MUDr. Dana Maňasková


Vyhledávání na medicinman.cz
 

Seboroická dermatitida

Dr. Landa

Promazávání obličeje při seborhoeické dermatitidě

  • Brutnákový olej, olivový olej, pupalkový olej
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  • Popíjení čajů Dr. Landa

Kazuistika

  • úzdrava těžké seborhoey 10 let neúspěšně léčené různými dermatology do 14-ti dnů

Kontakt

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    • Teď už kosmetici nevědí, jak lopuch vypadá...
  • Prof. RNDr. Lubomír Opletal, CSc.

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VodaMycí látky (např. Sodium Laureth Sulfate)Změkčovadla (např. Behentrimonium Methosulfate)Zvlhčující látky (např. Glycerin)ParfemaceKonzervantyBarviva

Synonyma

  • Seborrhoeic dermatitis
  • Seborrheic dermatitis AmE
  • Seborrhea
  • "seborrheic eczema" [1]

Definice

  • An inflammatory skin disorder
  • Affecting the scalp, face, and trunk
  • Typically scaly, flaky, itchy, red skin
  • Affects the sebum-gland rich areas of skin. [1]

Výskyt

  • Prevalence rate of seborrheic dermatitis is 3-5%
  • Worldwide distribution
  • The mildest form of this dermatitis, is probably far more common
    • Present in an estimated 15-20% of the population [2]
  • Slightly worse in males than in females [2]

Věk

Kojenci do 3 měs.

  • Seborrheic dermatitis in infants, also called cradle cap, is a harmless, temporary condition. 3)
  • It appears as thick, crusty, oily, yellow or brown scales over the child's scalp.
  • Similar scales may also be found on:
    • The eyelids
    • Around the hairline
    • Ear
    • Around the nose
    • In the groin 3)
  • Cradle cap may be seen in newborns and small children up to age 3 3)
  • Cradle cap is not contagious, nor is it caused by poor hygiene 3)
  • It is not an allergy 3)
  • It is not dangerous 3)
  • Cradle cap may or may not itch. 3)
  • Itching is not common among infants [1]
  • If it itches, excessive scratching of the area may cause additional inflammation, and breaks in skin may cause mild infections or bleeding. 3)
  • Uncommonly may present as a flexural eruption or erythroderma. [2]
  • Frequently, a stubborn diaper rash accompanies the scalp rash [1]
  • In infants the condition resolves itself within days and with no treatment [1]
  • Many patients experience alternating periods of the symptoms [1]

Děti

  • Seborrheic dermatitis is uncommon in preadolescent children, and tinea capitis is uncommon after adolescence, dandruff in a child is more likely to represent a fungal infection. A fungal culture should be completed for confirmation [2]

Dospělí

  • The usual onset occurs with puberty
  • It peaks at age 40 years and is less severe, but present, among older people. [2]
  • May last from few weeks to even years
  • Referred to a specialist when:
    • It becomes painful
    • The individual suspects that the skin might have become infected
    • They have tried self-care therapy without success
    • Can cause discomfort and interfere in one's daily activities
  • prevent potentially long-lasting damage to the hair follicles which may lead to hair loss [1]

Příčiny

  • Unknown

Zhoršující faktory

Stres

  • Illness
  • Psychological stress
  • Fatigue
  • Trauma škrábáním, ale i trauma lebky 3)
  • Oily skin, infrequent shampoos or skin cleaning 3)
  • Use of lotions that contain alcohol 3)
  • Skin disorders (such as acne) 3)
  • Obesity may increase the risk 3)
  • Reduced by:
    • General health [1]

Výživa

  • In children
    • Excessive vitamin A intake can cause seborrhoeic dermatitis. [1]
  • Nedostatek (vždy i riziko narušení mentálního vývoje = významné příčiny):

Provokující medikace

Various medications may flare or induce seborrheic dermatitis

  • Auranofin
  • Aurothioglucose
  • Buspirone
  • Chlorpromazine
  • Cimetidine
  • Ethionamide
  • Gold
  • Griseofulvin
  • Haloperidol
  • Interferon alfa
  • lithium
  • Methoxsalen
  • Methyldopa
  • Phenothiazines
  • Psoralens
  • Stanozolol
  • Thiothixene
  • Trioxsalen [2]
  • Bepanthen (vlastní zkušenost)

