Seborrheic dermatitis: diagnosis and management

Seborrheic dermatitis is a chronic inflammatory pathology that is localized in areas of the body with a large number of sebaceous glands and can significantly impair quality of life patients. It is a clinical diagnosis based on typical lesions and their location. The disease develops both in healthy people and in patients with a weakened immune system of various origins.

Let's talk on estet-portal.com about pathophysiology, clinical diagnosis of pathology and diagnosis by biopsy , modern tactics for managing seborrheic dermatitis.

• Pathophysiology of seborrheic dermatitis: immune response and Malassezia
• Diagnosis of seborrheic dermatitis: clinic, biopsy
• Management of seborrheic dermatitis: skin head, face and body

Pathophysiology of seborrheic dermatitis: immune response and Malassezia

Redness, itching and flaking in seborrheic dermatitis develop due to changes in the functioning of skin cells. The yeast genus Malassezia induces a non-specific immune response that triggers a cascade of skin changes.

Read also: Chronic scalp dermatoses

The yeast penetrates the stratum corneum, releasing lipases, which leads to the formation of free fatty acids, and initiates the inflammatory process. Inflammation causes hyperproliferation and incomplete differentiation of corneocytes, disrupting the barrier function and thus further opening access for penetration of Malassezia. fungi Diagnosis of seborrheic dermatitis: clinic, biopsy

In adolescents and adults

, the clinical picture of seborrheic dermatitis is most often represented by scaly, greasy, erythematous lesions on the scalp, skin of the nasolabial folds, ears, eyebrows, anterior surface of the chest and upper third of the back, accompanied by peeling and itching.

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It is necessary to differentiate
the disease from a large number of pathologies, however, the typical localization and characteristics of skin lesions allow clinical diagnosis of this pathology. If clinical diagnosis fails, a biopsy will confirm seborrheic dermatitis by criteria such as parakeratosis in the epidermal layer, plugged follicular orifices, and spongiosis.

Severity of symptoms of seborrheic dermatitis can vary due to

with

stress and exposure to sun. Management of seborrheic dermatitis: scalp, face and body

For moderate

seborrheic dermatitis of the scalp, shampoos containing selenium sulfide, zinc pyrithione, coal tar, tea tree oil should be included in the treatment.  

For long-term control of pathology, it is recommended to use

antifungal

shampoos containing ketoconazole 2% or ciclopirox 1% daily or 2-3 times a week for several weeks before the start of the remission period. For a full-fledged effect, the composition of the product must be on the hair and scalp for at least 5 minutes. According to studies, preparations containing ketoconazole and zinc do not lose their effectiveness after 3 months of use.

Depending on the severity of scalp inflammation,

topical corticosteroids

may be helpful, but long-term use is associated with side effects: fluocinone, betomethasone valerate can reduce itching and inflammation.

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clobetasol

0.05% shampoo twice weekly, alternating with 2% ketoconazole twice weekly, may reduce symptoms faster and last longer maintain control of seborrheic dermatitis after discontinuation compared to a single drug.

Read also: 

Perioral dermatitis: clinic, differential diagnosis, therapy To treat seborrheic dermatitis

on the face

and body, topical antifungals, corticosteroids, and calcineurin inhibitors.  

Corticosteroids

should be considered second-line drugs as long-term use is associated with telangiectasias and atrophy of the skin.

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Clinical forms of telangiectasias and their treatment Studies show that

topical calcineurin inhibitors

may be as effective as topical antifungals and corticosteroids, but have less side effects. FDA warning pimecrolimus and tacrolimus may be associated with lymphoma and skin cancer. Although not enough evidence has been found for this, The American Academy of Dermatology recommends that topical calcineurin inhibitors should be avoided and applied only to limited areas. They should also be considered second-line drugs.

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Psoriasis of the scalp Treatment of seborrheic dermatitis with

antifungals

is the mainstay of treatment for seborrheic dermatitis of the scalp, face and body. Due to possible side effects, anti-inflammatory drugs - topical corticosteroids and calcineurin inhibitors - should only be used for a short period of time. Since seborrheic dermatitis is a chronic pathology, supportive care is necessary.

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