Seborrheic dermatitis

Seborrheic dermatitis (or seborrheic eczema) is a chronic skin condition characterized by inflammation and flaking of the skin, usually in oily areas such as the face (especially the T-zone, including the forehead, nose, and chin), scalp, ears, chest, back, and skin folds. The condition can appear as red patches, yellow scales, dryness, itching, and sometimes inflamed blisters.

Seborrheic dermatitis is often associated with overactive sebaceous glands, which leads to a buildup of sebum (the skin's natural oil) and inflammation. However, the exact causes of the condition are not fully understood and may include genetic, immune, and environmental factors.

Seborrheic dermatitis may recur and be aggravated by stress, weather conditions, and other factors. Treatment usually involves topical treatments such as creams and shampoos that help reduce inflammation and dryness of the skin, as well as control symptoms of itching and flaking. In some cases, medications containing antimicrobial or anti-inflammatory ingredients may be required. If you suspect you have seborrheic dermatitis, it is recommended that you consult a dermatologist for an accurate diagnosis and appropriate treatment.

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Epidemiology

Seborrheic dermatitis is a fairly common skin condition. Its epidemiology may vary depending on age, gender, geographic location, and other factors. Here are some key aspects of seborrheic dermatitis epidemiology:

1. Age: Seborrheic dermatitis can occur at any age, but it is most common in infants under 3 months of age and in adults between the ages of 30 and 60.
2. Gender: The disease occurs in both men and women. In men, it may manifest itself more severely and more frequently.
3. Geographical distribution: Seborrheic dermatitis occurs everywhere and does not depend on geographical location.
4. Genetic predisposition: People with a family history of seborrheic dermatitis or related conditions such as psoriasis and eczema may have a higher risk of developing the condition.
5. Association with other conditions: Seborrheic dermatitis may be accompanied by other skin conditions such as rosacea or acne.
6. Risk factors: Risk factors for seborrheic dermatitis may include stress, lack of sleep, changes in hormonal balance and weather conditions.

The epidemiology of seborrheic dermatitis may vary between studies and regions, but the condition remains quite common and can impact the quality of life of those who suffer from it.

Causes seborrheic dermatitis

The causes of seborrheic dermatitis are not fully understood, but it is believed to be caused by a combination of factors, including:

1. Overactive seborrheic glands: This type of dermatitis is caused by excess production of sebum (oily fluid) by the sebaceous glands of the skin. This may be due to hormonal changes, such as testosterone levels, which may be elevated in men.
2. Fungal infection: Fungi such as Malassezia can be considered as one of the causes of seborrheic dermatitis. These fungi are normally present on human skin, but under certain conditions such as oily skin and immune system disorders, they can cause inflammation.
3. Hormonal changes: Hormonal fluctuations, such as changes in sex hormone levels (estrogen and testosterone), can affect the skin and contribute to the development of seborrheic dermatitis. This explains why dermatitis is more common in adolescents during puberty and in adults.
4. Genetic predisposition: Some people have a family history of seborrheic dermatitis, which may indicate a genetic predisposition to the condition.
5. Stress and psycho-emotional factors: Stress and emotional tension can worsen the symptoms of seborrheic dermatitis or become one of the reasons for its exacerbation.
6. Weather conditions: Cold and dry climates can worsen seborrheic dermatitis symptoms.
7. Poor skin hygiene: Not washing your face enough, using harsh detergents, or not caring for your face and hair properly can also contribute to the development of seborrheic dermatitis.

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Risk factors

Seborrheic dermatitis can develop in people of all ages and genders, but there are a number of risk factors that can increase the likelihood of its occurrence. Here are some of them:

1. Hormonal changes: Changes in sex hormone levels, such as estrogen and testosterone, can affect the skin and contribute to the development of seborrheic dermatitis. This explains why dermatitis is more common in adolescents during puberty and in adults.
2. Genetic predisposition: Some people may have a family history of seborrheic dermatitis, which may indicate a genetic predisposition to the condition. If someone in your family has had seborrheic dermatitis, you may also be at increased risk.
3. Stress and psycho-emotional factors: Stress and emotional tension can worsen the symptoms of seborrheic dermatitis or become one of the reasons for its exacerbation.
4. Weather conditions: Cold and dry climates can worsen symptoms of seborrheic dermatitis. Winds and low humidity can cause skin irritation.
5. Poor skin hygiene: Not washing your face enough, using harsh detergents, or not caring for your face and hair properly can also contribute to the development of seborrheic dermatitis.
6. Fungal infection: Fungi such as Malassezia can be considered as one of the causes of seborrheic dermatitis. These fungi are normally present on human skin, but under certain conditions such as oily skin and immune system disorders, they can cause inflammation.
7. Using the wrong cosmetics: Certain cosmetic products, especially those containing harsh chemicals, can cause irritation and worsen seborrheic dermatitis symptoms.
8. Systemic diseases: In some people, seborrheic dermatitis may be associated with systemic diseases, such as certain types of neurological and immune disorders.

