Seborrhoeic Dermatitis by Aseem

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Seborrhoeic Dermatitis by Aseem

  1. 1. SEBORRHOEIC DERMATITIS
  2. 2. INTRODUCTION • Chronic Papulo-Squamous Dermatitis with Yellowish, Waxy, Branny Scaling • Syn : SEBORRHOEIC ECZEMA • Associated with SEBORRHOEA • Along distribution of Sebaceous Glands (Primarily Scalp / Face / Trunk)
  3. 3. ETYMOLOGY Seborrhoeic (Latin : ‘Sebum’ – Oil/Wax + ‘Orrhoea’ – Flow) Dermatitis (Greek: ‘Derma’ – Skin + ‘itis’ – Inflammation)
  4. 4. HISTORY • Described in 16th Century by Greek Physician Paulus Aeginata ( Paul of Aegina) • Pityriasis Spectrum • Implication of ‘Furfur fungus’ • Medica Operi (Published in 1542)
  5. 5. EPIDEMIOLOGY • Bimodal Age Incidence 0-3 Months of life 4th – 7th Decade of life • Common in HIV/AIDS & PARKINSONISM • Men > Women • 03 – 05 % Prevalence
  6. 6. ETIOPATHOGENESIS • EXACT CAUSE UNKNOWN • SEBORRHOEA No Sebaceous Gland Pathology Sebum Production Infancy  Puberty Retention of Skin Surface Lipids (Eczema Flanneraire)
  7. 7. ETIOPATHOGENESIS • Sebum =  CHOLESTEROL / TRIGs  SQUALENE / WAX ESTERS / FFAs Thought to be an Aberration in EPIDERMAL PROFILERATION
  8. 8. ETIOPATHOGENESIS • MICROBIAL EFFECTS • Candida Albicans • Staphylococcus Aureus Previously • Propionibacterium Acne
  9. 9. ETIOPATHOGENESIS • Malassezia Furfur (erst Pityrosporum Ovale) • Lipophilic Yeast / 665,000 Org per sq cm (500,000 in Normal Skin) • Aggravating > Causative • T-Cell Activation +/- Complement Activation
  10. 10. ETIOPATHOGENESIS • DRUGS (Gold / Arsenic / Methyl DOPA) • SEASONAL PREDILECTION (Winters) • EMOTIONAL LABILITY / STRESS • NUTRITIONAL DEFICIENCY (Zn / BIOTIN) • ??GENETIC
  11. 11. CLINICAL PATTERNS : INFANTS CRADLE CAP TRUNCAL LESIONS LENIER’S DISEASE (FAM / NON-FAM)
  12. 12. CLINICAL PATTERN : ADULTS • SCALP • FACE • TRUNK PETALOID / PITYRIASIFORM / FLEXURAL EZCEMATOUS PLAQUES / FOLLICULAR • GENERALIZED
  13. 13. SEBACOUS GLANDS : DISTRIBUTION
  14. 14. INFANTILE SEB DERM • SCALP Initially Sparse Inflammatory Yellowish, Oily Flakes  Thick Crusted, Grayish-Yellow Scales over an Erythematous Plaque (Extn beyond Hairline) without Alopecia - Crusta Lactea / Cradle Cap
  15. 15. INFANTILE SEB DERM
  16. 16. INFANTILE SEB DERM
  17. 17. INFANTILE SEB DERM • S
  18. 18. INFANTILE SEB DERM
  19. 19. INFANTILE SEB DERM
  20. 20. LEINER’S DISEASE • Syn : Erythroderma Desquamativum Dermatitis Seborrhoides Infantum Discovered by Leiner in 1908 Complication of Infantile Seb Derm with Confluent Scaly Erythema > 90 % BSA + GI Manifest + Anemia C5 Deficiency (Familial)
  21. 21. LENIER’S DISEASE
  22. 22. LENIER’S DISEASE