Genetická dispozice

Environmental

  • Changes in humidity
  • Changes in seasons
    • Activity is increased in winter and early spring, with remissions commonly occurring in summer. [2]

Hormonální vlivy


Neurologické vlivy

  • Parkinson's disease
    • One of the autonomic signs of Parkinson's disease [1]
  • Stroke [1]

Imunitní systém

  • Unfavourable epidermic response to the infection, with the skin becoming inflamed and flaking [1]
  • With immunodeficiency (especially HIV) [1]
    • The dermatitis appears early in persons with AIDS
    • Affects 25-50% of persons with AIDS
  • Has greater involvement and greater activity in those with diminished T-cell function
  • Helper T cells, phytohemagglutinin and concanavalin stimulation, and antibody titers are depressed [2]

Malassezia furfur (formerly Pityrosporum ovale)

  • Likely plays a key role [1]
  • Its lipase activity—releasing inflammatory free fatty acids—and from its ability to activate the alternative complement pathway [2]
  • Malassezia organisms are probably not the cause but are a cofactor linked to a T-cell depression, increased sebum levels, and an activation of the alternative complement pathway. Persons prone to this dermatitis also may have a skin-barrier dysfunction. [2]
  • Main species found in the scalp is Malassezia globosa
  • Malassezia globosa produces toxic substances that irritate and inflame the skin
  • Patients with seborrhoeic dermatitis appear to have a reduced resistance to the yeast. [1]
  • However, the colonization rate of affected skin may be lower than that of unaffected skin. [1]
  • Saturated, not unsaturated, fatty acids support Malassezia growth [1]
  • Pure, unsaturated FAs were unable to support growth of M. globosa or M. furfur.
  • Interestingly, growth of both species was supported by saturated FAs. This is further evidenced by lard, which is rich in saturated triglycerides.
  • Number density of M. globosa and M. restricta do not directly correlate to dandruff presence or severity [1]
    • Removal correlates directly with amelioration of flaking
  • In dandruff susceptible individuals
      • Pure OA
      • An unsaturated FA
      • And Malassezia metabolite [1]
    • Induces flaking in the absence of Malassezia
  • Malassezia hydrolyze human sebum, releasing a mixture of saturated and unsaturated fatty acids. [1]
  • They take up the required saturated FAs, leaving behind unsaturated FAs.
  • The unsaturated FAs penetrate the stratum corneum and due to their non-uniform structure breach the skin's barrier function.
  • This barrier breach induces an irritation response, leading to dandruff and seborrheic dermatitis.
  • The widely present yeast, Malassezia furfur (formerly known as Pityrosporum ovale), is involved [1]

Klinika

  • In adolescents and adults
    • Scalp scaling (dandruff)
    • Mild to marked erythema or "redness" of the nasolabial fold
      • Especially during times of stress or sleep deprivation. [1]
  • Gradually and usually the first signs of seborrheic dermatitis are
    • The flakes of skin called dandruff [1]
  • May occur anywhere on the skin of:
    • The face
    • Behind the ears
    • In areas where the skin folds
  • In more rare cases:
    • Near the eyelashes
    • On the forehead
    • Around the sides of the nose
  • Other body areas:
    • The chest
    • Upper back
  • Basically on any part of the body where there is certain amount of hair and therefore follicles which might become inflamed.
  • A sign that the condition has become more severe is:
    • The formation of thick, oily and yellow scales
    • Might appear on the forehead
    • Around the sides of the nose
    • On the skin near the eyelashes [1]
  • The flakes can be
    • Yellow
    • White
    • Grayish [1]
  • In more severe cases
    • Yellowish to reddish scaly pimples appear
    • Along the hairline
    • Behind the ears
    • In the ear canal
    • On the eyebrows
    • On the bridge of the nose
    • Around the nose
    • On the chest
    • On the upper back [1]
    • Presternal or interscapular involvement is more common than nonscaling intertrigo of the umbilicus, axillae, inframammary and inguinal folds, perineum, or anogenital crease, which also may be present. [2]
  • In some cases hair loss
  • Patchy scaling
  • Thick crusts on the scalp
  • Red, greasy skin covered with flaky white or yellow scales
  • Itching
  • Soreness and yellow or white scales that may attach to the hair shaft [1]
  • Hypopigmentation is seen in blacks [2]
  • An annular or geographic petaloid scaling is the most common. A rare pityriasiform variety can be seen on the trunk and the neck, with peripheral scaling around ovoid patches, mimicking pityriasis rosea. [2]
  • Infectious eczematoid dermatitis, with oozing and crusting, suggests secondary infection. [2]

