The development of seborrhea is associated with hormonal disorders

The causes of seborrhea are not fully understood. On the one hand, genetic factors play a significant role in its occurrence, since increased sebum secretion and abundant development of the sebaceous glands are often observed as a family feature.

On the other hand, the leading role of hormonal disorders in patients with seborrhea has been proven, because increased production of androgens in the body enhances the formation of sebum. Clarification of the causes of exacerbation of the disease will help to choose an adequate treatment strategy.

As an independent skin disease, seborrhea was known in ancient times. The term "seborrhea" comes from a combination of two words: the Latin sebum (fat) and the Greek rrhea (teku). Seborrhea is a change in the functional state of the skin, which is based on a violation of the secretory function of the sebaceous glands. This is expressed in increased secretion and a qualitative change in sebum.

Features of the sebaceous glands

The bulk of the sebaceous glands is associated with hair follicles. The duct of the sebaceous gland opens at the mouth of the hair follicle of long, bristly and vellus hair. Part of the sebaceous glands is located in isolation in the region of the nasolabial triangle, forehead, red border of the lips, corners of the eyes, nipples and paranasal region of the mammary glands, glans penis, labia minora and clitoris. The number of sebaceous glands in different parts of the skin is not the same. The places of the greatest accumulation of the sebaceous glands (the central part of the face, forehead, scalp, auricles, décolleté, interscapular region, shoulders) are called seborrheic zones, since they are most affected in violation of the secretion of sebum. The sebaceous glands are located on the border of the reticular and papillary layers of the dermis and have an alveolar structure with branched end sections and excretory ducts. The alveoli are composed of stratified epithelium containing two types of cells: basal cells and sebocytes. Sebocytes perform a secretory function, accumulating lipids in the form of large inclusions. Moving outward in the direction of the duct of the gland, sebocytes are destroyed and turn into a secret — sebum.

The size of the sebaceous glands is different in different parts of the skin. The largest sebaceous glands are associated with vellus hair follicles, and the smallest — with long hair follicles. There are several varieties of sebaceous glands, the number of glands per 1 cm2 reaches several hundred. Their number and magnitude depend on age, neurogenic and endocrine factors. In childhood, the sebaceous glands are at rest. The size of the sebaceous glands undergo changes in different age periods. So, they have a relatively large value immediately after birth and in the first months of a child's life, then they decrease. A sharp increase in their size occurs during puberty. In old age, the sebaceous glands are significantly reduced and reduce secretory activity. According to M. Roh et al. (2006), in men, the production of sebum directly depends on the size of the sebaceous glands. In women, sebum secretion correlates with the menstrual cycle and is significantly higher in the ovulation phase than in the follicular or luteal phase.

Causes of seborrhea

As a rule, seborrhea begins during puberty, but can develop at any time in a person's life. There is such a thing as "physiological seborrhea", when the signs of the disease first appear during puberty as a result of an increase in the secretion of the sebaceous glands against the background of age-related hormonal changes in the body. After the end of puberty, the secretion of the sebaceous glands with physiological seborrhea normalizes and the signs of dermatosis disappear.

The causes of seborrhea are not fully understood. Genetic factors play a significant role in its occurrence. Increased sebum secretion and abundant development of the sebaceous glands are often observed as a family feature. As a rule, in such patients, at least one of the parents has similar skin changes.

At present, the leading role of hormonal disorders in patients with seborrhea has been proven, which is expressed in the violation of the normal ratio of androgens and estrogens. The skin and its appendages (sebaceous and sweat glands, hair follicles) are androgen-dependent. Increased production of androgens in the body increases the formation of sebum. The occurrence of seborrhea in women is associated with a violation of the ratio in the body between androgens and progesterone. In such patients, hyperandrogenemia is more often found in combination with hypoestrogenism or hyperprogesteronemia, and in the sebum there is also a marked increase in the amount of androgens and a decrease in estrogens. Men make up about 40% of patients with oily seborrhea. The main cause of seborrhea in them is changes in the amount of androgens and their metabolism.

In addition, a violation of sebum secretion is observed in Parkinson's and Itsenko– Cushing's diseases, lethargic encephalitis, in patients with mental illness — schizophrenia, manic-depressive and infectious psychoses, epilepsy. An increased separation of sebum is possible with prolonged use of glucocorticosteroid drugs, anabolics, testosterone, progesterone.

The clinical course of seborrhea is significantly affected by dysfunctions of the autonomic nervous system, gastrointestinal tract and the presence of foci of focal infection. Neurogenic regulation of secretion is mainly carried out by the autonomic system. Increased sebum secretion is found in vagotonics along with other signs of increased vagus tone — sharply increased sweating, persistent red dermographism, acrocyanosis. The central nervous system also affects the secretion of sebum, as evidenced by disorders of the nervous system with various lesions of the cerebral cortex and subcortical formations, as well as peripheral nerves. It has now been found that the sebaceous glands contain receptors for neurotransmitters released from nerve endings in response to irritation, which explains the role of psychogenic stress in impaired sebum secretion.