  23. 23. DIFFERENTIALS : INF SEB DERM • ATOPIC DERMATITIS • PSORIASIS • SCABIES
  24. 24. TREATMENT • SCALP WARM OIL COMPRESSES 3 % SALICYLIC ACID SHAMPOO / OIL DESONIDE LOT 0.05 % HYDROCORTISONE CREAM 1 % IMIDAZOLE SHAMPOOS
  25. 25. TREATMENT • BODY/ INTERTIGO CLIOQUINOL 0.2 – 0.5% IN Zn OIL KETOCONAZOLE 2% CREAM / SOFTPASTE DESONIDE LOT 0.05%
  26. 26. ADULT SEB DERM
  27. 27. SCALP IN SEB DERM • PITYRIASIS SICCA • PATCHY SEB DERM + CORONA SEBORRHEICA • PITYRIASIS AMIANTACEA
  28. 28. PITYRIASIS SICCA (DANDRUFF)
  29. 29. SEB DERM : SCALP • Perifollicular, Erythematous Plaques with Branny Gray-Yellow, Greasy Scales • CORONA SEBORRHOEICA • May cause reversible Alopecia
  30. 30. SEB DERM : SCALP • s
  31. 31. SEB DERM : SCALP
  32. 32. SEB DERM : SCALP • A
  33. 33. PITYRIASIS AMIANTACEA • Syn : Tinea Amiantacea / Asbestos Scalp • Heavy Micaceous, Crusted Scaling extending to Follicle • Binding of Proximal Portions of Hair • Assoc with Strep / AD / LS / PSOR
  34. 34. PITYRIASIS AMIANTACEA
  35. 35. ADULT SEB DERM • Wide Spectrum • SEBORRHOEIC ECZEMATID Erythema NASOLABIAL / RETROAURICULAR Seborrhoea PRESTERNAL / SHOULDER BLADES White, Fluffy Scaly Scalp - Pityriasis Sicca (Dandruff)
  36. 36. SEBORRHOEIC ECZEMATID
  37. 37. SEB DERM : FACE • PRURITIC ERYTHEMATOUS PLAQUES, POWDERY to GREASY SCALES seen over GLABELLA EYEBROWS NASOLABIAL / PARANASAL FOLD RETROAURICULAR FOLD BEARD REGION Assoc with BLEPHARITIS / OTITIS EXTERNA
  38. 38. SEB DERM : FACE
  39. 39. SEB DERM : FACE
  40. 40. SEBORRHOEIC BLEPHARITIS
  41. 41. SEBORRHOEIC BLEPHARITIS
  42. 42. SEBORRHOEIC OTITIS EXTERNA
  43. 43. SEB DERM : TRUNK
  44. 44. SEB DERM : TRUNK
  45. 45. SEBORRHOEIC ERYTHRODERMA • Confluent Erythema • Yellowish – Gray Scaling + Exfoliation • Covering > 90 % BSA • Differential Diagnoses
  46. 46. SEBORRHOEIC ERYTHRODERMA
  47. 47. DIFFERENTIALS : SEB DERM
  48. 48. TREATMENT • TOPICALS SELENIUM SULFIDE SHAMPOO 1 – 2.5% COAL TAR 1-5% OINT / SHAMPOO MILD – MODERATE CORTICOSTEROIDS DESONIDE LOT 0.05% LOT MOMETASONE 0.1 % CR FLUCINOLONE ACET 0.01% SH
  49. 49. TREATMENT : TOPICALS ANTIFUNGALS ZPTO 1-2% SHAMPOO KETOCONAZOLE 2 % SHAMPOO/ CREAM CICLOPIROX OLAMINE 1% SH / CR TERBINAFINE 1% CREAM / SOLUTION METRONIDAZOLE 1% GEL KERATOLYTICS (SALICYLIC ACID 5-6% OINT)
  50. 50. TREATMENT : TOPICALS • IMMUNOMODULATORS TACROLIMUS OINT 0.1 % PIMECROLIMUS OINT 1% OTHERS - BENZOYL PEROXIDE 2.5 – 5%
  51. 51. TREAMENT • SYSTEMIC KETOCONAZOLE 200MG / DAY X 07D ITRACONZAOLE 200 MG / DAY X 07D TERBINAFINE 250 MG OD X 28 D ISOTRETINOIN
  52. 52. THANK YOU

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