![]() Kembara Xtra - Medicine- Seborrheic Dermatitis Introduction A persistent, superficial, recurrent inflammatory skin condition that mostly affects the scalp, brows, and face and, to a lesser extent, the chest and back, is found in sebum-rich, hairy areas of the body. Prevalence and incidence of disease Predominant ages are childhood, adolescence, and adulthood; males outnumber females in terms of incidence. Prevalence Infantile seborrheic dermatitis: up to 71% in the first 3 months of infancy, all ethnicities, all climates; seborrheic dermatitis: 1-3%; in immunosuppressed people up to 83% Pathophysiology and Etiology Malassezia, a type of skin-surface yeast, may be a contributing cause. Genetic and environmental factors: Stress/illness frequently causes flares. Compares increased sebaceous gland activity during childhood and adolescence or as a result of some medications that cause acne. The fact that immunosuppressed people are more likely to develop seborrheic dermatitis suggests that immunological systems, though the exact mechanisms are not fully understood, are involved in the pathogenesis of the illness. Genetics Family history is good; no genetic indicators have been found so far. Risk factors include: emotional stress; obesity; oily skin; acne; immunosuppressed conditions like AIDS, lymphoma, and organ transplantation; Parkinson's disease; epilepsy; traumatic brain injury; and spinal cord injury. Additionally, certain medications, such as buspirone, chlorpromazine, cimetidine, ethionamide, griseofulvin, haloperidol, interferon, methyldopa, psoralen, and IL GENERAL PREVENTION To soften the affected regions of seborrheic skin, wash it more frequently than usual. Associated Conditions AIDS and Parkinson's disease Seborrheic dermatitis is often diagnosed based on a history and physical examination. If the diagnosis is still not apparent, a punch biopsy of the skin will provide it. Presenting History Activity is heightened in winter and early spring, with remissions typically occurring in summer. Intermittent active phases with burning, scaling, and itching alternate with inactive ones. Infants may get cradle cap, which causes greasy scaling of the scalp with occasional erythema, diaper rash, and/or axillary dermatitis. Cradle cap often goes away on its own by 8 to 12 months. Adults: A red, oily rash with indistinct edges made up of macules and plaques. - A glazed, reddish appearance in the skin folds. Low levels of pruritus, hypopigmented, scaling macules on skin of color, and a chronic waxing and waning course Bilateral and symmetrical - Predominantly seen in areas of hairy skin, including the scalp, eyebrows, eyelid margins, nasolabial folds, ears, retroauricular folds, buttock crease, inguinal area, genitals, and armpits. clinical assessment The appearance of the scalp can range from light, patchy scaling to extensive, thick, adhering crusts. Plaques are uncommon. Similar to psoriasis, seborrheic dermatitis can extend to the postauricular skin, the back of the neck, and the forehead. Skin lesions appear as thick, yellowish, greasy scaling over red, swollen skin, and hypopigmentation can be visible in darker skin tones. Oozing and crusting from infectious eczematoid dermatitis indicate a subsequent infection. Seborrheic blepharitis can develop on its own. Multiple Diagnoses Infants with atopic dermatitis may have difficulty being distinguished. Psoriasis: Usually affects the nail beds and extensor surfaces of the knees, elbows, and hands. - Rather than modest scaling and erythema, scalp psoriasis will be more clearly distinguished from seborrheic dermatitis by crusted, infiltrating plaques. The Candida Tinea cruris/capitis: These should be suspected when standard treatments don't work or hair loss develops. Otitis externa with auricular eczema Rosacea : In cases of discoid lupus erythematosus, skin biopsy is recommended. Histiocytosis X: a seborrheic-like eruption may be present. Non-inflammatory scalp-only dandruff Drug eruption Laboratory Results Other/Diagnostic Procedures If: - Conventional therapy are ineffective, think about having a biopsy. There are noteworthy Petechiae. Histiocytosis X is thought to exist. If the following conditions exist: - The condition is resistant to therapy - Pustules and baldness are visible. Interpretation of Tests broad modifications Characteristic features include hyperkeratosis, acanthosis, exaggerated rete ridges, localized spongiosis, and parakeratosis. Hair follicles are surrounded with parakeratotic scale, and there is a light superficial inflammatory lymphocytic infiltration. Management Increase the frequency of shampooing; modest amounts of sunlight may be beneficial. Infants with cradle cap may benefit from more frequent shampooing with a gentle, non-medicated shampoo, as mentioned above. – Apply heated mineral oil to remove thick scale, and then wash it off an hour later with mild soap, a soft-bristled toothbrush, or a terrycloth washcloth. Adults -- Use antiseborrheic shampoos to clean all impacted