Seborrheic dermatitis( seborrhea) - Causes, symptoms and treatment. MF.
Causes of seborrheic dermatitis
Seborrheic dermatitis is an inflammation of the skin as a result of increased release of qualitatively alter fat and active action of microbial agents - Pitirosporum orbiculare and Pityrosporum ovale - opportunistic fungi from the genus Malassezia. Such a lesion is affected by the skin densely populated by the sebaceous glands, namely, the face( forehead, chin, nose, and bowel-shaped folds), scalp skin, chest( middle line region), back( interblade area), ear shell area.
It is noted that the activity of these opportunistic fungi increases under adverse conditions, such as immune and endocrine disorders, stresses and various lesions of the nervous system. It is known that opportunistic fungi from the genus Malassezia concentrate around the mouth of the sebaceous glands in order to extract fatty acids that saturate the sebaceous secret excessively. Thus seborrhea - a change in the quality and quantity of sebum contributes to the hyperactivation of fungal microflora: Pityrosporum ovale, parasitic mainly on the scalp and Pityrosporum orbiculare, tropic to the sebaceous glands of the chest and back. Adverse effects of alkaline detergents, excessive sweating and the winter season are considered unfavorable factors for strengthening the pathological process.
Symptoms of seborrheic dermatitis
In seborrheic dermatitis, skin lesions are gradual, slowly progressive, accompanied by itching, often intense. On seborrheic sites against a backdrop of red spots appear plaques with fairly distinct boundaries, formed as a result of the fusion of small nodules of a yellowish-pink color, covered with fatty scales. The process of skin lesion is often symmetrical and due to peripheral growth and resolution in the center of the plaque can acquire garlandlike and annular forms.
On the photo the symptoms of seborrheic dermatitis of the face
The pathological process located in the folds( behind the bones, under the mammary glands, in the groin) is often accompanied by wetting, the appearance of sticky crusts and cracks.
In the photo, the symptoms of seborrheic dermatitis( nocturnal folds)
When the skin of the scalp is damaged, uneven peeling or the formation of dense crusts. Often, on examination, you can see yellow or white scales, attached to the hair shaft, as well as dandruff. The hair is usually thinner and thinning, which eventually leads to diffuse alopecia( baldness).
In the photo, the symptoms of seborrheic dermatitis of the scalp
With prolonged course of the process, in severe cases, seborrheic dermatitis can progress. Peeling in this case becomes significant, the scales thicken. Often, a secondary infection is added in the form of honey-yellow crusts. Redness of the skin and peeling may increase in size, up to erythroderma - redness of significant skin areas. A similar condition requires mandatory medical supervision and additional examination.
In the photo, the symptoms of seborrheic dermatitis of the body: erythrodermia
In newborns with a combination of seborrhoeic erythroderma with diarrhea and a delay in the addition of body weight, a serious skin lesion is diagnosed - desquamative erythroderma of Leiner. This condition is classified as severe and requires urgent medical intervention.
In the photo, symptoms of seborrheic dermatitis in a child: dairy scab
Survey in seborrheic dermatitis
When diagnosing seborrheic dermatitis, it is necessary to exclude skin diseases such as atopic dermatitis, eczematid, psoriasis, fungal diseases( ringworm) and microbial skin lesions. To do this, it is necessary to conduct microscopic and mycological examination of skin scales for pathogenic fungi. Sometimes resort to a diagnostic biopsy, in which, together with numerous signs, neutrophil cells in crusts and scales, as well as in the mouths of hair follicles, will be fixed. With seborrheic dermatitis, which proceeds torpidly, additional study of the patient's hormonal status is necessary.
Treatment of seborrheic dermatitis
It is known that to date there are no drugs that normalize the work of the sebaceous glands, so the problem of treating seborrheic dermatitis should be aimed at correcting the manifestations of individual symptoms. So, for example, when the process is localized on the scalp, first of all, a specific antifungal treatment is preferred. In this case, shampoos containing such antifungal components as ketoconazole or cyclopyrox, as well as zinc pyrithione and tar are used.
In the treatment of seborrheic dermatitis, other shampoos with zinc pyrithione are also used.
Shampoo, containing both ketoconazole and zinc pyrithione, often helps to quickly solve the problem of seborrheic dermatitis of the scalp and cause a longer remission.
In the acute period, it is possible to use these shampoos daily until the symptoms decrease. With a decrease in the effectiveness of one of the shampoos, it may be alternated with another. In the absence of complete stabilization of the process, the dermatologist additionally prescribes means containing selenium sulphide, tar and salicylic acid. A combination of antifungal shampoos and components that have a drying effect reduce infiltration, swelling, redness and help to achieve a faster recovery of the scalp skin. Well-proven 1-2% paste "Sulsen", as a therapeutic and prophylactic for seborrheic dermatitis of the scalp. After applying the therapeutic shampoo, a small amount of 2% of the paste( about 5 ml) is rubbed in circular motions into the hair roots, and the emulsion formed is aged on the scalp for 30 minutes and then washed off with warm water.
This treatment is usually carried out once a week for 3 months. Supportive therapy in a similar mode is carried out by 1% paste. A good effect in the treatment of seborrheic dermatitis of the scalp is provided by "Head and shoulders", "Friederm-zinc" and "Friederm-tar" shampoos.