Seborrhea is characterized by a tendency to a chronic course with frequent exacerbations.

Clinical signs of seborrhea

There are several clinical varieties: oily, dry and mixed seborrhea.

One of the most famous dermatologists of the last millennium, J. Darier (1889), described seborrhea, calling this disease "xerosis", by which he meant signs of overdeveloped and overactive sebaceous glands in the form of porous and somewhat thickened skin of the face, resembling an orange peel, a grayish-yellowish hue, constantly shiny due to excess sebum secretion. The main symptom of oily seborrhea — it is greasy, shiny skin. Depending on the physico-chemical composition of sebum, liquid and thick forms of oily seborrhea are distinguished. With liquid seborrhea, the sebaceous secret has the consistency of vegetable oil due to an increase in the amount of free fatty acids in it.
The second pathognomonic sign of oily seborrhea is abundant large-lamellar scales on the scalp. If in people with normal skin the cells exfoliate in such small particles that they cannot be seen, then with seborrhea the surface of the skin becomes too oily, the particles stick together into plates, which sometimes form scales of quite large sizes.

The hair of such patients is also greasy, shiny, stuck together in strands and quickly polluted. With hard physical and mental work, excitement, elevated ambient temperature, sebum secretion increases even more.

The functional significance of sebum is very high. The composition of sebum in seborrhea and in a person with normal skin varies significantly. With this dermatosis, the concentration of linoleic acid in sebum decreases, which leads to an increase in the pH of the skin, a change in the permeability of the epithelium, and the growth of microorganisms on the surface of the skin. Therefore, it is wrong to consider seborrhea as a painful condition caused solely by increased production of sebum. With seborrhea, as in a greenhouse, conditions are created for the appearance of skin diseases such as pyoderma, juvenile acne, etc. Oily skin forms an ideal environment for the reproduction of carinobacteria and staphylococci that produce endogenous lipase, which breaks down sebum triglycerides into free fatty acids; these, in turn, cause skin irritation.

Acne is an unpleasant complication of oily seborrhea. When the sebaceous-hair follicle is clogged with horny masses in patients with oily seborrhea, optimal conditions are created for the reproduction of anaerobic microflora. These microorganisms, although they are representatives of the normal flora of the skin, multiply abundantly under such conditions and damage the walls of the ducts and glands. As a result, an inflammatory granulomatous reaction — eel.

Mixed seborrhea is a combined form, when the symptoms of oily seborrhea are observed in the area of ​​the skin of the face, and dry seborrhea in the area of ​​the scalp.

Dry seborrhea — disease resulting from hypofunction of the sebaceous glands. This dermatosis often appears in children before puberty, due to insufficient development of the sebaceous-hair apparatus of the skin, but it can also occur in adults under the influence of various causes. With dry seborrhea, sebum secretion is reduced, horny scales almost completely cover the hair and scalp, easily separating from the skin, pollute the hair to one degree or another. In some patients, the scales, layering on top of each other, form crusts of a yellowish-white or grayish-white color. Due to reduced sebum secretion, the hair is dry, thin, brittle with split ends. With this form of seborrhea, spots of pink or reddish color can be located on the skin of the trunk and extremities — seborrhea. Of the subjective sensations, patients note a feeling of tightening of the skin, a slight itching, aggravated after washing, especially with cold water. In some cases, the manifestations of dry seborrhea are insignificant and are expressed by dry skin, increased flaking, which may look like dandruff.

Dandruff with seborrhea

Dandruff is also accompanied by flaking on the scalp, thinning and thinning hair. Since dandruff is one of the signs of seborrhea, these two concepts are very often combined. However, this is not entirely correct. Dandruff can appear on its own, as a result of a violation of the normal physiological state of the skin of the scalp, and is characterized by the presence of abundant small scales, most often in the occipital-parietal region.

Human skin performs one of the important functions — barrier-protective. The first blow of aggressive environmental factors takes the epidermis, the most important component of which is the stratum corneum, which is a complex structure. The horny layer of the epidermis has a unique structure, which is called brisk and mortar ("brick and cement"), where the role of "bricks" is played by horny cells, and "cement" — intercellular lipids. Due to a natural process from the surface of the skin, spontaneous rejection of horny cells occurs daily. When changing clothes and walking in the air, several hundred thousand scales appear near a person (up to 20,000 in 1 minute). During the year, more than 100 g of scales are rejected from each square meter. When the stratum corneum is damaged and the integrity of the skin barrier is violated due to the action of external or internal factors, an adaptive reaction occurs in the form of an increase in the number of horny cells. However, if the damage is too great or permanent, the response leads to the development of pathological processes — the skin becomes dry, flaky, and in some cases inflamed. In this case, dandruff appears on the scalp.