It is important to remember that the presence of risk factors does not guarantee the development of seborrheic dermatitis, and vice versa, the absence of risk factors does not exclude its possibility.

Pathogenesis

The pathogenesis of seborrheic dermatitis (SD) is not fully understood, but it is believed that the development of this disease is associated with several factors:

1. Genetics: Genetic predisposition plays an important role. If someone in your immediate family has had diabetes, you may have a higher risk of developing it.
2. Hormonal changes: Hormones such as testosterone and dihydrotestosterone can increase the activity of the seborrheic glands in the skin, leading to increased sebum (an oily secretion). This promotes the growth of Malassezia fungus on the skin, which in turn can cause inflammation.
3. Malassezia Fungus: Malassezia fungus is commonly found on human skin. In people with diabetes, this fungus can grow in excess and cause irritation and inflammation.
4. Immune system: Controlling the growth of Malassezia and preventing skin inflammation depends on a healthy immune system. In some people with diabetes, the immune system is unable to effectively fight the fungus.
5. Sebum secretion: Excess secretion of sebum, an oily substance, can make the skin more suitable for the growth of Malassezia fungus.
6. Psycho-emotional stress: Stress can worsen the symptoms of diabetes. It is believed that stress affects the normal functioning of the immune system and can increase the activity of the seborrheic glands.
7. Cosmetics and detergents: Using low-quality or aggressive cosmetics and detergents can irritate the skin and contribute to the development of diabetes.
8. Climate conditions: SD is more common in cold and dry climates.

The pathogenesis of diabetes is complex and multifaceted, and it is important to remember that not all factors leading to the development of this disease are fully understood.

Histopathology

Focal parakeratosis, moderate acanthosis, spongiosis (intercellular edema), non-specific inflammation of the dermis are observed. Neutrophils are characteristically present in the enlarged openings of hair follicles, as part of crusts and scales.

Symptoms seborrheic dermatitis

Symptoms of seborrheic dermatitis can vary depending on its type and severity. The main signs of seborrheic dermatitis include:

1. Oily and flaky skin: One of the main symptoms is oily skin, especially around the forehead, nose and chin (the so-called "T-zone"). The skin may be oily, shiny and covered with greasy yellow or white scales.
2. Redness: Skin affected by seborrheic dermatitis may appear red and inflamed. Red spots are often visible on the skin.
3. Burning and itching: Seborrheic dermatitis can cause severe itching and a burning sensation, especially in the affected area of skin.
4. Dryness: In some cases, the skin may also become dry and irritated, especially around the eyebrows and behind the ears.
5. Yellow, greasy crusts: Yellow, greasy crusts known as "seborrheic scales" may form on the scalp, eyebrows, eyelashes and other hairy areas.
6. Hair breakage and loss: Seborrheic dermatitis can cause hair breakage and even hair loss in some cases.
7. Inflamed or scratchy areas: In some patients, seborrheic dermatitis may cause inflamed and scratchy areas on the skin, especially around the eyebrows and behind the ears.
8. Feeling of tension: Skin may feel tight and unsatisfactory.

Symptoms of seborrheic dermatitis may be temporary or intermittent and may worsen with stress, climate change, and other factors.

Forms

Seborrheic dermatitis can manifest itself in several different forms, depending on where it appears on the skin and the nature of the symptoms. The main forms of seborrheic dermatitis are listed below:

1. Seborrheic dermatitis of the scalp (flaky scalp, seborrheic psoriasis): This is the most common form of seborrheic dermatitis. It appears as yellowish or white flakes on the scalp, accompanied by itching. This condition is sometimes called "dandruff."
2. Seborrheic dermatitis of the face: This form of seborrheic dermatitis affects areas of the face such as the eyebrows, nose, folds between the nose and lips. Symptoms include redness of the skin, oiliness, scaling and itching.
3. Seborrheic dermatitis on the body: Symptoms may include patches of redness, oily skin, and scaly skin on the chest, back, groin, and other areas of the body.
4. Seborrheic dermatitis of the ears: This form affects the ears and may be accompanied by itching and wax discharge.
5. Seborrheic dermatitis on the lips and around the mouth: Appears as yellowish scales around the lips and on their edges.
6. Seborrheic Dermatitis on the Scalp: In this case, seborrheic dermatitis can affect the scalp area, causing itching and flaking.
7. Seborrheic dermatitis in infants (infant urticaria): This condition is characterized by the appearance of yellowish scales on the scalp and face of infants. It usually does not cause discomfort and disappears on its own.