In cases that are resistant to the treatment described above, a combination of antifungal and hormonal components may be prescribed by a dermatologist. Self-use such tools are not allowed, because they have numerous contraindications and side effects.
When the skin of the face is affected by the inflammatory seborrheic process, appropriate facial skin care is prescribed. It is necessary to use means that do not cause irritating effect in relation to the skin. In this area, the cosmetics of the firm "Bioderma", the line "Senzibo", have proved to be very good. It is most preferable to care for the skin without contact with water - cleansing lotions.
Treatment of affected skin in the first place should be aimed at reducing inflammation. To this end, various bolts containing zinc are used. The use of the Zindol bolt 2 times a day stabilizes the inflammation of the skin in a short time. The use of the antifungal cream "Lamisil" 2 times a day on the affected skin reduces the aggression of opportunistic fungi from the genus Malassezia at the mouth of the hair follicles and thereby causes an exfoliating and anti-inflammatory effect. Creams containing zinc pyrithione are well proven in the treatment of seborrheic dermatitis of the face.
Recently, more and more active in dermatology, external immunomodulators are used, which also have anti-inflammatory and antifungal activity. This cream "Elidel" and "Protopik", which can be used at a certain stage of treating seborrheic dermatitis, under the supervision of a doctor.
In case of defeat of seborrheic dermatitis of the skin of the chest and back, all the above mentioned means are used. These are shampoos, the foam of which, when washed, is applied to the torso, and antifungal creams, and chatterboxes and immunomodulators for external use.
When seborrheic wrinkling process is damaged, use of Castellani liquid is considered to be an effective tool.
Folk remedies for treating seborrheic dermatitis
Of the many folk remedies in the treatment of seborrheic dermatitis, more and more recently one has to hear about the use of tea tree oil. This authority of tea tree oil has gained thanks to its antifungal effect. Unfortunately, the anti-inflammatory properties of this remedy are not numerous, therefore tea tree oil can not be a drug of choice in the treatment of seborrheic dermatitis. A good drying effect is caused by decoctions of herbs used in the form of lotions and moist-drying dressings with an active inflammatory process. To prevent injury to the skin with itching, it is possible to use diluted lemon juice in the form of rubbing itchy skin areas.
To achieve a longer period of remission, daily hygienic skin care is required, while avoiding the use of soap and cleansers that irritate the skin. As the exacerbation of the process is caused by the occasional hygienic care of the face, the growing of the beard and mustache is an aggravating factor in the development of the pathological process. When choosing underwear, it must be taken into account that cotton soft clothing significantly reduces skin irritation. Ultraviolet irradiation in suberythmic doses in the treatment of seborrheic dermatitis helps to achieve a longer remission effect.
When making recommendations for a diet for patients with seborrheic dermatitis, it is necessary to give preference to low-calorie foods, as well as to exclude drinks that enhance the secretion of sebum.
Doctor's consultation on the topic of "seborrheic dermatitis":
1. Why does my husband's seborrheic dermatitis constantly worsen under stress?
It is known that in functional and organic disorders of the nervous system the body is not able to retain opportunistic fungi from the genus Malassezia in the saprophytic state. The active form of these fungi significantly increases and they begin to show their pathogenic qualities. This is due to the effect of free fatty acids, which actively increase when fungal lipolytic enzymes act on sebum, which provokes skin inflammation.
2. Is it true that seborrheic dermatitis is more common in men than in women ?
Indeed, this explains the phenomenon of the effect of androgens on the activity of the sebaceous glands. Most likely this is due to the presence of special receptors on the surface of cells of sebaceous glandses to sex hormones, which causes changes in sebum secretion and disruption of skin barrier properties.
3. Do seborrheic dermatitis occur in children?
In children, seborrheic dermatitis is manifested in the form of thick plaques of yellow color, often fatty and scaly. This is the so-called milk scab. Usually they appear at the age of 3 months. Such rashes do not itch and do not cause trouble to babies and are removed painlessly with the help of vegetable oils.
4. Dandruff and seborrheic dermatitis are the same thing?
No. Seborrheic dermatitis, unlike dandruff, is characterized by an inflammatory reaction of the skin and the presence of lesions.
5. A year ago I had an eczema of brushes. Recently, a plaque appeared on his chest. The dermatologist diagnosed seborrheic dermatitis. I asked him if it could be eczema again. He replied that he did not. How can this be confirmed?
Dermatologists have their own diagnostic techniques. For example, when scraping a plaque caused by an eczematous process, spot erosion will be determined.
6. Can one person have seborrheic dermatitis and psoriasis at the same time? And how to distinguish them from each other?
Yes, this combination is often found. The difference of plaques in these skin pathologies is revealed by the diagnostic scaling of scales with a scalpel. In psoriasis, the symptoms of the psoriatic triad are clearly discernible: the enhancement of silvery scaling( a symptom of the "stearin stain"), a shiny surface( symptom of the "terminal film") is exposed under the scales, blood droplets appearing at the end of plaque scraping( a symptom of "bloody dew").
Doctor-dermatovenereologist, Kuklin TP