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Seborrheic Dermatitis

Article · July 2015

DOI: 10.19070/2572-7354-150003

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International Journal of Pediatric Health Care & Advancements (IJPA)

IISSN 2572-7354
Seborrheic Dermatitis
Review Article
Alexander K. C. Leung1*, Barankin B2

1
Clinical Professor of Pediatrics, University of Calgary, Pediatric Consultant, Alberta Children's Hospital, Canada.
2
Dermatologist, Medical Director and Founder, Toronto Dermatology Centre, Canada.

Abstract

Seborrheic dermatitis is a common chronic inflammatory skin disease characterized by erythema and greasy scales affecting
areas rich in sebaceous glands. Seborrheic dermatitis has two incidence peaks, the first in the first three months of life and
the second beginning at puberty, reaching its apex at 30 to 40 years of age. Infants with seborrheic dermatitis often present
with focal or diffuse scaling and crusting of the scalp. Erythematous or salmon-colored sharply demarcated patches with
yellow-white scales may involve the face, postauricular areas, trunk, and intertriginous and flexural areas of the body. In the
diaper area, infantile seborrheic dermatitis presents as a sharply demarcated, erythematous, scaly eruption with a tendency
to coalesce, resulting in the formation of a large confluent lesion. Pruritus is characteristically absent. In adolescence and
beyond, seborrheic dermatitis usually presents as greasy scaling of the scalp. It may also present as ill-defined erythema-
tous patches with yellow-white, greasy scales affecting the nasolabial folds, eyelids, eyebrows, glabella, postauricular area,
anterior chest, and less commonly the upper back. Mild periodic pruritus is common in adolescent seborrheic dermatitis.
Scalp lesions in infantile seborrheic dermatitis usually respond to simple daily shampooing alone or in combination with
non-prescription mild shampoos specific for seborrheic dermatitis. For infantile scalp seborrheic dermatitis that does not
respond to the above measures, for seborrheic dermatitis lesions elsewhere, and for adolescent or adult seborrheic derma-
titis, the use of topical antifungals, calcineurin inhibitors, and low to mid potency corticosteroids should be considered. A
compounded mixture of these ingredients is also often employed.

Keywords: Erythema; Greasy Scales; Cradle Cap; Diaper Rash; Topical Antifungals.

*Corresponding Author:
Alexander K. C. Leung MBBS, FRCPC, FRCP(UK & Irel), FRCPCH, Epidemiology
FAAP,
Clinical Professor of Pediatrics, University of Calgary, Pediatric Consult-
ant, Alberta Children's Hospital, #200, 233 – 16th Avenue NW Calgary, Seborrheic dermatitis has two incidence peaks, the first in the first
Alberta, Canada T2M 0H5, Canada. three months of life and the second beginning at puberty, reach-
Fax: (403) 230-3322 ing its apex at 30 to 40 years of age [5-7]. The condition affects
E-mail: [email protected] up to 70% of infants in the first 3 months of life [3, 5] and 3 to
5% of young adults [7-9]. Seborrheic dermatitis is more common
Received: June 01, 2015 in males than females, presumably because androgens stimulate
Accepted: July 22, 2015
sebum production [6, 8].
Published: July 24, 2015

Citation: Alexander K. C. Leung, Barankin B (2015) Seborrheic Derma- Etiology

titis. Int J Pediat Health Care Adv. 2(1), 7-9.
doi: http://dx.doi.org/10.19070/2572-7354-150003 Seborrheic dermatitis might result from excessive sebaceous
gland activity with sebum overproduction as the dermatitis usu-
Copyright: Alexander K. C. Leung© 2015. This is an open-access ar- ally develop in areas with the highest density of these glands [1].
ticle distributed under the terms of the Creative Commons Attribution
The high prevalence of infantile seborrheic dermatitis in early in-
License, which permits unrestricted use, distribution and reproduction in
any medium, provided the original author and source are credited. fancy can be explained by a transient surge of gonadotropins with
a resulting rise in testosterone levels which peaks at 1 to 3 months
of age. It is believed that the sebum permits growth and prolifera-
Introduction
tion of commensal yeasts of the Malassezia (formerly known as
Pityrosporum) family which, through the action of lipases, degrade
Seborrheic dermatitis is a common chronic inflammatory skin
lipids on the skin surface with production of unsaturated and
disease characterized by erythema and greasy scales [1]. The con-
saturated fatty acids [7, 9]. The inflammation which causes hy-
dition typically affects areas rich in sebaceous glands such as the
perproliferation of stratum corneum (scaling) results from non-
scalp, eyebrows, glabella, nasolabial folds, postauricular area, and
immunogenic irritation due to unsaturated fatty acids and the cel-
intertriginous areas [2, 3]. In general, scaling tends to predominate
lular immune response to these yeasts [2, 7, 9]. There is a genetic
on the scalp whereas erythema tends to predominate in the flex-
predisposition; there is an increase in the frequency of HLA-A32,
ural folds and intertriginous areas [4].
HLA-AW30, HLA-AW31, HLA-B12, and HLA-B18 in patients

Alexander K. C. Leung, Barankin B (2015) Seborrheic Dermatitis. Int J Pediat Health Care Adv. 2(1), 7-9.
7
 http://scidoc.org/IJPA.php

with seborrheic dermatitis [7, 9]. immunodeficiency disorder.

