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Seborrhoeic Dermatitis by Aseem
This document discusses seborrheic dermatitis, a chronic papulosquamous skin condition associated with seborrhea and seen along sebaceous gland distributions like the scalp, face, and trunk. It presents in infants as cradle cap and in adults as flaky, greasy, or powdery erythematous patches with scaling. Causative factors may include sebum retention, Malassezia yeasts, and genetic or nutritional factors. Treatment involves topical antifungals, corticosteroids, keratolytics, immunomodulators, coal tar, or systemic antifungals. Differential diagnoses include atopic dermatitis, psoriasis, and tinea
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Seborrhoeic Dermatitis by Aseem
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- 2. INTRODUCTION • Chronic Papulo-SquamousDermatitis with Yellowish, Waxy, Branny Scaling • Syn : SEBORRHOEIC ECZEMA • Associated with SEBORRHOEA • Along distribution of Sebaceous Glands (Primarily Scalp / Face / Trunk)
- 3. ETYMOLOGY Seborrhoeic (Latin : ‘Sebum’– Oil/Wax + ‘Orrhoea’ – Flow) Dermatitis (Greek: ‘Derma’ – Skin + ‘itis’ – Inflammation)
- 4. HISTORY • Described in16th Century by Greek Physician Paulus Aeginata ( Paul of Aegina) • Pityriasis Spectrum • Implication of ‘Furfur fungus’ • Medica Operi (Published in 1542)
- 5. EPIDEMIOLOGY • Bimodal AgeIncidence 0-3 Months of life 4th – 7th Decade of life • Common in HIV/AIDS & PARKINSONISM • Men > Women • 03 – 05 % Prevalence
- 6. ETIOPATHOGENESIS • EXACT CAUSEUNKNOWN • SEBORRHOEA No Sebaceous Gland Pathology Sebum Production Infancy Puberty Retention of Skin Surface Lipids (Eczema Flanneraire)
- 7. ETIOPATHOGENESIS • Sebum = CHOLESTEROL / TRIGs SQUALENE / WAX ESTERS / FFAs Thought to be an Aberration in EPIDERMAL PROFILERATION
- 8. ETIOPATHOGENESIS • MICROBIAL EFFECTS •Candida Albicans • Staphylococcus Aureus Previously • Propionibacterium Acne
- 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. ETIOPATHOGENESIS • DRUGS (Gold/ Arsenic / Methyl DOPA) • SEASONAL PREDILECTION (Winters) • EMOTIONAL LABILITY / STRESS • NUTRITIONAL DEFICIENCY (Zn / BIOTIN) • ??GENETIC
- 11. CLINICAL PATTERNS :INFANTS CRADLE CAP TRUNCAL LESIONS LENIER’S DISEASE (FAM / NON-FAM)
- 12. CLINICAL PATTERN :ADULTS • SCALP • FACE • TRUNK PETALOID / PITYRIASIFORM / FLEXURAL EZCEMATOUS PLAQUES / FOLLICULAR • GENERALIZED
- 13. SEBACOUS GLANDS :DISTRIBUTION
- 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
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- 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)
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- 23. DIFFERENTIALS : INFSEB DERM • ATOPIC DERMATITIS • PSORIASIS • SCABIES
- 24. TREATMENT • SCALP WARM OILCOMPRESSES 3 % SALICYLIC ACID SHAMPOO / OIL DESONIDE LOT 0.05 % HYDROCORTISONE CREAM 1 % IMIDAZOLE SHAMPOOS
- 25. TREATMENT • BODY/ INTERTIGO CLIOQUINOL0.2 – 0.5% IN Zn OIL KETOCONAZOLE 2% CREAM / SOFTPASTE DESONIDE LOT 0.05%
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- 27. SCALP IN SEBDERM • PITYRIASIS SICCA • PATCHY SEB DERM + CORONA SEBORRHEICA • PITYRIASIS AMIANTACEA
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- 29. SEB DERM :SCALP • Perifollicular, Erythematous Plaques with Branny Gray-Yellow, Greasy Scales • CORONA SEBORRHOEICA • May cause reversible Alopecia
- 30. SEB DERM :SCALP • s
- 31. SEB DERM :SCALP
- 32. SEB DERM :SCALP • A
- 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
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- 35. ADULT SEB DERM •Wide Spectrum • SEBORRHOEIC ECZEMATID Erythema NASOLABIAL / RETROAURICULAR Seborrhoea PRESTERNAL / SHOULDER BLADES White, Fluffy Scaly Scalp - Pityriasis Sicca (Dandruff)
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- 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. SEB DERM :FACE
- 39. SEB DERM :FACE
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- 43. SEB DERM :TRUNK
- 44. SEB DERM :TRUNK
- 45. SEBORRHOEIC ERYTHRODERMA • ConfluentErythema • Yellowish – Gray Scaling + Exfoliation • Covering > 90 % BSA • Differential Diagnoses
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- 48. TREATMENT • TOPICALS SELENIUM SULFIDESHAMPOO 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. TREATMENT : TOPICALS ANTIFUNGALS ZPTO1-2% SHAMPOO KETOCONAZOLE 2 % SHAMPOO/ CREAM CICLOPIROX OLAMINE 1% SH / CR TERBINAFINE 1% CREAM / SOLUTION METRONIDAZOLE 1% GEL KERATOLYTICS (SALICYLIC ACID 5-6% OINT)
- 50. TREATMENT : TOPICALS •IMMUNOMODULATORS TACROLIMUS OINT 0.1 % PIMECROLIMUS OINT 1% OTHERS - BENZOYL PEROXIDE 2.5 – 5%
- 51. TREAMENT • SYSTEMIC KETOCONAZOLE 200MG/ DAY X 07D ITRACONZAOLE 200 MG / DAY X 07D TERBINAFINE 250 MG OD X 28 D ISOTRETINOIN
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