Seborrheic psoriasis: the scalp, on the face, unlike seborrheic dermatitis

In most patients with vulgar psoriasis, characteristic eruptions appear not only on the skin of the elbows, knees, but also throughout the body, including the head. And the damage to the skin on the head is often defined as seborrheic psoriasis.

Probably, in due time the decisive role in the use of this term was played by the same localization of psoriasis of the scalp and other common skin pathology - seborrheic dermatitis. Then what is the difference between psoriasis and seborrheic dermatitis? And is it really seborrhoeic psoriasis of the scalp - it's just a diagnosis, reflecting the inability to distinguish two similar diseases from each other?

[1], [2]

Causes of the seborrheic psoriasis

If you adhere to this interpretation, then the causes of seborrheic psoriasis are the same as the psoriasis itself, that is, the disease develops in the presence of appropriate endocrine, immune or neurologically mediated factors. However, according to the journal Clinical Dermatology, seborrheic psoriasis is simply a combination of seborrheic dermatitis and psoriasis, in which both diseases develop simultaneously and ordinary psoriasis on the head looks a little different, and foreign experts call it another way - sebopsoriasis or seborrheic-like psoriasis (seborrheic-like psoriasis).

Indeed, the coexistence of psoriasis with seborrheic dermatitis is not uncommon, moreover, both diseases have even some symptomatic similarity, quite often causing problems with their differentiation when diagnosed. But, after all, how does psoriasis differ from seborrheic dermatitis?

First of all, each disease has its own causes, while the pathogenesis of psoriasis is not associated with any infectious agents. Details of why psoriasis can develop, what are the risk factors for its occurrence, and also the pathogenetic features of this disease, please read the special material fully devoted to this issue - Causes of psoriasis

But seborrheic dermatitis is associated with an abnormal increase in the production of sebaceous glands of the skin of the protective lipid secretion - sebum, which can have an allergic, hormonal or genetically determined etiology (with a fat type of skin).

However, mycologists believe that the main culprits for the development of seborrheic dermatitis are the unicellular lipid-dependent yeast of the genus Malassezia SPP (M. Sympodialis, M. Globosa, M. Slooffiae), living on the skin of each person (i.e., referring to the obligate skin microflora). They produce lipase, an enzyme that breaks down sebum, resulting in its composition changing: triglycerides pass into free fatty acids, the proportion of wax esters increases, and the alkalinity of the skin increases. The skin receptors (TLR, LRP-1, A2MR, etc.) react to this, triggering the chemotaxis of prostaglandins, interleukins, histamine and other mediators of inflammation and a local immune response in the form of edema, hyperemia, pruritus, etc.

In addition, with the combination of psoriasis with seborrheic dermatitis - against the background of excessive production of sebum and its accelerated oxidation - the proliferation of keratinocytes in ordinary psoriasis, as well as in dermatoses such as seborrheic forms of atopic dermatitis and psoriasis, is aggravated.

[3], [4], [5], [6], [7]

Symptoms of the seborrheic psoriasis

In fact, the symptoms of seborrheic psoriasis are a combination of symptoms of ordinary psoriasis on the head and seborrheic dermatitis.

If the first signs with vulgar psoriasis visually manifest clearly delimited hyperemic papules, which rapidly increase and become thickened with plaques covered with dry silver-white scales, the morphological elements of skin rash in seborrheic psoriasis have some differences.

Seborrhoeic psoriasis of the scalp is manifested by the same primary elements of eruptions with erythema and scaling, but the spots are covered with yellowish scales that are greasy to the touch. Separating scales are similar to fatty dandruff. The usual subjective symptom is the itching of the skin on the head, leading to excoriation, and a burning sensation of the damaged areas.

As a rule, individual elements of the rash merge, and the rashes diffuse throughout the head with the formation of yellow-gray crusts; the skin outside the line of hair growth on the forehead, behind the auricles and on the back surface of the neck is affected. There is a tendency to localize rashes on the face (more often in the area of nasolabial folds), and then seborrheic psoriasis on the face can be diagnosed. It is also possible the appearance of affected areas of the skin on the upper part of the chest or in the area of the scapula.