In adolescence and beyond, predisposing factors include HIV Diagnosis
infection, stress, medications (haloperidol, chlorpromazine, bus-
pirone, lithium), trisomy 21, and familial amyloidosis with poly- The diagnosis is mainly clinical, based on the characteristic clinical
neuropathy [3, 5, 6]. morphology of scaling and erythema in typical sebum-rich areas.
If necessary, the diagnosis can be aided by dermoscopy which
Histopathology shows atypical red vessels, arborizing vessels, and structureless
red areas [13]. If tinea capitis is suspected, a potassium hydrox-
Histological findings in the acute stage include spongiosis, focal ide wet-mount examination of scalp scrapings may help in the
parakeratosis, plugged follicular ostia, and superficial perivascular diagnosis. Referral to a dermatologist should be considered if the
and interstitial lymphocytic infiltration [2, 7]. In the chronic stage, diagnosis is in doubt.
changes include in addition to the aforementioned findings, ir-
regular acanthosis, a poorly formed or absent granular layer, and Differential Diagnosis
psoriasiform hyperplasia with dilatation of the capillaries and
venules of the superficial plexus [7]. Seborrheic dermatitis should be differentiated from atopic der-
matitis, irritant diaper dermatitis, tinea capitis, psoriasis, rosacea,
Clinical Manifestations Langerhans cell histiocytosis X, and immunodeficiency [11]. In-
fantile seborrheic dermatitis is distinguished from atopic derma-
Infantile seborrheic dermatitis usually develops within the first titis by its earlier age of onset, involvement of the scalp, diaper
month of life [10]. Infants with seborrheic dermatitis often pre- area, and flexural rather than extensor surfaces, well-defined le-
sent with focal or diffuse, white or yellow, greasy scaling and sions with dry fine scaling, absence of oozing or weeping, and
crusting of the scalp (Figure 1) [1, 2]. The lesion may become so absence of pruritus [10].
thickened that it forms a cap, meriting its description as cradle cap
[1]. Cradle cap is usually the initial and at times the only manifes- Typically, irritant contact dermatitis presents as confluent erythe-
tation of infantile seborrheic dermatitis [10]. Not uncommonly, ma and maceration on the convex skin surfaces in contact with
erythematous or salmon-colored sharply demarcated patches with the diaper. The skin has a shiny, glazed appearance. In contrast to
yellow-white scales may involve the face, external ear, postauricu- infantile seborrheic dermatitis, the intertriginous folds are usually
lar folds, trunk, and intertriginous and flexural areas of the body spared.
[1]. In the diaper area, infantile seborrheic dermatitis presents as
a sharply demarcated, erythematous, greasy, scaly eruption with Tinea capitis typically presents as fine scaling with patches of cir-
a tendency to coalesce, resulting in the formation of a large con- cular alopecia; diffuse or patchy, fine, white, adherent scaling of
fluent lesion; it may be mistaken for candidal dermatitis [1]. In the scalp resembling generalized dandruff; or patches of well-de-
infantile seborrheic dermatitis, oozing, weeping and pruritus are marcated areas of alopecia with fine scales, studded with broken-
characteristically absent [11]. off, swollen hair stubs, resulting in a “black dot” appearance.

In adolescence and beyond, seborrheic dermatitis usually presents In infants and young children, psoriasis often present as sharply
as greasy scaling of the scalp (dandruff). It may also present as demarcated erythematous plaques in the diaper and intertriginous
ill-defined erythematous patches with yellow-white, greasy scales areas. The classic silvery scales are usually absent. Compared to
on the nasolabial folds, eyelids, eyebrows, glabella (Figure 2), pos- infantile seborrheic dermatitis, the response to topical corticoster-
tauricular area, anterior chest, and less commonly the upper back oid is much slower, and there is no response to topical antifungals.
[11, 12]. In contrast to infantile seborrheic dermatitis, pruritus is
common in adolescent seborrheic dermatitis, especially with scalp Rosacea is characterized by telangiectasia, persistent erythema of
involvement [6]. Involvement of the eyelids may lead to blephari- the central face, small, dome-shaped erythematous papules, and/
tis with erythematous eyelids and potential destruction of eye- or tiny pustules on the central aspects of the face. The perioral
lid follicles [7, 8]. The upper chest and back are less commonly and periocular areas are typically spared. Facial flushing, dryness,
affected [12]. Generalized seborrheic dermatitis is uncommon scaling, edema, or burning/stinging (“sensitive skin”) sensation
which, if present, should lead to the suspicion of an underlying may be present.

Figure 1. Infantile seborrheic dermatitis presenting as yellowish adherent scales and crusting of the scalp.

Figure 2. A 16-year-old boy with seborrheic dermatitis presenting as white scales on the eyebrows and glabella.

Alexander K. C. Leung, Barankin B (2015) Seborrheic Dermatitis. Int J Pediat Health Care Adv. 2(1), 7-9.
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Alexander K. C. Leung, Barankin B (2015) Seborrheic Dermatitis. Int J Pediat Health Care Adv. 2(1), 7-9.
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