Dermatology - Seborrheic Dermatitis

Dermatology - Seborrheic Dermatitis 

Dermatitis is a prevalent and persistent skin condition characterized by inflammation and flaking. It primarily affects areas with high sebaceous gland activity, including the face, scalp, presternal area, and body folds. Dandruff refers to mild seborrheic dermatitis occurring on the scalp. Seborrheic Dermatitis (SD) is a condition that is more prevalent in males and affects approximately 2-5% of the population. It typically begins in infancy, adolescence, or most commonly, during maturity, namely between the ages of 20 and 50.

The onset of symptoms is gradual, and in some people, symptoms worsen in cold or dry settings. Sunlight can trigger flare-ups, but it also promotes improvement in certain patients. The presence of varied pruritus is frequently exacerbated by perspiration.
Abnormalities
The skin can seem orange-red or gray-white, and may have greasy or white dry scaling macules, papules of different sizes (ranging from 5 to 20 mm), or patches with well-defined edges. The scalp is mostly characterized by noticeable scaling, commonly referred to as "dandruff". Lesions on the trunk are distributed in a dispersed, separate, and multi-cyclic pattern, and on the face and trunk, lesions are separate and scattered. The lesions in the body folds are widespread, exudative, well-defined, and very red in color, often accompanied by erosions and fissures.

The diagnosis is made based on clinical observations, and the possible conditions to consider include psoriasis vulgaris, impetigo, dermatophytosis, pityriasis versicolor, intertriginous candidiasis, subacute lupus erythematosus, "seborrheic" papules in secondary syphilis, Langerhans cell histiocytosis, acrodermatitis enteropathica, zinc deficiency, pemphigus, and glucagonoma syndrome.

Advise people to utilize shampoos that contain selenium sulfide, zinc pyrithione, and/or tar. Alternatively, recommend prescribing a 2% ketoconazole shampoo. The foam from these shampoos can be applied to the face and chest. In cases of high severity, apply low-potency topical glucocorticoids following shampooing. For newborns, eliminate crusts by applying warm oil compresses, then using 2% ketoconazole shampoo, and either 1–2.5% hydrocortisone cream, 2% ketoconazole cream, or 1% pimecrolimus cream. To address maintenance issues, if shampoo alone proves to be unsuccessful, utilize a solution containing 3% sulfur precipitate and 2% salicylic acid in an oil-in-water base.
Regular application of hydrocortisone cream with a concentration of 1-2.5% is effective, although it is necessary to closely observe for any signs of atrophy.
Pimecrolimus cream with a concentration of 1% and tacrolimus ointment with a concentration of 0.1% are both proven to be safe and efficacious.