Stages

In the clinical picture of the development of seborrhoeic psoriasis, the same stages are distinguished as in the conventional: progressive, stationary and regressive. For more information, see - Steps of psoriasis

[8], [9], [10], [11], [12]

Complications and consequences

The consequences and complications of this disease are associated with scratching and their infection, as well as extensive exfoliation of large areas of the epidermis and the threat of development of erythroderma.

[13], [14], [15], [16], [17]

Diagnostics of the seborrheic psoriasis

As already noted, the diagnosis of seborrheic psoriasis causes certain difficulties, especially in cases where the manifestation of psoriasis does not start with plaques on the elbows, but with the appearance of papulo-squamous eruptions on the head.

To diagnose seborrhoeic psoriasis, instrumental diagnostics - dermatoscopy, as well as laboratory examination of flakes and a sample of plaque tissue or spots are performed.

[18], [19], [20], [21]

Differential diagnosis

Differential diagnosis is necessary to not confuse seborrheic psoriasis with such diseases as atopic and seborrheic dermatitis, keratosis, lichen, etc.

[22], [23], [24], [25]

Treatment of the seborrheic psoriasis

To treat seborrheic psoriasis was the most effective, you need to use drugs recommended by a dermatologist.

Usually start with the use of an antifungal therapeutic shampoo containing ketoconazole (Nizoral, Dermazol, etc.) or zinc pyrithione - daily for 10-14 days.

To soften and remove crusts suitable ointments: salicylic, tar, with urea. Thus, Keratolan ointment (with urea, betaine and lactic acid), which can be applied up to three times a day, copes well with squamous eruptions.

Reduce the intensity of hyperkeratosis ointments and creams containing vitamin D3 or its derivatives. For example, ointment Calcitriol (Forcal) is applied to the affected areas twice a day for one to three months.

Also read - Creams for psoriasis

Dermatotropin preparations with strong corticosteroids in fungal infections are contraindicated, but for seborrhoeic psoriasis appoint lighter GSK. Most often, doctors recommend ointments and gels with fluocinolone acetonide (Cinaphlan, Flucinar, Flunolone) or shlipun with clobetasol. It should be borne in mind that drugs based on corticosteroids can not be used for a long time, since it is fraught with side effects that manifest themselves atrophy of the epidermis, extensive hyperemia, inflammation of the hair follicles, etc.

To reduce the level of stress leading to exacerbation of hyperkeratosis skin pathologies, mild sedatives can be prescribed; as fortifying agents take aloe juice, tincture of Eleutherococcus or Aralia; necessarily take vitamins (retinol, tocopherol, riboflavin, pyridoxine, nicotinic and orotic acid).

A physiotherapy treatment includes: UV irradiation; Oxygen, hydrogen sulphide and sea baths; applications with sulfite mud.

Alternative treatment

Among the methods that offer alternative treatment for seborrheic psoriasis, it should be noted:

• rubbing into the skin in damaged areas of mineral oils with the addition of essential oils of tea tree, thuja, sophora, chamomile, carrot seed;
• lubrication of rashes with a mixture of fish oil or cottonseed oil with aloe juice (in a 2: 1 ratio);
• smearing the skin with a solution of propolis (per 100 ml of water 10 g) or a suspension of turmeric (teaspoon), dissolved in apple cider vinegar (150-180 ml);
• Applying on the skin of the head gruel from crushed fresh berries of mountain ash.

Widely practiced herbal treatment, and phytotherapists advised to use for baths and washing the head of celandine, oregano, violet tri-color, string, calendula, licorice root and elecampane.

Read also - Treatment of psoriasis in the home

Prevention

How to prevent seborrheic psoriasis, while it is not known, but with the methods of prevention that are being used to prevent psoriasis, can be found here - Prophylaxis of psoriasis.

[26], [27], [28], [29], [30], [31]

Forecast

The prognosis for the complete cure of this disease, alas, is disappointing: this disease is chronic, although with persistent treatment it is possible to achieve sufficiently long periods of remission.

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