Seborrhoeic Dermatitis by Aseem
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Transcript of Seborrhoeic Dermatitis by Aseem
SEBORRHOEIC DERMATITIS
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)
ETYMOLOGY
Seborrhoeic (Latin : ‘Sebum’ – Oil/Wax + ‘Orrhoea’ – Flow)
Dermatitis(Greek: ‘Derma’ – Skin + ‘itis’ – Inflammation)
HISTORY
• Described in 16th Century by Greek Physician Paulus Aeginata ( Paul of Aegina)
• Pityriasis Spectrum • Implication of ‘Furfur fungus’
• Medica Operi (Published in 1542)
EPIDEMIOLOGY
• Bimodal Age Incidence0-3 Months of life4th – 7th Decade of life
• Common in HIV/AIDS & PARKINSONISM
• Men > Women
• 03 – 05 % Prevalence
ETIOPATHOGENESIS
• EXACT CAUSE UNKNOWN
• SEBORRHOEA No Sebaceous Gland Pathology
Sebum Production Infancy Puberty Retention of Skin Surface Lipids (Eczema Flanneraire)
ETIOPATHOGENESIS
• Sebum = CHOLESTEROL / TRIGs
SQUALENE / WAX ESTERS / FFAs
Thought to be an Aberration in EPIDERMAL PROFILERATION
ETIOPATHOGENESIS
• MICROBIAL EFFECTS
• Candida Albicans • Staphylococcus Aureus
Previously• Propionibacterium Acne
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
ETIOPATHOGENESIS
• DRUGS (Gold / Arsenic / Methyl DOPA)
• SEASONAL PREDILECTION (Winters)
• EMOTIONAL LABILITY / STRESS
• NUTRITIONAL DEFICIENCY (Zn / BIOTIN)
• ??GENETIC
CLINICAL PATTERNS : INFANTS
CRADLE CAP
TRUNCAL LESIONS
LENIER’S DISEASE (FAM / NON-FAM)
CLINICAL PATTERN : ADULTS
• SCALP• FACE• TRUNK
PETALOID / PITYRIASIFORM / FLEXURAL EZCEMATOUS PLAQUES / FOLLICULAR
• GENERALIZED
SEBACOUS GLANDS : DISTRIBUTION
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
INFANTILE SEB DERM
INFANTILE SEB DERM
INFANTILE SEB DERM
• S
INFANTILE SEB DERM
INFANTILE SEB DERM
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)
LENIER’S DISEASE
LENIER’S DISEASE
DIFFERENTIALS : INF SEB DERM
• ATOPIC DERMATITIS
• PSORIASIS
• SCABIES
TREATMENT
• SCALP
WARM OIL COMPRESSES 3 % SALICYLIC ACID SHAMPOO / OIL DESONIDE LOT 0.05 %
HYDROCORTISONE CREAM 1 % IMIDAZOLE SHAMPOOS
TREATMENT
• BODY/ INTERTIGO
CLIOQUINOL 0.2 – 0.5% IN Zn OIL KETOCONAZOLE 2% CREAM /
SOFTPASTE DESONIDE LOT 0.05%
ADULT SEB DERM
SCALP IN SEB DERM
• PITYRIASIS SICCA
• PATCHY SEB DERM + CORONA SEBORRHEICA
• PITYRIASIS AMIANTACEA
PITYRIASIS SICCA (DANDRUFF)
SEB DERM : SCALP
• Perifollicular, Erythematous Plaques with Branny Gray-Yellow, Greasy Scales
• CORONA SEBORRHOEICA
• May cause reversible Alopecia
SEB DERM : SCALP
• s
SEB DERM : SCALP
SEB DERM : SCALP
• A
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
PITYRIASIS AMIANTACEA
ADULT SEB DERM
• Wide Spectrum
• SEBORRHOEIC ECZEMATID
Erythema NASOLABIAL / RETROAURICULAR Seborrhoea PRESTERNAL / SHOULDER BLADES White, Fluffy Scaly Scalp - Pityriasis Sicca
(Dandruff)
SEBORRHOEIC ECZEMATID
SEB DERM : FACE
• PRURITIC ERYTHEMATOUS PLAQUES, POWDERY to GREASY SCALES seen over
GLABELLAEYEBROWS
NASOLABIAL / PARANASAL FOLDRETROAURICULAR FOLDBEARD REGION
Assoc with BLEPHARITIS / OTITIS EXTERNA
SEB DERM : FACE
SEB DERM : FACE
SEBORRHOEIC BLEPHARITIS
SEBORRHOEIC BLEPHARITIS
SEBORRHOEIC OTITIS EXTERNA
SEB DERM : TRUNK
SEB DERM : TRUNK
SEBORRHOEIC ERYTHRODERMA
• Confluent Erythema• Yellowish – Gray Scaling + Exfoliation
• Covering > 90 % BSA
• Differential Diagnoses
SEBORRHOEIC ERYTHRODERMA
DIFFERENTIALS : SEB DERM
TREATMENT
• TOPICALS
SELENIUM SULFIDE SHAMPOO 1 – 2.5%
COAL TAR 1-5% OINT / SHAMPOO
MILD – MODERATE CORTICOSTEROIDSDESONIDE LOT 0.05% LOTMOMETASONE 0.1 % CRFLUCINOLONE ACET 0.01% SH
TREATMENT : TOPICALS
ANTIFUNGALS ZPTO 1-2% SHAMPOOKETOCONAZOLE 2 % SHAMPOO/ CREAMCICLOPIROX OLAMINE 1% SH / CRTERBINAFINE 1% CREAM / SOLUTIONMETRONIDAZOLE 1% GEL
KERATOLYTICS (SALICYLIC ACID 5-6% OINT)
TREATMENT : TOPICALS
• IMMUNOMODULATORS
TACROLIMUS OINT 0.1 %
PIMECROLIMUS OINT 1%
OTHERS - BENZOYL PEROXIDE 2.5 – 5%
TREAMENT
• SYSTEMIC
KETOCONAZOLE 200MG / DAY X 07D
ITRACONZAOLE 200 MG / DAY X 07D
TERBINAFINE 250 MG OD X 28 D
ISOTRETINOIN
THANK YOU