Seborrheic dermatitis

1. Seborrheic dermatitis

2. Seborrheic dermatitis Chronic papulosquamous condition Occur on sebum-rich area of scalp, face and trunk Occur as an isolated condition or in conjunction with other disorder such as blepharitis, acne vulgaris, ocular rosacea Varies from mild dandruff to exfoliative erythroderma

3. Seborrheic dermatitis (cont.) Aggravated by change in humidity, change in season, trauma (e.g. scratching) or emotional stress Associated with several systemic disease include AIDS, zinc deficiency, Parkinson disease Frequently seen in patient who received psoralen with UVA therapy

4. Causative factor Malassezia globosa Sebum production Genetic susceptibility for inflammatory response

5. Malassezia and seborrheic dermatitis Lipophilic yeast Found in normal skin Research document supported relation between Malassezia and seborrheic dermatitis :clinical response to antifungal drug :increase in number of Malassezia in recurrence disease

6. Causes Malassezia are not the cause but are a cofactor link to T-cell depression, increase sebum level and activation of the alternative complement pathway Skin barrier dysfunction prone to disease Medication that induced flare up : auranofin, aurothioglucose, buspirone, chlorpromazine, cimetidine, ethionamide, gold, griseofulvin, haloperidol, interferon Alfa, lithium, methoxsalen, methyldopa, phenothiazines, psoralens, stanozolol, thiothixene and trioxsalen

7. Epidemiology Occurrence 1-3% Variable age range include infant through adult Increase rate of occurrence in infant and 4-5th decade of life Male > female African-American > Caucasian

8. Epidemiology (cont.) 34-83% found in AIDS Higher rate of occurrence in DM, obesity, malabsorption, Parkinson disease, epilepsy

9. Etiology Unclear Sebum and lipid level :increase sebum and lipid level in Parkinson disease, African-American > Caucasian :large and active sebaceous gland in newborn infant

10. Etiology (cont.) Immunologic response :depress T-cell function lead to increase Malassezia growth :increase natural killer cell activation :increase inflammatory interleukin Medication induced :found in Parkinson treated with specific neuroepileptic drug

11. Clinical Depend on age, skin type, presence or absence of concurrent systemic illness Dry and flaky with white scale or greasy with crusting Skin type 4-6 :reduce visible erythema :hypo or hyperpigmented

12. Clinical (cont.) Increase in winter and early spring Remission commonly in summer

13. Clinical finding in newborn infant Scale located throughout the scalp but also on face, chest, groin, neck, ears and eyelid Cradle cap and napkin dermatitis appearance Related to sebum overproduction

14. Clinical finding in newborn infant (cont.) Severe generalized seborrheic dermatitis may represent Leiner disease (exfoliative disorder with anemia, diarrhea, immunodeficiency, concomitants bacterial and candidial infection

16. Clinical finding in adult Involved scalp, face, chest, axillae, submammary area, groin, gluteal region Scalp and face involvement :most prominent around eyebrows, perinasal skin, postauricular area, ears, eyelids

17. Clinical finding in adult (cont.) :may extend from frontal scalp onto upper forehead Perinasal and post auricular skin can appear either hypopigmented, hyperpigmented, erythematous Crusting may be seen in inner ear and ear canal

18. Clinical finding in adult (cont.) Chest, axillae, groin, gluteal involvement is usually scaly with hypopigmentation or erythema beneath the scale Occasionally bacterial superinfection

23. Clinical finding in immunocompromise Similar to normal adult but more extensive More visible inflamed skin Involvement include blepharitis, Meibomian gland occlusion result in scaling and burning of eyelids Diffuse lesion at axillae, extremities and groin

24. Clinical finding in immunocompromise (cont.) Generalized seborrheic erythroderma is rare but more often May presented bacterial, candidial, dermatophyte superinfection Moist and extreme erythema plaques at torso and extremities