Komplikace

  • Secondary infection in the intertriginous areas and on the eyelids.
  • Candidal overgrowth is common in infantile napkin dermatitis.
    • Such children may have a diaper dermatitis variant of seborrheic dermatitis or psoriasis.
  • Generalized seborrheic erythroderma is rare, often in association with:
    • AIDS
    • Congestive heart failure
    • Parkinson disease
    • Immunosuppression in premature infants [2]

Hair loss

  • Side effects to inflammation may include temporary hair loss.
  • If severe outbreaks are untreated for extended intervals, permanent hair loss may result, because of damage to hair follicles. [1]

Příčiny

  • Yeast causing seborrheic dermatitis is the main cause of hair loss due to this condition
  • Excess oil production by the oil glands due to reasons such as
    • Hormonal imbalance
    • Stress
    • Extreme hot or cold weather conditions
    • Weakened immune system
    • Parkinson's disease
    • Certain neurological conditions
    • Keeping the scalp unclean [1]

Seborrheic blepharitis

  • May respond to gentle cleaning of eyelashes with baby shampoo and cotton applicators [2]
  • The use of ketoconazole cream in this anatomical region is controversial [2]

Treatments

Režim

  • Early treatment of flares is encouraged
  • Behavior modification techniques in reducing excoriations
  • Use of hair spray or hair pomades should be stopped [2]
  • Brush your child's hair with a clean, soft brush after each shampoo and several times during the day. 3)
  • If scales do not easily loosen and wash off:
    • Mineral oil to the baby's scalp and wrap warm, wet cloths around his head for up to an hour before shampooing
  • Contact your physician if:
    • Scales continue to be a problem
    • Child seems uncomfortable or scratches his scalp 3)
    • If patches of seborrheic dermatitis drain fluid or pus, form crusts, or become very red or painful 3)

Topical treatments

Shampoos

  • Daily, gentle shampoos with a mild soap while scales are present when disappeared, twice weekly. 3)
  • Longer period of lathering
  • After lathering, let soak in for 10 min prior to rinsing :2::
  • Effective shampoos are containing:
    • Salicylic acid
    • Tar
      • Polytar
      • Inhibiting T-lymphocyte activation
      • Safer than topical steroids for prolonged use or in skin folds.
    • selenium
    • Sulfur
      • "Konopný šampón na seborhoeu" (volně prod. v lékárně)
    • Zinc
    • Ketoconazole
      • Nizoral šampón (volně prod. )
    • Ciclopirox
      • May help by reducing Malassezia yeast scalp reservoirs [2]
    • Resorcin 3)
  • May be used on truncal lesions or in beards
  • May cause inflammation in the intertriginous or facial areas [2]

Okluze

  • Overnight occlusion of:
    • Tar
    • Bath oil
    • Baker's P&S solution
  • May help to soften thick scalp plaques
  • Derma-Smoothe F/S oil
    • Especially helpful when widespread scalp plaques are present [2]

Gely

  • 1% metronidazole gel
    • Effective for seborrheic dermatitis of the face [2]
  • Nonsteroidal cream [2]

Cleansers

Creams/lotions that contain:

  • Antifungal
  • Anti-inflammatory
    • močovina
      • Excipialy - například s mandlovým olejem
  • Sebo-suppressive
  • Keratolytic ingredients [1]

Sprej

  • Clotrimazol AL spray 1% - lze ošetřit rozsáhlejší kožní plochy a skalp

1. Combinations of the usual agents

  • A dandruff shampoo
  • An antifungal agent
  • Topical steroid [1]
    • May hasten recurrences [2]
    • May foster dependence because of a rebound effect [2]
    • Are discouraged except for short-term use [2]

2. Short-term topical steroid in a "pulse fashion"

Class III

  • Nonfluorinated steroid should be tried first
    • Mometasone furoate (Elocon)
    • Betamethasone
      • Suppreses migration of polymorphonuclear leukocytes [2]
      • Reverses capillary permeability [2]
      • Affects production of lymphokines [2]
      • Inhibitory effect on Langerhans cells [2]