The pathological process can also occur without noticeable inflammation of the skin and manifest itself only by peeling (dry seborrhea). In other cases, there is pronounced inflammation of the skin, on which thick exudative scales and crusts are located (oily seborrhea, steatoid pityriasis). Sometimes the inflammation spreads to the red border of the lips with the appearance of scales, deep painful cracks, hemorrhagic crusts (exfoliative cheilitis). Papules may appear on the skin of the cheeks, forehead and other areas as a result of infiltration of erythematous spots, on which powerful yellowish scaly crusts appear. Pronounced hyperkeratosis makes them look like psoriatic papules (psoriasiform seborrhea). In severe cases, seborrheic dermatitis can take on a widespread exfoliative character, up to desquamative erythroderma.

Complications and consequences

Seborrheic dermatitis is generally not considered a serious medical condition and rarely leads to serious complications. However, with prolonged or improper skin care, as well as in the presence of other factors, some complications and unpleasant consequences may arise:

1. Itching and discomfort: One of the most common and unpleasant symptoms of seborrheic dermatitis is itching. Itching can be intense and interfere with normal life.
2. Skin infections: Seborrheic skin allows bacteria and fungi to penetrate more easily, which can lead to the development of secondary infections such as pyoderma (purulent inflammation of the skin).
3. Persistent breakouts: In some people, seborrheic dermatitis may recur periodically or become chronic, resulting in ongoing breakouts and discomfort.
4. Cosmetic concerns: Seborrheic dermatitis can affect the appearance of the skin, causing redness, flaking, and yellowish scales. This can cause discomfort and negatively affect self-esteem.
5. Stress and Depression: Long-term presence of seborrheic dermatitis symptoms and their visible manifestation on the skin can cause emotional stress and depression.
6. Spread to other areas of the skin: In rare cases, seborrheic dermatitis can spread to other parts of the body, including the chest, back, and forehead.
7. Decreased quality of life: Seborrheic dermatitis can significantly reduce your quality of life, especially if symptoms are not controlled and treated.

Diagnostics seborrheic dermatitis

Diagnosis of seborrheic dermatitis typically involves the following steps:

1. Medical examination: A doctor (usually a dermatologist) will examine your skin and ask questions about your symptoms, their duration, and their nature. This will help the doctor make a preliminary diagnosis.
2. Medical history: You may be asked about your previous or existing skin problems, treatments you have had, and other medical conditions.
3. Lab tests: In some cases, your doctor may take a swab of the affected skin for lab tests to rule out other skin conditions, such as fungal infections. These tests can also help confirm the diagnosis of seborrheic dermatitis.

Differential diagnosis

Seborrheic dermatitis may have similar symptoms to other skin conditions, so differential diagnosis is important to correctly identify the cause of the symptoms. Below are some conditions that may be included in the differential diagnosis of seborrheic dermatitis:

1. Psoriasis: This is a chronic skin condition that can also cause dry, flaky skin and redness. However, psoriasis usually has the characteristic psoriatic plaques that are not characteristic of seborrheic dermatitis.
2. Eczema (atopic dermatitis): Eczema can also cause itchy and inflamed skin, but it usually has characteristic rashes that are different from seborrheic dermatitis.
3. Contact dermatitis: This type of dermatitis is caused by contact with irritants or allergens and may exhibit symptoms similar to seborrheic dermatitis but is most often accompanied by a rash or rash.
4. Dermatophytoses: Fungal infections of the skin (such as lichen) can cause symptoms similar to seborrheic dermatitis, such as scaling and itching. Diagnosis of such infections may require laboratory testing.
5. Leishmaniasis: This is a disease caused by the protozoan parasite Leishmania and can affect the skin and mucous membranes, causing symptoms similar to seborrheic dermatitis.
6. Rosacea: This is a chronic skin condition that can cause redness and inflammation of the skin on the face, similar to the symptoms of seborrheic dermatitis. However, rosacea is usually more specific in location and may be accompanied by visible red blisters and blood vessels on the skin.

