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Seborrheic dermatitis is a common chronic inflammatory skin condition characterized by poorly defined scaling and erythematous patches. It can be associated with pruritus and mainly affects areas rich in sebum, such as the scalp, face, upper chest and back. Although its pathogenesis is not fully understood, some postulate that the condition is the result of colonization of the skin of affected individuals with species of the genus Malassezia (formerly Pityrosporum). A variety of treatment modalities are available, including eradicating the fungus, reducing or treating the inflammatory process, and decreasing sebum production.
Well, there is definitely an association between seborrheic dermatitis and fungal infections. It turns out that a yeast that grows naturally on the skin (called malassezia) can be problematic in combination with a predisposition to sebum overproduction and inflammatory triggers. Allergy and skin irritation are sometimes implicated as a cause of seborrheic dermatitis. However, the most common cause is a reaction to a form of yeast called Malassezia.
This yeast is a normal inhabitant of the sebaceous glands of our skin. Seborrheic dermatitis is not a case of fungal overgrowth, but it is believed that the interaction of yeast with the body’s immune system is what causes redness, itching and peeling. Sometimes the symptoms of seborrheic dermatitis worsen with stress or the change of season. Symptoms may also increase and decrease over time.
Considered a chronic form of eczema, seborrheic dermatitis appears on the body, where there are many oil-producing glands (sebaceous) such as the upper back, nose and scalp. Dermatologists often begin treating mild cases with a topical antifungal cream or medicated shampoo, such as a prescription antifungal shampoo or an over-the-counter anti-dandruff product. Seborrheic dermatitis is a papulosquamous disorder that occurs in sebum-rich areas of the scalp, face, and trunk (see image below). In addition to sebum, this dermatitis is related to Malassezia, immunological abnormalities and complement activation.
Its severity ranges from mild dandruff to exfoliative erythroderma. Seborrheic dermatitis is a chronic inflammatory disorder that affects areas of the head and trunk where the sebaceous glands are most prominent. Lipophilic yeasts of the genus Malassezia, as well as genetic, environmental and general health factors, contribute to this disorder. Seborrhea of the scalp ranges from mild dandruff to dense, diffuse, sticky scales.
Facial and trunk seborrhea is characterized by powdery or greasy scales in the folds of the skin and along the margins of the hair. Treatment options include application of selenium sulfide, shampoos containing pyrithione zinc or ketoconazole, topical ketoconazole cream or terbinafine solution, topical sodium sulfacetamide, and topical corticosteroids. Because seborrheic dermatitis is a visible condition, patients often feel embarrassed and may see themselves as disfigured. Drug treatment options for seborrheic dermatitis include antifungal preparations (selenium sulfide, pyrithione zinc, azole agents, sulfacetamide sodium and topical terbinafine) that decrease colonization by lipophilic yeasts and anti-inflammatory agents (topical steroids).
It is a good choice for when seborrheic dermatitis appears around the hairline, on the chin, back and chest. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. In cases where seborrheic dermatitis is widespread, the use of oral therapy such as ketoconazole, itraconazole and terbinafine may be preferred. We have previously identified the species of Malassezia that correlates with dandruff and seborrheic dermatitis.
Seborrheic dermatitis secondary to immunosuppression, such as that associated with HIV infection, has not been associated with increased growth or number of Malassezia (Pityrosporum) colonies; therefore, treatment with corticosteroids may be more beneficial in this circumstance. Several antifungal agents are beneficial for patients with seborrheic dermatitis, the main of them – topical selenium, zinc, ketoconazole and ciclopirox for milder symptoms. A multicenter, randomized, randomized, 4-week, parallel group and multicenter pilot study to compare the safety and efficacy of a non-steroidal cream (Promiseb Topical Cream) and a 0.05% desonide cream in twice-daily treatment of mild to moderate seborrheic dermatitis of the face. Treatment with daily doses of isotretinoin as low as 0.1 to 0.3 mg per kg may improve severe seborrhea after four weeks of treatment.
1% pimecrolimus cream is effective in seborrheic dermatitis refractory to treatment with topical corticosteroids. The range of treatments for seborrheic dermatitis can be overwhelming for patients, but a pharmacist can help find the right therapy or advise them when consultation with a dermatologist is warranted. However, in adults, seborrheic dermatitis usually follows a pattern of inflammation and clearance that can last for years. Seborrheic dermatitis can affect people of any age, although it is most common in infants and adults between the ages of 30 and 60.
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