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Seborrhoeic dermatitis, sometimes inaccurately referred to as seborrhoea, is a long-term skin disorder. Symptoms include red, scaly, greasy, itchy, and inflamed skin. Areas of the skin rich in sebum, oil-producing glands are often affected including the scalp, face, and chest. It can result in social or self-esteem problems. In babies, when the scalp is primarily involved, it is called cradle cap. Dandruff is a milder form of the condition without inflammation. The cause is unclear but believed to involve a number of genetic and environmental factors. Risk factors include immunocompromised, poor immune function, Parkinson's disease, and alcoholic pancreatitis. The condition may worsen with psychological stress, stress or during the winter. The ''Malassezia'' yeast is believed to play a role. It is not a result of poor hygiene. Diagnosis is typically based on the symptoms. The condition is not contagious. The typical treatment is antifungal medications, antifungal cream and anti-inflammatory agents. Specifically, ketoconazole or ciclopirox are effective. It is unclear if other antifungals, such as miconazole, are equally effective as they have been poorly studied. Other options may include salicylic acid, coal tar, benzoyl peroxide, and phototherapy. The condition is most common in infants within the 3 first months or in adults aged 30 to 70 years. In adults between 1% and 10% of people are affected. Males are more often affected than females. Up to 70% of babies may be affected at some point in time.


Signs and symptoms

Seborrhoeic dermatitis' symptoms appear gradually, and usually the first signs are flaky skin and scalp. Symptoms occur most commonly anywhere on the skin of the scalp, behind the ears, on the face, and in areas where the skin folds. Flakes may be yellow, white or grayish. Redness and flaking may also occur on the skin near the eyelashes, on the forehead, around the sides of the human nose, nose, on the chest, and on the upper back. In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back. Commonly, patients experience mild redness, scaly skin lesions and in some cases hair loss. Other symptoms include patchy scaling or thick crusts on the scalp, red, greasy skin covered with flaky white or yellow scales, itching, soreness and yellow or white scales that may attach to the hair shaft. Seborrhoeic dermatitis can occur in infants younger than three months and it causes a thick, oily, yellowish crust around the hairline and on the scalp. Itching is not common among infants. Frequently, a stubborn diaper rash accompanies the scalp rash.


Causes

The cause of seborrhoeic dermatitis has not been fully clarified. In addition to the presence of ''Malassezia'', genetic, environmental, hormonal, and immune-system factors are necessary for and/or modulate the expression of seborrhoeic dermatitis. The condition may be aggravated by illness, psychological stress, fatigue, sleep deprivation, change of season, and reduced general health. In children and babies, excessive vitamin A intake or issues with delta-6 desaturase, Δ6-desaturase enzymes have been correlated with increased risk. Seborrhoeic dermatitis-like eruptions are also associated with Vitamin B6 deficiency, vitamin B6 deficiency. Those with immunodeficiency (especially infection with HIV) and with neurological disorders such as Parkinson's disease (for which the condition is an Signs and symptoms of Parkinson's disease#Autonomic, autonomic sign) and stroke are particularly prone to it.


Climate

Low humidity, and low temperature, is responsible for high frequency of seborrheic dermatitis.


Fungi

The condition is thought to be due to a local inflammatory response to over-Infection#Colonization, colonization by ''Malassezia'' fungi species in sebum-producing skin areas including the scalp, face, chest, back, underarms, and groin. This is based on observations of high counts of ''Malassezia'' species in skin affected by seborrhoeic dermatitis and on the effectiveness of antifungals in treating the condition. Such species of ''Malassezia'' include ''M. furfur'' (formerly ''Pityrosporum ovale, P. ovale''), ''M. globosa'', ''M. restricta'', ''M. sympodialis'', and ''M. slooffiae''. Although ''Malassezia'' appears to be the central predisposing factor in seborrhoeic dermatitis, it is thought that other factors are necessary for the presence of ''Malassezia'' to result in the pathology characteristic of the condition. This is based on the fact that summer growth of ''Malassezia'' in the skin alone do not result in seborrhoeic dermatitis. Besides antifungals, the effectiveness of anti-inflammatory drugs, which reduce inflammation, and antiandrogens, which reduce sebum production, provide further insights into the pathophysiology of seborrhoeic dermatitis. Eunuchs, owing to their low androgen levels and small sebaceous glands, do not develop seborrheic dermatitis.


Management


Humidity

A humidifier can be used to prevent low indoor humidity during winter (especially with indoor heating), and dry season. And a dehumidifier can be used during seasons with excessive humidity.