For accurate diagnosis and differential diagnosis, the doctor may require additional clinical studies, including laboratory tests and skin biopsy.

Treatment seborrheic dermatitis

Treatment for seborrheic dermatitis can vary depending on the severity of symptoms and their location. Typically, your doctor will prescribe a combination approach that may include:

Hygienic measures:

• Regularly wash your scalp and face with a mild shampoo that does not dry out the skin.
• Avoid hot water and harsh detergents, which may worsen symptoms.
• Facial and body skin care with gentle cleansers.

Antifungal agents

Antifungal agents can be used in the treatment of seborrheic dermatitis, since one of the hypotheses for the development of this disease is the activation of yeast-like fungi Malassezia on the skin. These fungi can contribute to the development of inflammatory processes and symptoms of seborrheic dermatitis.

Examples of antifungal agents that can be used to treat seborrheic dermatitis include:

• Ketoconazole (eg, as shampoos or creams).
• Zinc pyrithione (often used in antifungal shampoos).
• Selenium disulfide (also found in antifungal shampoos).
• Clotrimazole.

These medications may help reduce the activity of Malassezia fungi and reduce inflammation in the skin, which in turn may lead to improvement in seborrheic dermatitis symptoms.

Treatment for seborrheic dermatitis usually involves not only antifungal agents, but also regular skin care, the use of gentle cleansers, and possibly dietary and lifestyle adjustments.

Glucocorticosteroids

Glucocorticosteroids (corticosteroids) can be used in the treatment of seborrheic dermatitis to reduce inflammation and symptoms of the condition. They are one of the main types of drug therapy for seborrheic dermatitis and can be given either topically (externally) as creams, ointments, lotions or shampoos, or orally as tablets or injections in severe cases.

The benefits of using glucocorticosteroids in the treatment of seborrheic dermatitis include:

1. Reduce inflammation: Glucocorticosteroids can quickly reduce inflammation and itching in the skin, which helps relieve symptoms.
2. Reduce rashes: They can help reduce rashes and redness on the skin.
3. Fast acting: These medications often act quickly and provide rapid relief of symptoms.

However, it is important to use glucocorticosteroids as directed by your doctor, as misuse or overuse can cause side effects such as skin irritation, skin atrophy, or pituitary-adrenal axis dysfunction.

A dermatologist or physician can select the appropriate medication and determine the duration of its use based on the severity of seborrheic dermatitis and the individual patient's characteristics. They can also recommend skin maintenance products and caution against long-term use of glucocorticosteroids, especially as monotherapy.

Antiseborrheic agents

Antiseborrheic agents are used in the treatment of seborrheic dermatitis to reduce excess sebum (skin oil) production and control the symptoms of the condition. Some of the antiseborrheic agents that may be used include:

1. Anti-seborrheic shampoos: These shampoos contain active ingredients such as salicylic acid, ketoconazole, zinc pyrithione, and others that help control sebum production and reduce itching and flaking of the scalp. They can be effective in treating seborrheic dermatitis on the scalp.
2. Creams and ointments: Some antiseborrheic creams and ointments can be used on other areas of the skin, not just the scalp. They also contain active ingredients, such as salicylic acid or sulfur, and can help reduce inflammation and symptoms.
3. Systemic medications: In some cases, when seborrheic dermatitis is severe or affects large areas of skin, your doctor may prescribe systemic medications, such as antimicrobials or sebum-regulating medications. However, the use of systemic medications should be prescribed and monitored by your doctor.

Antipruritic drugs

• Use of antohistamines to relieve itching, especially if the symptoms of seborrheic dermatitis are accompanied by intense itching.

Dieting

A seborrheic dermatitis diet may help reduce the symptoms of this condition, although there is no direct link between diet and seborrheic dermatitis. However, certain foods and dietary factors may contribute to worsening symptoms. It is important to remember that reactions to foods vary from person to person, and what works for one person may not work for another. Here are some dietary recommendations for people with seborrheic dermatitis:

1. Avoid foods that may trigger an allergic reaction: Certain foods, such as milk, eggs, gluten, nuts, and seafood, may worsen seborrheic dermatitis symptoms in some people. If you suspect you have an allergy to certain foods, see your doctor or allergist for testing and advice.
2. Increase your antioxidant intake: Foods rich in antioxidants (such as vitamins C and E, selenium) can help reduce inflammation and boost immunity. Include fruits, vegetables, berries, nuts, and leafy greens in your diet.
3. Drink enough water: Hydration is important for healthy skin. Drink enough water throughout the day.
4. Avoid excess sugar and fatty foods: Too much sugar and fat can contribute to inflammation and worsen skin conditions.
5. Eating the Right Fatty Acids: Some studies suggest that adding omega-3 fatty acids to your diet may help improve skin health. Fatty fish, flaxseed, and nuts are good sources of omega-3s.
6. Consult a doctor or nutritionist: If you have seborrheic dermatitis and want to make changes to your diet, it is best to first consult with a doctor or nutritionist. They can offer individual recommendations based on your specific needs and characteristics.

