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AlexanderSalava

Seborrhoeic Dermatitis in the Adult

Essentials

  • Diagnosis is based on the typical appearance and location of the rash.
  • Typical sites of the disease are the scalp, face, ears, bends, chest and genital area. It has different clinical manifestations.
  • Management consists of symptomatic treatment.

Epidemiology and aetiology

  • Prevalence about 3-5%
  • Endogenous and multifactorial
  • Increased sebum production (seborrhoea), the properties of sebum and the patient's immunological response favour the growth of Malassezia yeasts and other microbes. Malassezia yeasts degrade sebum to fatty acids, which results in skin irritation.
  • There have been reports of an association between sudden onset or flare ups and certain conditions (e.g. immunosuppression, HIV infection, Parkinson's disease) and medicines (lithium, haloperidol, antiepileptic drugs, systemic glucocorticoids).

Symptoms and signs

  • Well-demarcated, scaly and erythematous patchy lesions that may coalesce to form larger lesions on the face and other areas
  • Intermittent symptom emergence on sebum-rich skin areas.
    • Scalp (pictures 1 2) (pityriasis capitis, i.e. "dandruff")
    • Face (picture 3), eyebrows, nasolabial folds (picture 4), "sideburn" areas (pictures 5 6)
    • Pinna of the ear and ear canal
    • Central upper parts of the chest and, sometimes, of the back (high sweat rate areas: the bra triangle and the triangular area between the shoulders and the scapulae, picture 7)
    • Armpits (picture 8)
    • Gluteal cleft (picture 9), groins (pictures 10 11), genital area (glans penis, scrotum; picture 12)
  • Various clinical manifestations include
    • greasy or dry scaling of the scalp, sometimes thick scalp plaques (picture 13)
    • seborrhoeic dermatitis of the ear canal and ears
    • eyelid dermatitis, seborrhoeic blepharitis
    • patchy lesions on the high sweat rate areas of the upper torso
    • well-demarcated erythema and excoriation in the flexural areas (= an intertrigo)
    • seborrhoeic dermatitis of the gland penis (balanitis) or testicles
    • Pityrosporum (Malassezia) folliculitis (itchy papulopustules on the chest and upper back).

Diagnosis

  • Diagnosis is based on the typical appearance and location of the rash.
  • In some cases fungal samples (for microscopy and culture) are indicated to exclude tinea. Malassezia yeasts can be seen in microscopy, no growth in the fungal culture.

Differential diagnosis

  • Psoriasis Psoriasis: the scales are thicker, the sites of predilection are different, i.e. elbows and knees, palms and soles. Nail changes, and psoriasis often has a familial occurrence.
  • Atopic dermatitis: different typical locations
    • The scalp lesions are sometimes identical with those caused by seborrhoeic dermatitis
  • Tinea: must be borne in mind, for example in dermatitis of the groins
  • Tinea versicolor: on the chest, trunk, shoulders with well-circumscribed orange-brown blotches
  • Rosacea: even redness on convex surfaces of the face, papulopustules, dilated superficial blood vessels

Treatment

Consultation

  • In severe cases and cases refractory to therapy a dermatologist should be consulted.

    References

    • Dall'Oglio F, Nasca MR, Gerbino C, et al. An Overview of the Diagnosis and Management of Seborrheic Dermatitis. Clin Cosmet Investig Dermatol 2022;15():1537-1548. [PubMed]
    • Borda LJ, Perper M, Keri JE. Borda LJ, Perper M, Keri JE. Treatment of seborrheic dermatitis: a comprehensive review. J Dermatolog Treat 2019;30(2):158-169. [PubMed]. J Dermatolog Treat. 2018 May 24:1-12.
    • Gupta AK, Versteeg SG. Topical treatment of facial seborrheic dermatitis: a systematic review. Am J Clin Dermatol 2017;18(2):193-213. [PubMed]
    • Hald M, Arendrup MC, Svejgaard EL, et al. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol 2015;95(1):12-9. [PubMed].
    • Naldi L, Diphoorn J. Seborrhoeic dermatitis of the scalp. BMJ Clin Evid 2015;2015():. [PubMed]
    • Alizadeh N, Monadi Nori H, Golchi J, et al. Comparison the efficacy of fluconazole and terbinafine in patients with moderate to severe seborrheic dermatitis. Dermatol Res Pract 2014;2014:705402. [PubMed].