Class I

  • Extra-potent

Class II

  • Once or twice per day, even on the face
  • Must be stopped after two weeks because of the increased frequency of side effects
  • If the patient responds before the two-week limit, the agent should be stopped immediately [1]
    • Clobetasol propionate (Temovate)
    • Fluocinonide (Lidex) [1]

Adjuvant therapy

Čištění skalpu

  • Dandruff shampoo and an antifungal agent [1]
  • Is essential during the "pulse" period
  • Should be continued as maintenance therapy after each pulse [1]
  • Maintaining the scalp clean is mandatory for sufferers of seborrheic dermatitis
  • There are several special shampoos that contain: [1]
    • Sulfur
    • Zinc or salicylic acid
  • A thorough cleaning of the scalp is the first step to be made in preventing and curing this condition
    • By having a proper scalp hygiene, the bacteria and fungus are removed and the likelihood of developing a follicular inflammation is reduced [1]

Topical cortisone creams

  • Class IV or lower corticosteroid creams, lotions, or solutions can be used for acute flares. [2]
    • Highly effective in minimizing the symptoms of this condition, especially inflammation and itchiness [1]

Nonsteroidal anti-inflammatory agent

  • Calcineurin inhibitors [2]
    • Pimecrolimus [2]
      • Currently indicated only for atopic dermatitis in immunocompetent patients >2 y. [2]
      • Use cream sparingly to avoid maceration in skin folds. [2]
    • Tacrolimus [2]
      • Should not cause steroid-type skin atrophy
      • Currently indicated only for atopic dermatitis in immunocompetent patients ? 2 y [2]
  • Sulfur [2]
  • Sulfonamide combinations [2]
  • Propylene glycol [2]

Antimykotika

  • Zinc pyrithione
  • Salicylic acid
  • selenium sulfide
  • Ketoconazole 1%
    • Ketoconazole cream 2% (Nizoral)
    • Ketoconazole foam (Extina)
    • Ketoconazole shampoo 2% (Nizoral 2%; prescription only in USA),
    • Ketoconazole shampoo 1% (Nizoral A-D Shampoo; over-the-counter in USA) [2]
      • Imidazole broad-spectrum antifungal [2]
      • Inhibits synthesis of ergosterol, causing cellular components to leak [2]
  • Climbazole
  • Piroctone olamine
  • Clotrimazole
  • Sulfur
  • Ciclopiroxolamine
  • Sodium sulfacetamide
  • Terbinafine
  • Fluconazole
  • Itraconazole [1]
    • Naftifine [2]
  • Systemic ketoconazole or fluconazole may help if seborrheic dermatitis is severe or unresponsive [2]
    • 400 mg of oral ketoconazole daily for 2 weeks [2]

Další medikace

  • Coal tar
    • Can be very effective
    • Is not advised to be used for a prolonged time
    • Is carcinogenic
  • Lithium gluconate
  • Lithium succinate
  • Vitamin B6 ointment
  • Topical steroid
    • Chronic treatment with topical corticosteroids may lead to permanent atrophy and telangiectasia of the skin.
  • Pimecrolimus, brand name Elidel
  • Isotretinoin (Accutane)
    • At low dose 5 mg to 10 mg
    • As a last resort in refractory disease
    • Sebosuppressive agent
    • Potentially serious side effects [1]

Phototherapy

  • UV-A and UV-B laser
  • Red and blue LED light
  • Inhibit the growth of Malassezia
  • Reduce the inflammation [1]

Natural treatments

  • Aloe Vera applied topically
  • Tea tree oil
    • Diluted to 5% applied topically
  • Viola tricolor or Heartsease
    • Applied topically
    • Recognised by Germany's Commission E as Monograph 195 for the treatment of Cradle Cap a form of seborrheic dermatitis.
  • Honey
    • Apply diluted crude(raw)honey
    • 90% honey diluted in warm water
    • Every other day on the lesions with gentle rubbing for 2-3 mins
    • Honey is left on for 3 hr before gentle rinsing with warm water
    • Treatment is continued for 4 weeks.
  • Avocado Extracts
    • AV119 & 5-alpha Avocuta, also known as butyl avocadate applied topically
  • Monarda fistulosa [1]

Supplements

  • Lactobacillus casei
  • Lactobacillus paracasei
  • Lactoferrin
  • Vitamin B7 - Biotin
  • Vitamin B6
  • Vitamin B2
  • Vitamin B3: Nicotinamide, also known as Niacinamide (významné !!)
  • Zinc [1] (velmi významné !!!)