It is important to remember that diet can help reduce the symptoms of seborrheic dermatitis, but it is not a substitute for medical treatment. A doctor should always determine the best approach to treating this condition.

Physiotherapy

Physical therapy can be a useful adjunct to drug treatment for seborrheic dermatitis, but is not always the primary treatment. Here are some types of physical therapy that may be used to treat seborrheic dermatitis:

1. UV light (ultraviolet light): UV light can help reduce the inflammation and itching associated with seborrheic dermatitis. However, it should be done under the supervision of a professional, as improper use of UV rays can damage the skin.
2. Electrophoresis: This method uses an electric current to deliver medications through the skin. It can help improve the effectiveness of medications and reduce the symptoms of seborrheic dermatitis.
3. Laser therapy: Laser irradiation can be used to treat seborrheic dermatitis by reducing inflammation and itching. However, this method also requires specialist supervision.
4. Infrared: Infrared rays can help reduce inflammation and speed up the skin's healing process.
5. Biofeedback: This is a feedback method that can help patients learn to manage stress and reduce skin inflammation through relaxation.

When deciding to use physical therapy to treat seborrheic dermatitis, it is important to consult with a doctor or dermatologist. A specialist will help you choose the most appropriate physical therapy method, taking into account the individual characteristics of your condition and needs. Physical therapy can also be used in combination with medication to achieve the best results.

Prevention

Prevention of seborrheic dermatitis includes a number of measures that help reduce the risk of developing this condition or its exacerbations. Here are some recommendations for preventing seborrheic dermatitis:

1. Proper hygiene: Wash your scalp and face regularly with a mild shampoo and cleanser designed for your skin type. Avoid overuse of harsh cleansers, which can dry out your skin.
2. Avoid stress: Stress can contribute to the flare-up of seborrheic dermatitis. Focus on relaxation techniques such as yoga, meditation, and deep breathing to reduce stress.
3. Eat Right: Eating a balanced diet rich in vitamins and minerals can help maintain healthy skin. Avoid excess sugar and fatty foods, which can worsen symptoms.
4. Avoiding allergens: Try to avoid contact with possible allergens that can cause skin inflammation. This may include house pollen, animals, and certain cosmetic products.
5. Avoiding excessive skin care: Using too many cosmetics or washing your face multiple times a day can make seborrheic dermatitis worse. Follow your dermatologist's skin care recommendations.
6. Avoid hot showers: Hot water can dry out your skin and make symptoms worse. Use cool or lukewarm water when washing.
7. Avoid getting too cold: Cold winds and low temperatures can also cause seborrheic dermatitis to flare up. In cold weather, wear hats and protect your skin from the wind.
8. Follow Treatment: If you have already been diagnosed with seborrheic dermatitis, it is important to follow your doctor's instructions and use recommended medications to control your symptoms.

Forecast

The prognosis for seborrheic dermatitis depends on its severity, the degree of control, and the overall health of the patient. In most cases, seborrheic dermatitis is easily treated and controlled with medication and non-medication methods. The prognosis is usually good, but there is a risk of relapse and the need for regular skin care.

It is important to note that seborrheic dermatitis is a chronic condition, and even after symptoms improve, it can return. However, with proper skin care and regular follow-up with your doctor, most people with seborrheic dermatitis can achieve long-term stability.

If symptoms of seborrheic dermatitis become severe, do not respond to treatment, or are accompanied by complications, it may require more intensive medical intervention. For example, the doctor may decide to prescribe stronger medications or additional tests.

It is important for patients with seborrheic dermatitis to see a dermatologist regularly, follow skin care recommendations, and take medications as prescribed to keep the condition under control. Effective management of seborrheic dermatitis can significantly improve quality of life and prevent flare-ups.

References

• Ivanov, Skripkin, Butov: Dermatovenerology. National leadership. - Moscow: GEOTAR-Media, 2020
• Dermatovenerology. National leadership. Brief edition / ed. Yu. S. Butova, Yu. K. Skripkina, O. L. Ivanova. - Moscow: GEOTAR-Media, 2020.