areas. Start with over-the-counter remedies (such as selenium sulfide), letting shampoo or lotion sit on the skin for a few minutes before rinsing it off. If no improvement is seen, move on to stronger remedies (such as those containing coal tar, sulfur, or salicylic acid). - 10% liquid carbonic detergents in Nivea oil may be used at bedtime for dense scalp scaling, with the head covered by a shower cap. For one to three weeks, this should be done every night. MEDICATION Initial Line If the non-prescription shampoo is ineffective, try a shampoo with coal tar or ketoconazole. After massaging it in, leave it on for a while before removing. Topical antifungal medications for adults For clearance, use 2% ketoconazole or miconazole shampoo twice weekly (let it sit on the scalp for a few minutes before rinsing off), and then once a week or every other week for maintenance (2),(3). Scales in other locations can be removed using 2% ketoconazole or 2% sertaconazole lotion (2). Ketoconazole 2% shampoo can also be used to treat facial hair (2), as can ciclopirox 1% shampoo used twice weekly (3). - Corticosteroid creams Start with 1% hydrocortisone and work your way up to stronger (fluorinated) steroid formulations every day for two to four weeks. To limit the danger of skin atrophy, hypopigmentation, and/or systemic absorption (particularly in newborns, children, and the elderly), avoid prolonged use of powerful steroids. Safety measures: If applied to the face or to skin folds, fluorinated corticosteroids and greater quantities of hydrocortisone (e.g., 2.5%) may result in atrophy or striae. Additional topical agents Coal tar 1% shampoo twice a week, selenium sulfide 2.5% shampoo, zinc pyrithione 1% shampoo twice a week, and lithium gluconate/succinate 8% ointment/gel twice a week. Once the condition is under control, washing with zinc soaps or selenium lotion along with sporadic steroid cream application may help to maintain remission. Next Line Calcineurin inhibitors (Not associated with hypopigmentation and skin shrinkage. Just as efficient as topical steroids; additional side effects may occur) 1% cream pimecrolimus BID (6) - Tacrolimus ointment, 0.1% For severe or resistant seborrheic dermatitis, systemic antifungal therapy is recommended (3),(4). Itraconazole: efficacious and has an excellent safety profile at 200 mg daily (3),(4) 200 mg/day of ketoconazole is linked to greater relapses (4). Terbinafine: 250 mg per day for 4 to 6 weeks, or 250 mg per day for pulse treatment for 12 days per month for 3 months. Daily regimen for one to two months, then twice-weekly dose for long-term maintenance therapy Observe any possible hepatotoxic effects. Hyaluronic acid sodium salt gel, 0.2% BID, a low-molecular-weight hyaluronic acid Problems to Refer Adults with resistant SD should be tested for HIV if there has been no improvement after receiving first-line medication and there are concerns about systemic infection (like HIV). Various Therapies Honey's antifungal, antioxidant, and antibacterial properties make it beneficial in treating and preventing SD flare-ups. Aloe vera's anti-inflammatory and antifungal properties reduce SD-related itching and scaling. Gamma-lineolic acid (GLA), an essential amino acid found in borage oil, may be useful in treating infantile SD. Tea-tree essential oil is beneficial in mild to moderate instances and has antifungal, anti-inflammatory, and antioxidant properties. Quassia Amara extract outperformed topical anti-inflammatory and antifungal medications, particularly against Malassezia yeast. 1% ciclopiroxolamine and 2% ketoconazole Constant Care In comparison to people with straighter hair, who might favor drying agents, people with coiled hair or hair that has been heat- or chemically-treated will need less drying agents to avoid hair breaking. The risk of hair damage can be reduced by applying shampoos and other topical therapies directly to the scalp rather than the hair shaft. Patient Follow-Up Monitoring Depending on the severity of the disease and the patient's reaction to treatment, every 2 to 12 weeks Seborrheic dermatitis often goes away in infants between the ages of 6 and 8 months. Seborrheic dermatitis in adults is typically chronic and recurrent, with flare-ups and remissions. Shampoos and topical steroid medications are typically used to treat disease. Hypopigmentation or erythema often goes away with treatment. Complications Fluorinated corticosteroids may cause skin atrophy or striae, especially if they are applied to the face. Fluorinated steroids can cause cataracts and/or glaucoma when used near the eyes. Herpes keratitis is a rare complication of herpes simplex: advise the patient to quit eyelid steroids if herpes simplex develops. Tar-containing medications can occasionally induce photosensitivity.
0 Comments
Leave a Reply. |
Kembara XtraFacts about medicine and its subtopic such as anatomy, physiology, biochemistry, pharmacology, medicine, pediatrics, psychiatry, obstetrics and gynecology and surgery. Categories
All
|