in a symmetrical pattern . Yellowish scaling between eyelashes and eyelids causing blepharitis with honey colored crusting on free margins.[71]
Upper Chest SD presents as petalloid or pityriasiform.

Petalloid: Small reddish follicular or perifollicular papules that may coalesce forming patches resembling petals of flower.
Pityriasiform: Common on skin tension lines and intertriginous areas and presents as oval scaly macules and patches. This type involves extensive involvement of the body.[100]

Body Folds Lesions usually present as moist, macerated, and erythematous lesions. May lead to fissuring and secondary infection.[17]
SD of

Immunosuppression

It may present as extensive scaling and erythema involving unusual sites such as extremities and is refractory to treatment. It is usually seen in children and adults with immunosuppression such as HIV/AIDS.[108][109]


Imaging Findings

There are no imaging findings associated with seborrheic dermatitis.[41]

Other Diagnostic Studies

There are no other diagnostic studies for seborrheic dermatitis.

Treatment

The mainstay of treatment for seborrheic dermatitis is medical therapy. Depending on age and severity of symptoms the treatment may be categorized as follows:

Severity Acute Therapy Maintainence Therapy
Infants Mild
  • Self limited, resolves in few months
Moderate to Severe
Adults Mild
Moderate to Severe

The following are the preferred treatment regimens for seborrheic dermatitis:[128]

  • Preferred regimen (1): Ketoconazole 2% in shampoo, foam, gel, or cream
  • Scalp: Twice/week for clearance THEN once/week or every other week for maintenance
  • Other areas: From bid to twice/week for clearance THEN from twice/week to once every other week for maintenance
  • Preferred regimen (2): Bifonazole 1% in shampoo or cream
  • Scalp: 3 times/week for clearance
  • Other areas: qd for clearance
  • Preferred regimen (3): Ciclopirox olamine (also called ciclopirox) 1.0% or 1.5% in shampoo or cream
  • Scalp: Twice to 3 times/week for clearance THEN once/week or every 2 week for maintenance
  • Other areas: Twice daily for clearance THEN qd for maintenance
  • Scalp: Twice weekly in a short- contact fashion (up to 10 min application, then washing)
  • Preferred regimen (5): Desonide 0.05% lotion bid on scalp and other areas

Plant-based treatments

Main article: Phytotherapy

The World Health Organization mentions Aloe vera gel as a yet to be scientifically proven traditional medicine treatment for Seborrhoeic dermatitis.[129]

Surgery

Surgical intervention is not recommended for the management of seborrrheic dermatitis.

Prevention

Primary Prevention

There is no established method for prevention of seborrheic dermatitis.[71]

Secondary Prevention

Secondary prevention strategies following seborrheic dermatitis include:

References

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  2. ↑ Low, R. Cranston, and H. W. Barber. "Discussion on the etiology of seborrhoea and seborrhoeic dermatitis." The British Medical Journal (1922): 752-757.
  3. ↑ 3.0 3.1 Dessinioti C, Katsambas A (2013). "Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies". Clin Dermatol. 31 (4): 343–51. doi:10.1016/j.clindermatol.2013.01.001. PMID 23806151.
  4. ↑ Dessinioti, Clio, and Andreas Katsambas. "Seborrheic dermatitis: Etiology, risk factors, and treatments:: Facts and controversies." Clinics in dermatology 31.4 (2013): 343-351.
  5. ↑ ===Classification by Anatomical Location===Peyri, J., and M. Lleonart. "Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis." Actas Dermo-Sifiliográficas (English Edition) 98.7 (2007): 476-482.
  6. ↑ name="pmid6220754">Burton JL, Pye RJ (1983). "Seborrhoea is not a feature of seborrhoeic dermatitis". Br Med J (Clin Res Ed). 286 (6372): 1169–70. PMC 1547390. PMID 6220754.
  7. ↑ 7.0 7.1 {{cite journal| author=Thomas DS, Ingham E, Bojar RA, Holland KT| title=In vitro modulation of human keratinocyte pro- and anti-inflammatory cytokine production by the capsule of Malassezia species. | journal=FEMS Immunol Med Microbiol | year= 2008 | volume= 54 | issue= 2 | pages= 203-14 | pmid=: 18752620 | doi=10.1111/j.1574-695X.2008.00468.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?
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  9. ↑ Dessinioti, Clio, and Andreas Katsambas. "Seborrheic dermatitis: Etiology, risk factors, and treatments:: Facts and controversies." Clinics in dermatology 31.4 (2013): 343-351.
  10. ↑ ===Classification by Anatomical Location===Peyri, J., and M. Lleonart. "Clinical and therapeutic profile and quality of life of patients with seborrheic dermatitis." Actas Dermo-Sifiliográficas (English Edition) 98.7 (2007): 476-482.
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  41. ↑ "STD Facts - Syphilis".
  42. ↑ Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM (2017). "Clinical, histological and therapeutic features of Bowen's disease". Rom J Morphol Embryol. 58 (1): 33–40. PMID 28523295.
  43. ↑ Murao K, Yoshioka R, Kubo Y (2014). "Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease". J. Dermatol. 41 (10): 878–84. doi:10.1111/1346-8138.12613. PMID 25201325.
  44. ↑ Szatkowski J, Schwartz RA (2015). "Acute generalized exanthematous pustulosis (AGEP): A review and update". J. Am. Acad. Dermatol. 73 (5): 843–8. doi:10.1016/j.jaad.2015.07.017. PMID 26354880.
  45. ↑ Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ (2002). "Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation". Am. J. Pathol. 161 (6): 2079–86. doi:10.1016/S0002-9440(10)64486-0. PMC 1850901. PMID 12466124.
  46. ↑ Ankad BS, Beergouder SL (2016). "Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective". Dermatol Pract Concept. 6 (2): 9–15. doi:10.5826/dpc.0602a03. PMC 4866621. PMID 27222766.
  47. ↑ Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W (2009). "Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis". Arch Dermatol. 145 (9): 1040–7. doi:10.1001/archdermatol.2009.200. PMID 19770446.
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  117. ↑ Gupta, Aditya K., Karyn Nicol, and Roma Batra. "Role of antifungal agents in the treatment of seborrheic dermatitis." American journal of clinical dermatology 5.6 (2004): 417-422.
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