Seborrheic dermatitis

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Comprehensive overview of "seborrheic dermatitis” further evidence showing the effectiveness and safety of pimecrolimus

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Seborrheic dermatitis

  1. 1. Comprehensive overview of "seborrheic dermatitis” further evidence showing the effectiveness and safety of pimecrolimus Almansouri Daifallah MD
  2. 2. Outcomes • Terminology: – – – – • • • • • • • • • • • • • • • • • • • Origin: Arabic: French: Synonym: Definition. Etiology Risk factors Epidemiology Pathophysiology Dermatopathology Local Symptoms Systemic symptoms: Signs Investigation, and DDx, DDx Complications Prognosis Psychological impact Guidelines Priscription table of 1st line medication dose 2 commonest and 2 most serious side effects: Patient education Progression, severity and response assessment methods
  3. 3. Definition • Seborrhoeic dermatitis (SD) is chronic-recurrent common skin inflammation affect sebaceousgland-rich areas of skin causes scaling. • Dandruff(pityriasis sicca): mildest form of seborrhoeic dermatitis “scaling without inflammation”. • Cradle cap “ ” : is transient form of seborrhoeic dermatitis affecting infants. • SD may be presoriatic stage and may associated with psoraisis and called “seborrhiasis”
  4. 4. Terminology – Origin: • Seborrhic: adjective from “sebum” and means that the disease particularly affects the sebaceous-gland-rich areas of skin. But not caused by seborrhoea. • Dermatitis: derma: skin, -itis: inflammation. – Arabic: – French: dermatite séborrhéique – Synonym: Dandruff(pityriasis sicca), cradle cap.
  5. 5. Cradle cap • DDx: langerhans cell histocytosis
  6. 6. Etiology • Unknown • Possible factors: – ? Malassezia species – ? Immune response: decrease some immunity component. – Genetic; small role.
  7. 7. Risk factors • HIV; 10X and resistant • Neural diseases; Parkinson disease, facial palsy • Neuroleptic medications • Emotional stress
  8. 8. Epidemiology • % • Two peaks: infant after 2 wks + 20s -30s. • M>F
  9. 9. Pathophysiology Genetics: Immune system NB. The amount of malassezia is not changed. Malassezia species •Helper T cells, phytohemagglutinin and concanavalin stimulation, and antibody titers Malassezia globosa• Malassezia furfur• Malassezia restricta• Malassezia grow and secrete lipases This lipase hydrolyzes sebum TG into > unsaturated fatty acid (non-uniform) > penetrating the skin cause > epidermal hyperprolifration (causes parakeratosis) and inflammation (causes spongiosis) >flakes shedding , loss skin barrier function. RESULT: Inflammation > pruritis. Hyperprolifration> flakes = SD
  10. 10. Summery of pathophysiology • Malassezia ecosystem and interaction with the epidermis. • Initiation and propagation of inflammation; • Disruption of proliferation and differentiation processes of the epidermis; and • Physical and functional skin barrier disruption.
  11. 11. Dermatopathology • • Spongiosis focal parakeratosis (partially nucleated cells)
  12. 12. Local symptoms and signs Symptoms • Pruritus • sensation of tightness “dryness”. • Hair: alopecia and less shine. Aggravated by: winter, dry, indoor, sweating. Signs • Skin: Orange-red “erythema” OR grey white. • Scaling macules: white/ greasy/ yellow orange. • Dryness “sensation of tightness”. • Hair: brittle narrow hair.
  13. 13. Corona seborrhoica Where? confined to areas of the head and trunk where sebaceous glands are most prominent. Classification: area based
  14. 14. Classification: Head • Areas: – Scalp, – eyebrows – eyelashes (blepharitis) – beard (follicular orifices)
  15. 15. Classification: face • Areas: • forehead (“corona seborrhoica”), • nasolabial folds • eye-brows • Glabella
  16. 16. Classification: Trunk
  17. 17. Classification: Body Folds Areas: • • • • • • Axillae, Groins, Anogenital area, Submammary areas, Umbilicus, Diaper area Description: diffuse, exudative, sharply marinated, brightly erythematous eruption; erosions and fissures common. Tx: Same as other areas but Castellani's paint is very effective
  18. 18. Management (nice+aad) I. Remove crust: salicylic acid, olive oil, coal tar shampoo. II. Ketoconazole 2% shampoo I. II. III. If failed > Selenium sulphide shampoo 2.5% or ciclopirox 1%. If no compliance > zinc pyrithione shampoo If symptoms subside > continue: once week for 2 weeks. III. Severe itching: potent steroid I. betamethasone valerate 0.1%, II. hydrocortisone butyrate 0.1% III. mometasone furoate 0.1%. Nb. Steroid not applied on bear. IV. F/U not required unless complicated or resistant
  19. 19. Prescription Medication Route dose salicylic acid shampo o Message for few Once daily minutes after wetting hair One month Ketoconazol e 2% shampoo shampo o left on for five to Twice/week ten minutes One month Pimecrolimu Cream s 1% fluocinolone shampo acetonide o 0.01% frequency duration Twice daily ≤30 mL 2-4 weeks safe Once daily 2-4 weeks Quick Zinc + B6 retinoic acid Spec Indicati To exclude deficiency orally 1mg/ Kg daily 2 weeks Very severe
  20. 20. Medication SE Medication Contraindications salicylic acid Sick child or < 2yr Ketoconazole 2% shampoo Safe for pregnant SE Management Irritation/ burning sensation dryness fluocinolone acetonide 0.01% hypersensitivity to peanuts over-the-counter conditioner TC complications Stop immediately. Very safe, rarely; irritation Subside within 1st day Pregnancy; Cat C Pimecrolimus
  21. 21. DDx Disease Face Differentiation Smear for bacteria Pitryasis rosea KOH Pitryasis varsicolor Other Response to Rosacea Tx Impetigo Trunk Rosacea KOH Dermatophytosis KOH Mild psoriasis vulgaris Indistinguishable
  22. 22. Dandruff • Dandruff is desquamation without inflammation. • Tx: zinc pyrithione shampoo 1 to 2%.
  23. 23. SD-like lesions • B6 or zinc oxide deficiency.
  24. 24. Follow Up • Response assessment: • Relapse is prevented by once/ week antifungal shampoo usage.
  25. 25. Summary • Flaking and pruritus are hallmark of SD.
  26. 26. References • http://www.pgbeautygroomingscience.com/r ole-of-lipid-metabolism-in-seborrheicdermatitis-dandruff.php • http://www.ncbi.nlm.nih.gov/pubmed?term= 6220754 • http://www.medicaljournals.se/acta/content/ ?doi=10.2340/00015555-1382&html=1

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