Seborrheic Eczema

Seborrheic eczema (synonyms: seborrheic dermatitis, disseborrheic dermatitis, Unna's disease) is a chronic skin disease, based on a violation of the secretory function of the sebaceous glands, detected in the sebaceous glands-rich areas of the skin.

[1], [2], [3], [4]

Epidemiology of seborrheic eczema

The average incidence of the disease among the population is 3-5%, but in patients with immunodeficiency it is much more common: from 30 to 80%. It usually begins during puberty, but can develop at any age. The majority of patients fall ill before the age of 30, after 50 years the risk of developing the disease increases again. Men get sick more often. The main complaint of patients is itching, aggravated by sweating. The condition often worsens in winter.

[5], [6], [7], [8], [9], [10], [11], [12], [13]

Causes and pathogenesis of seborrheic eczema

The causes and pathogenesis of seborrheic eczema have not been studied enough. Genetic factors, hyperproduction of the sebaceous glands, pathological changes in the function of the sebaceous glands, bacteria found in the mouths of the hair follicles and sebaceous glands, stress, and allergic reactions play a significant role in its development.

Hyperfunction of the sebaceous glands is an important predisposing factor. In newborns, the sebaceous glands are active due to the endogenous formation of androgens, therefore seborrheic eczema can develop in children up to 3 months. At a later age, the activity of the sebaceous glands decreases, therefore, the development of seborrheic eczema occurs less frequently. The effect of androgens explains the more frequent occurrence of the disease in men. Qualitative changes in sebum have not been proven.

The role of the nervous system is evidenced by facts such as the connection of Parkinson's disease and seborrheic eczema. In case of poliomyelitis or sirin-gomielia, skin changes often occur only in the area of the trigeminal nerve. Patients also often emphasize that stress exacerbates skin manifestations. Manifestations of the disease are more pronounced in winter. With a lack of zinc or enteropathic acrodermatitis, the risk of seborrheic dermatitis is increased. There is a metabolic disorder of essential fatty acids. Vitamin B deficiency can also cause similar dermatosis.

Currently, the possible role of the Malassezia yeast (Pityrosporum) in the development of seborrheic dermatitis is being widely studied. The link is confirmed by the fact that in the treatment of seborrheic eczema with antifungal drugs, a decrease in the manifestations of the disease and a decrease in the colonization of the skin of Malassezia are observed. The number of yeast cells on the patient's skin surface significantly exceeds the normal values (5 * 10 ⁵ cm ² in healthy and 9.2 x 10 ⁵ cm ^-2 in patients with seborrheic eczema). The mycelial phase of fungi in seborrheic eczema occurs in 26% of patients (in healthy cases - in 6% of cases). It is also assumed that seborrheic eczema is a peculiar specific reaction of the skin to Malassezia. Various disorders of the immune system were studied in patients with seborrheic eczema as a result of the activity of yeast-like fungi: the interrelation of antibody titers to Malassezia with the severity of seborrhoeic eczema of the scalp was noted.

Etiological role is played not only by the yeast Malassezia. For example, in some infants suffering from seborrheic eczema, numerous colonies of Candida albicans are sown from feces and from the surface of the skin, and application tests and the reaction of lymphocyte transformation confirm the presence of sensitization. It is also known about the cross-antigens of C. Albicans and Malassezia.

However, it is likely that different patient groups have their own specific pathogenesis of this disease, since, for example, Malassezia cells are seeded much less frequently in patients with severe immunodeficiency than in patients without immunopathology. Seborrheic eczema is also one of the most important markers of HIV-infected patients.

[14], [15]

Symptoms of seborrheic eczema

Symptoms of seborrheic eczema are characterized by a tendency to chronic course, frequent relapses, and are difficult to treat. Cosmetic deficiencies can lead to psychological problems in patients, cause violations of social adaptation. The main complaint of patients is itching, aggravated by sweating.

[16], [17], [18], [19]

Children's seborrheic eczema

Children's seborrheic eczema often occurs in the first six months of a child’s life and usually disappears completely within a few months. More often obese children are sick. A lesion occurs on the skin of the scalp, but the skin of the face in the area of the eyebrows and nasolabial folds may be affected, flexion of the limbs, large body folds may be involved in the process of spreading. On the scalp part of the head, the layers of fat, surrounded by cracks of yellowish scales - gneiss are formed. Disseminated foci of infection, localized in large folds, resemble those of psoriasis, but are prone to rapid cure.

Rashes occur in places characterized by a high content of sebaceous glands - the face, scalp, chest, interscapular region, large folds. Symptoms are most often represented by the presence of inflammatory reddened and slightly infiltrated foci with irregular outlines, with yellowish scales and crusts on a hyperemia background. The lesion has the form of either large drainage foci resembling a geographic map, or round with clear boundaries of multiple foci resembling pityriasis versicolor. With strong subjective sensations - itching, burning - excoriations, cracks appear, a secondary infection joins. The ducts of the sebaceous glands look dilated.