There are many causes of dandruff. Most often, this is the use of a hair dryer when drying hair, improper hair care, a lack of vitamins A, B, stress, a poorly chosen hair care line, frequent hair coloring, metabolic disorders, etc. And, as mentioned above, dandruff can serve the first sign of seborrhea.

Complications are also possible with dry seborrhea. Violation of sebum secretion contributes to the activation of yeast-like fungus — oval pityrosporum (Pytyrosporum ovale and Pytyrosporum orbiculare), which, as a saprophyte, is present in the norm in many people, and in the presence of seborrhea becomes pathogenic and causes increased flaking and itching on the skin of the scalp.

Seborrhea treatment

Prognostic estimates for seborrhea should be restrained, since we are talking about a rather long constitutional condition. Prevention of seborrhea does not exist, but with constant efforts, you can keep it at an acceptable level. To do this, it is enough to properly care for problem skin. The classical therapy of this dermatosis includes restorative agents, biogenic stimulants, vitamin A (or beta-carotene), B vitamins (especially B1, B2, B6), D, E, ascorbic and nicotinic acids, biotin, glycerophosphate, sulfur, calcium preparations , copper, iron, zinc oxide. In the correction of seborrhea, biologically active additives are used. Brewer's yeast — one of the richest sources of organic iron, protein, natural B vitamins, minerals, trace elements and amino acids. It is more expedient to prescribe brewer's yeast with a sulfur content. Of the physical methods, darsonvalization and cryomassage of the skin of the scalp, inductothermy of the adrenal region, laser puncture are used.

Correction with systemic antiandrogenic pharmacotherapy is necessary when patients have the so-called "dermatological androgen-dependent triad": androgenetic alopecia, hirsutism and acne. Patients with seborrhea, if possible, should exclude from the use of drugs that cause drug-induced acne and worsen the overall picture of dermatosis. Attention should be paid to anticonvulsants, psychotropic drugs, photosensitizers, some oral contraceptives, anti-tuberculosis, hormonal, anabolic and vitamin preparations. Topical comedogenic agents include sulfur, certain fats and oils, squalene, halogens, tar, resins, mercury, bismuth.

Many authors recommend following a specific diet. There are different opinions regarding the influence of therapeutic nutrition on the course of seborrhea. Foreign literature emphasizes that such patients do not require certain dietary restrictions, since diet does not have any effect on the course of dermatosis. In the domestic literature, on the contrary, great importance was attached to nutrition, which recommended limiting refined carbohydrates, white bread, sweets, salt, spices, spicy seasonings, foods high in cholesterol, and animal fats. Doctors advised to eat dairy products, boiled meat, low-fat fish, black bread, vegetables, fruits containing a lot of fiber. Now most dermatologists do not believe that diet can treat seborrhea. However, patients should be aware

Daily and correct skin care of the scalp and face is of particular importance. In this case, it is necessary to use cosmetics that are sold in pharmacies and are designed specifically for problem skin, do not contain dyes and fragrances. Currently, a modern trend in the external therapy of dermatoses is medical cosmetics. Medicinal substances based on cosmetics have a pronounced therapeutic effect and are easy to use, and the absence of contraindications makes it permissible to use these drugs without time limits.

For the care of the scalp with seborrhea, tar shampoos, which include Psorilom shampoo, are best suited. Its composition includes not only birch tar, but also an extract of string, St. John's wort and celandine, which act anti-inflammatory and antiseptic.

The combination of the antifungal components piroctone olamine and climbazole has a synergistic destructive effect on the fungi of the genus Malassezia, salicylic acid eliminates peeling, vitamin B5 has an anti-inflammatory effect.

Medicated anti-seborrheic shampoos may contain antifungal ingredients (ketoconazole), zinc (for the treatment of seborrheic dermatitis) or tar (for the treatment of oily seborrhea).

With great care, patients with seborrhea should treat the use of makeup and cosmetics. For skin care, you should trust the products of well-known cosmetic companies, which are widely represented in the pharmacy. High-quality cosmetics from reputable manufacturers, in addition to good decorative properties, usually contain components that moisturize the outer layer of the skin; mineral screens that protect against UV rays; micro sponges that absorb excess sebum.

As far as UV irradiation is concerned, up to now there is no consensus among the authors. Although the patients themselves note an improvement in the skin condition in the summer, we note that UV radiation, contrary to the old ideas about the healing effect, can increase comedonal lesions in seborrhea, and, in addition, one should not forget about the carcinogenic effect of increased insolation.

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