HOW I MANAGE IT DR. HANISH BABU, MD Dermatologist & Venereologist City Medical Centre, Ajman, UAE Read about: How to Get Rid of Seborrheic Dermatitis Copyright Dr.Hanish Babu, MD, 2009

THE DEFINITION Seborrhoeic Dermatitis is a hyperproliferative disorder of the epidermis in the sebaceous rich areas of the body associated with increased and altered sebum production and yeast colonization. Read about: How to Get Rid of Seborrheic Dermatitis

Seborrhoeic Dermatitis is a hyperproliferative disorder of the epidermis in the sebaceous rich areas of the body associated with increased and altered sebum production and yeast colonization.

THE QUESTION: Is the increased sebum production the primary event? Does the Malassezia colonization lead to increased sebum production? Read about: How to Get Rid of Seborrheic Dermatitis

Is the increased sebum production the primary event?

Does the Malassezia colonization lead to increased sebum production?

MALASSEZIA & SEBORRHEIC DERMATITIS Malassezia globosa; M.restricta Digestion of Seb.Tg Release of Oleic Acid Penetrate Str.Corneum Alternate pathway activn Barrier Compromised Increased Sebum Dermatitis Hyperproliferation Repair Process Dr.Hanish Babu, MD, 2009

Genetic Predisposition Seborrheic Diathesis Stress, Fatigue Environmental Hormonal Immune Def, Imm.alterations ?Food Alcohol Drugs Diseases Sebum Malassezia Sebum alteration Alternate Complement Pathway Inflammation Hyperproliferation & dermatitis

Mild –Moderate-Severe Dandruff Mild Moderate Severe Seborrheic Dermatitis Psoriasis overlap Seborrhiasis Read about: How to Get Rid of Seborrheic Dermatitis

DIFFERENTIAL DIAGNOSIS Scalp: Contact Dermatitis, Psoriasis, Atopic Dermatitis, Infective Dermatitis 2ry to Pediculosis Ear Canal: Otomycosis,Psoriasis,Contact Dermatitis Face: Rosacia,Contact Dermatitis,Psoriasis,Impetigo, 2ry Syphilis,Drug eruptions Chest and Back: Psoriasis, Pityriasis Rosea,Contact Dermatitis,Drug Eruptions Drug Eruptions: OCP, Systemic Steroids , Androgens, auranofin, aurothioglucose, buspirone, chlorpromazine, cimetidine, ethionamide, gold, griseofulvin , haloperidol, interferon alfa, lithium, methyldopa, phenothiazines, psoralens , beta blockers, stanozolol, thiothixene .

Scalp: Contact Dermatitis, Psoriasis, Atopic Dermatitis, Infective Dermatitis 2ry to Pediculosis

Ear Canal: Otomycosis,Psoriasis,Contact Dermatitis

Face: Rosacia,Contact Dermatitis,Psoriasis,Impetigo,

2ry Syphilis,Drug eruptions

Chest and Back: Psoriasis, Pityriasis Rosea,Contact Dermatitis,Drug Eruptions

Drug Eruptions: OCP, Systemic Steroids , Androgens, auranofin, aurothioglucose, buspirone, chlorpromazine, cimetidine, ethionamide, gold, griseofulvin , haloperidol, interferon alfa, lithium, methyldopa, phenothiazines, psoralens , beta blockers, stanozolol, thiothixene .

DISEASE ASSOCIATED WITH SEBORRHOEIC DERMATITIS Parkinsonism Other Neurological: Epilepsy, Idiopathic Post Encephalitis syndrome Immune deficiency: HIV, neoplasms, drug induced. Immune Alterations: C5 deficiency: Leiner’s Letterer Siwe: Scaling scalp with petechiae Read about: How to Get Rid of Seborrheic Dermatitis

Parkinsonism

Other Neurological: Epilepsy, Idiopathic Post Encephalitis syndrome

Immune deficiency: HIV, neoplasms, drug induced.

