-IBIS-1.5.0-
tx
cutaneous system
seborrheic dermatitis
diagnoses

definition and etiology

definition:
an inflammatory, greasy, scaling, disease usually affecting the scalp and face, but also can be seen in other areas rich in sebaceous glands; also known as "dandruff" (in adults) and "cradle cap" (in infants)

etiology:
The name is misleading in that the flow and composition of the sebum is normal. Seborrhea is very common and part of an " acne-seborrheic complex" frequently seen in brunettes with familial history. The eruption is basically oily and may present with superficial red papules, sticky crusts, fissures, and dry or wet yellowish scales. Itching is uncommon, and there is no hair loss over affected areas. It is most often seen in infants, and then in middle-aged and older adults. Rarely, seborrhea may develop into generalized body lesions.

signs and symptoms

signs and symptoms: onset is gradual in adults and evident in infants within the first three months of life
• adult mild case: diffuse dry or greasy scaling on the scalp
• adult severe case: yellow-red scaling papules along the hairline, eyebrows, eyelids, behind ears, external auditory canals, bridge of the nose, nasolabial folds, sternum
• infants: thick, yellow, crusted, symmetric lesions on the scalp, on a salmon-colored erythematous rash; facial involvement with red papules, cracks, and fissures behind their ears; there may or may not be scaling
• older children: can develop thick, hard to pull off, scaly areas that may reach 1-2 cm in diameter
• generally, the lesions are worse in winter and during fatigue and stress

lab findings:
• (+) food allergies/sensitivities

course and prognosis

Conventional treatment mainly consists of antidandruff shampoos containing selenium and, in worse cases, hydrocortisone creams. Generally, the prognosis is better than that of atopic dermatitis, though the disorder exacerbates and remits.

Naturopathic physicians and other practitioners have found that treatment of food sensitivities has a significant effect on ameliorating this condition.

differential diagnosis

scalp lesions:
• psoriasis: well-defined, dry
• lichen simplex chronicus: single patch, much itching, excoriation
• tinea capitis: broken-off hairs, (+) Wood's light (no longer diagnostic), (+) KOH prep
• atopic eczema: dry scales, all over body

face lesions:
• SLE or chronic discoid LE: butterfly eruption on central face, (+) ANA

body lesions:
• tinea corporis, tinea versicolor
• psoriasis
• pityriasis rosea
• candidiasis


footnotes