On the face of the lesion often located around the nose, in the nasolabial folds, the skin of the eyebrows. In some patients, there is deterioration after sun exposure or after ultraviolet irradiation. On the body, infiltration is usually mild due to the rejection of scales due to sweating. Large folds can be affected - axillary, inguinal, the clinical picture is reminiscent of candidiasis or intertrigo.

On the scalp, rashes have clearly delineated contours and a tendency to merge. Sometimes there is a total lesion of the scalp, resembling a shell. Foci often go to the back of the head, the side of the neck, retroauricular area. Often, in the retroauricular region, a long-lasting healing crack is formed, which is prone to secondary infection. In the center of the sternum or between the shoulder blades, the lesion takes the form of infiltrated hyperemic foci.

Seborrheic erythroderma is a complication of seborrheic eczema and occurs when intolerance to external treatment or as a result of contact sensitization.

[20],

Diagnosis of seborrheic eczema

Diagnosis of seborrheic eczema does not cause difficulties and is based on the typical clinical picture of the disease. The main difficulty is the differential diagnosis with vulgar psoriasis, especially with the defeat of the scalp. In psoriasis, the rash is located on the growth of hair, are more infiltrated, peeling is more dry. Seborrheic eczema is more likely to be treated than psoriatic lesions. With the defeat of large folds it is necessary to remember about candidiasis or intertrigo. When seborrheic erythroderma should be excluded syndrome Sesari.

[21], [22], [23]

Treatment of seborrheic eczema

Treatment of seborrheic eczema can be both local and systemic, and depends on the severity of the disease. Because of the tendency to relapse, treatment is long-term and is aimed at correcting seborrhea. Anti-inflammatory and antimycotic therapy is carried out.

In milder forms of seborrheic eczema with localization of lesions on smooth skin, an ointment, cream or antifungal solution solution is used, which is used 1-2 times a day for 2-4 weeks. Facial skin defatting is performed with alcohol solutions with the addition of salicylic acid (2-3%) or resorcinol (2%). During the day, use powder containing sulfur. For the face, products with erythromycin (Zenerit lotion) or ketoconazole (Nizoral cream) are recommended. Overnight, a drying treatment for seborrheic eczema is indicated: zinc lotion with clioquinol (5%) and / or ichthiol (2-5%), as well as sulfur (2-5%). Weeping foci are well treated with a 1% aqueous solution of brilliant green.

Local corticosteroids are one of the most effective treatments for seborrheic eczema. Corticosteroids have a powerful anti-inflammatory effect, but their long-term use is limited by side effects - the appearance of skin atrophy, telangiectasia, acne, perioral dermatitis. In children, corticosteroids should be prescribed with extreme caution, given the increased absorbability of the skin. Corticosteroid creams of low activity — prednisone and hydrocortisone — are prescribed to the face.

Anti-seboric drugs with keratolytic and antimicrobial additives are used for washing the head: selenium sulfide (Vichy Dercos shampoo with selenium sulfide), salicylic acid, tar ("T-gel", "Friderm-Tar"), zinc ("Friderm-Zinc"). Ketoconazole (Nizoral shampoo), active against lipophilic yeast-like fungi (2 times a week), is indicated. Antiseborrheic hair tinctures contain sulfur, salicylic acid, resorcinol, or non-feminized estrogens. For a short-term effect, alcohol solutions of glucocorticoids are shown, sometimes with the addition of tar. With a strong inflammatory process, halogenated glucocorticoids are prescribed in the foci. Creams, lotions or gels are recommended as bases.

In severe cases of the disease, characterized by the presence of foci with severe inflammation and dense layering of scales, keratolytics, such as salicylic acid or coal tar preparations, are used to remove the latter. After exfoliation, local antifungal and corticosteroid preparations are used. In addition, antihistamines, calcium preparations can be recommended, and in the case of bacterial infection, antibiotics are prescribed.

With the ineffectiveness of external therapy shows the use of systemic antimycotic drugs inside for one week: ketoconazole (200 mg / day), terbinafine (250 mg / day), fluconazole (100 mg / day), itraconazole (200 mg / day). The effects of ketoconazole and itraconazole have been studied most fully. Fluconazole and terbinafine are less effective against Malassezia, but are also used in the treatment of seborrheic eczema.

In severe cases, sebosupressive drugs are prescribed, such as isotretinoin, which reduces the activity and size of the sebaceous glands by up to 90% and also has an anti-inflammatory effect. It has been shown that daily administration of the drug in a daily dose of 0.1 to 0.3 mg / kg body weight leads to an improvement in severe seborrhea after 4 weeks of treatment.

The complex treatment of seborrheic eczema includes antihistamines, multivitamins, sedatives, drugs to normalize the functions of the gastrointestinal tract, and in the case of the addition of a secondary infection - antibacterial agents and eubiotics.