dermatitis seborrheica

Symptoms

The scalp may be dry with abundant grayish branny scales, or oozing and crusted (eczema capitis). The rash may spread to the forehead and postauricular regions. The forehead shows scaly and infiltrated lesions with dark red bases and localized loss of hair. The eyebrows and eyelashes may have dry, dirty white scales. Inflamed skin and scales may be present on the nasolabial folds or the vermilion border of the lips. On the sternal region, the lesions are greasy to the touch. Eruptions may also appear in interscapular, axillary, and genitocrural regions. Cold winter weather may worsen the condition.

Treatment

When the condition is limited to the scalp, frequent shampooing and use of mild keratolytic agents are indicated. Selenium-containing shampoos are helpful. Generalized seborrheic dermatitis requires careful attention, including scrupulous skin hygiene, frequent washing and shampooing with selenium sulfide suspension to remove scales, keeping the skin as dry as possible, and using dusting powders. Fluorinated corticosteroids may be applied topically to hairless areas, and systemic cortisone preparations may be required. The differential diagnosis includes psoriasis; it should be ruled out and neurologic conditions recognized as possible predisposing factors.

Patient care

The health care provider explains to the patient that the condition has remissions and exacerbations and that hormone imbalances, nutritional status, infection, and emotional stress influence its course. The patient is taught to apply prescribed corticosteroids to the body and face. Fluorinated corticosteroids should be used with caution near the eyelids, on the face, and in the groin. To avoid developing a secondary Candida yeast infection in body creases or folds, the patient is advised to cleanse these areas carefully, to dry gently but thoroughly, and to ensure that the skin is well aerated. He or she is taught to treat seborrheic scalp conditions (dandruff) with proper and frequent shampooing, alternating two or three different types of shampoo to prevent the development of resistance to a particular product. External irritants and excessive heat and perspiration should be avoided. Rubbing and scratching the skin are discouraged because they prolong exacerbations and increase the risk for secondary infection and excoriation, esp. since scaly, pruritic lesions present in skin areas with high bacteria counts. Oral antibiotics (such as tetracycline) may be prescribed (as for acne vulgaris) in small doses over a prolonged period to reduce bacterial colonization. The patient is advised to take tetracycline at least 1 hr before or 2 hr after meals, since the drug is poorly absorbed with food. The patient also is taught about the adverse effects of the drug (photosensitivity, birth defects, nausea, vomiting, and candidal vaginitis) and their management. Adherence to the treatment regimen is stressed to achieve optimal results. Psychological support or counseling is provided as necessary to deal with related body image concerns.