Medications

A variety of different types of medications are able to reduce symptoms of seborrhoeic dermatitis. These include certain antifungal medication, antifungals, anti-inflammatory agents like corticosteroids and nonsteroidal anti-inflammatory drugs, antiandrogens, and antihistamines, among others.


Antifungals

Regular use of an over-the-counter or prescription antifungal shampoo or cream may help those with recurrent episodes. The topical antifungal medications ketoconazole and ciclopirox have the best evidence. It is unclear if other antifungals are equally effective as this has not been sufficiently studied. Antifungals that have been studied and found to be effective in the treatment of seborrhoeic dermatitis include ketoconazole, fluconazole, miconazole, bifonazole, sertaconazole, clotrimazole, flutrimazole, ciclopirox, terbinafine, butenafine, selenium sulfide, and lithium (medication), lithium salts such as lithium gluconate and lithium succinate. Topical climbazole appears to have little effectiveness in the treatment of seborrhoeic dermatitis. Systemic therapy with oral antifungals including itraconazole, fluconazole, ketoconazole, and terbinafine is effective.


Anti-inflammatory treatments

Topical corticosteroids have been shown to be effective in short-term treatment of seborrhoeic dermatitis, and are as effective or more effective than antifungal treatment with azoles. There is also evidence for the effectiveness of calcineurin inhibitors like tacrolimus and pimecrolimus as well as lithium (medication), lithium salt therapy. Oral immunosuppressive treatment, such as with prednisone, has been used in short courses as a last resort in seborrhoeic dermatitis due to its potential side effects.


Antiandrogens

Seborrhoea, which is sometimes associated with seborrhoeic dermatitis, is recognized as an androgen-sensitive condition – that is, it is caused or aggravated by androgen sex hormones such as testosterone and dihydrotestosterone – and is a common symptom of hyperandrogenism (e.g., that seen in polycystic ovary syndrome). In addition, seborrhoea, as well as acne, are commonly associated with puberty due to the steep increase of androgen levels at that time. In accordance with the involvement of androgens in seborrhoea, antiandrogens, such as cyproterone acetate, spironolactone, flutamide, and nilutamide, are highly effective in alleviating the condition. As such, they are used in the treatment of seborrhoea, particularly severe cases. While beneficial in seborrhoea, effectiveness may vary with different antiandrogens; for instance, spironolactone (which is regarded as a relatively weak antiandrogen) has been found to produce a 50% improvement after three months of treatment, whereas flutamide has been found to result in an 80% improvement within three months. Cyproterone acetate is similarly more potent and effective than spironolactone, and results in considerable improvement or disappearance of acne and seborrhoea in 90% of patients within three months. Systemic antiandrogen therapy are generally used to treat seborrhoea only in women, and not in men, as these medications can result in feminization (biology), feminization (e.g., gynecomastia), sexual dysfunction, and infertility in males. In addition, antiandrogens theoretically have the potential to feminize male fetuses in pregnant women, and for this reason, are usually combined with effective birth control in sexually active women who can or may become pregnant.


Antihistamines

Antihistamines are used primarily to reduce itching, if present. However, research studies suggest that some antihistamines have anti-inflammatory properties.


Other treatments

* Coal tar can be effective. Although no significant increased risk of cancer in human treatment with coal tar shampoos has been found, caution is advised since coal tar is carcinogenic in animals, and heavy human occupational exposures do increase cancer risks. * Isotretinoin, a sebosuppressive agent, may be used to reduce sebaceous gland activity as a last resort in flareup, refractory disease. However, isotretinoin has potentially serious side effects and few patients with seborrhoeic dermatitis are appropriate candidates for therapy. * Keratolytics like topical urea * Metronidazole * Topical 4% nicotinamide


Phototherapy

Another potential option is natural and artificial ultraviolet radiation, UV radiation since it can curb the growth of ''Malassezia'' yeast Some recommend photodynamic therapy using UV-A#Explanation, UV-A and UV-B#Explanation, UV-B laser or red and blue LED light to inhibit the growth of ''Malassezia'' fungus and reduce seborrhoeic inflammation.


Epidemiology

Seborrhoeic dermatitis affects 1 to 5% of the general population. It is slightly more common in men, but affected women tend to have more severe symptoms. The condition usually recurs throughout a person's lifetime. Seborrhoeic dermatitis can occur in any age group but usually starts at puberty and peaks in incidence at around 40 years of age. It can reportedly affect as many as 31% of older people. Severity is worse in dry climates.


See also

* Seborrheic keratosis *Eczema herpeticum, condition that primarily manifests in childhood


References


External links


American Academy of Dermatology: Seborrheic dermatitis
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