Immune Alterations: C5 deficiency: Leiner’s

Letterer Siwe: Scaling scalp with petechiae

PRINCIPLES OF MANAGEMENT Patient education No Cure. Like dental care: daily attention. Regular Washing of scalp Anti seborrhoeic treatment alternating with normql shampooing Hair tonics & tinctures with alcohol base: Aggravate Normal Soap & Shaving Creams: Use emollients and emollient soap substitutes Alter Food Habits: low fat, low sugar diet ; cut down on the alcohol. Manage Stress

Patient education

No Cure. Like dental care: daily attention.

Regular Washing of scalp

Anti seborrhoeic treatment alternating with normql shampooing

Hair tonics & tinctures with alcohol base: Aggravate

Normal Soap & Shaving Creams: Use emollients and emollient soap substitutes

Alter Food Habits: low fat, low sugar diet ; cut down on the alcohol.

Manage Stress

MANAGEMENT 1. Regulation of Hyper-Seborrhea Control Of Dietary Habits Stress Management Regular Washing without causing irritation Avoidance of offending drug, alcohol Usage of creams containing antiseborrhoeic agents: Zinc Acetyl Methionate, Undecylenic Acid Derivatives Other antifungal creams and solutions to control Malassezia Read about: How to Get Rid of Seborrheic Dermatitis

1. Regulation of Hyper-Seborrhea

Control Of Dietary Habits

Stress Management

Regular Washing without causing irritation

Avoidance of offending drug, alcohol

Usage of creams containing antiseborrhoeic agents:

Zinc Acetyl Methionate,

Undecylenic Acid Derivatives

Other antifungal creams and solutions to control Malassezia

MANAGEMENT 2. Control of the Yeast Imidazole solutions or creams: 2-3 times a week Antifungal shampoos: Daily till control, then weekly twice.(Ketoconazole, Zinc Pyrethrone,Cyclopirox,Undecylenic acid etc) Regular Washing Other shampoos: containing Tar ,Salicylic acid or selenium sulphide Avoidance of offending drug, alcohol Control of Seborrhoea Read about: How to Get Rid of Seborrheic Dermatitis

2. Control of the Yeast

Imidazole solutions or creams: 2-3 times a week

Antifungal shampoos: Daily till control,

then weekly twice.(Ketoconazole, Zinc Pyrethrone,Cyclopirox,Undecylenic acid etc)

Regular Washing

Other shampoos: containing Tar ,Salicylic acid or selenium sulphide

Avoidance of offending drug, alcohol

Control of Seborrhoea

MANAGEMENT 3. Removal Of Thick Scales Overnight application of tar/urea/salicylic acid containing creams Rubbing with warm mineral oil and washing off If crusting and oozing: A course of antibiotic with a steroid-antifungal cream for 5-7 days;once scales and 2ry infection is cleared; start antimalassezia treatment Read about: How to Get Rid of Seborrheic Dermatitis

3. Removal Of Thick Scales

Overnight application of tar/urea/salicylic acid containing creams

Rubbing with warm mineral oil and washing off

If crusting and oozing: A course of antibiotic with a steroid-antifungal cream for 5-7 days;once scales and 2ry infection is cleared; start antimalassezia treatment

MANAGEMENT 4. Severe and Un-responsive Cases 1- 2 Weeks’ course of systemic antiyeast treatment with Ketoconazole,Itraconazole or Fluconazole Class IV or lower strength topical steroid creams, lotions or solutions for acute flares for 5-7 days only. Continue with anti seborrhoeic/ antiyeast measures Other alternatives: Calcineurin derivatives Pimecrolimus/tacrolimus, metronidazole gel, Narrow band UVB therapy etc.

4. Severe and Un-responsive Cases

1- 2 Weeks’ course of systemic antiyeast treatment with Ketoconazole,Itraconazole or Fluconazole

Class IV or lower strength topical steroid creams, lotions or solutions for acute flares for 5-7 days only.

Continue with anti seborrhoeic/ antiyeast measures

Other alternatives: Calcineurin derivatives Pimecrolimus/tacrolimus, metronidazole gel, Narrow band UVB therapy etc.

THANK YOU! Read about: How to Get Rid of Seborrheic Dermatitis Read about: How to Get Rid of Dandruff Copyright Dr.Hanish Babu, MD, 2009