Diet

  • Relationship between seborrheic dermatitis and intestinal yeast, such as candida
  • Antifungal diet
  • Foods rich in antioxidants and beta-carotene [1]

Alternative treatments

  • Milk of magnesia [1]
  • Droždí (velmi účinné)
    • Povařené (mrtvé) droždí
      • Omývání vyrážky na obličeji a přidávání do příkrmů

Prevention

  • Good hygiene and daily use of over-the-counter or prescription anti-fungal shampoo:
    • Nizoral
    • Medicated Selsun Blue
    • Medicated Head & Shoulders
  • Regular stays in the sun are beneficial to healing
  • UV-radiation (especially in the winter) is recommended by doctors
  • Very short hair cut (more air and sun comes to the concerned areas)
  • Frequent hair washing - at least every two days [1]

Diferenciální diagnóza

  • Asteatotic Eczema
  • Lichen Simplex Chronicus
  • Atopic Dermatitis
  • Lupus Erythematosus, Acute
    • Seborrheic derm. may appear as a butterfly rash, similar to the acute facial eruption associated with systemic lupus erythematosus. [2]
  • Candidiasis, Cutaneous
  • Nummular Dermatitis
  • Contact Dermatitis, Allergic
  • Pemphigus Erythematosus
  • Contact Dermatitis, Irritant
  • Pemphigus Foliaceus
  • Dermatologic Manifestations of Gastrointestinal Disease
  • Perioral Dermatitis
  • Dermatomyositis
  • Pityriasis Rosea
  • Drug Eruptions
  • Rosacea
  • Drug-Induced Photosensitivity
  • Tinea Capitis
    • A skin biopsy may be needed in persons with exfoliative erythroderma, and a fungal culture can be used to rule out tinea capitis [2]
  • Erythrasma
  • Tinea Corporis
  • Extramammary Paget Disease
  • Tinea Cruris
  • Glucagonoma Syndrome
  • Tinea Versicolor
  • Impetigo
  • Intertrigo [2]
  • Pelagra !!! (při postižení obličeje aj.)
  • Deficit zinku !!! (postižení obličeje, opruzeniny ap.)
  • Xerotic eczema
  • Chronic granulomatous disease
  • Exfoliative erythroderma
  • Facial chapping
  • Infectious eczematoid dermatitis
  • Letterer-Siwe disease
    • Letterer-Siwe disease in infants may manifest as a scaling scalp and purpura. [2]
  • Activation of complement [2]
  • Scaling drug eruptions
  • Staphylococcal blepharitis
  • Tinea amiantacea
  • Tinea versicolor
  • Vitamin B and/or zinc deficiency [2]
  • Sebopsoriasis (psoriasis) is distinguished by dermatopathologic findings:
    • Regular acanthosis
    • Thinned rete ridges
    • Exocytosis
    • Parakeratosis
    • An absence of spongiosis
    • Neutrophils may be seen in both diseases [2]

Bioptické vyšetření

  • Dermatopathologic findings of seborrheic dermatitis are nonspecific:
    • Hyperkeratosis
    • Acanthosis
    • Accentuated rete ridges
    • Focal spongiosis
    • Parakeratosis


Literatura:

[1] Anon. Dermatitis and eczema: Seborrhoeic dermatitis [online]. Wikipedia, the free encyclopedia, 11 March 2011 [cit. 2011-03-14]. Dostupné z: < en.wikipedia.org/wiki/Seborrhoeic_dermatitis >.
[2] SELDEN, MD, Samuel . Seborrheic Dermatitis. E-Medicine [online]. Jul 13, 2010, ?, [cit. 2011-03-15]. Dostupný z WWW: < emedicine.medscape.com/article/1108312-overview >.
[3] BERMAN, Kevin . Medline plus [online]. Atlanta Center for Dermatologic Disease : 7/18/2007 [cit. 2011-03-15]. Seborrheic dermatitis.Dostupné z WWW: < www.nlm.nih.gov/medlineplus/ency/article/000963.htm >.



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Poslední aktualizace: 18. 12. 2022 1:48:09