Seborrheic Dermatitis

A. Definitions
Seborrheic dermatitis is a chronic disease that attacks papuloskuamosa infants and adults
are often found on the body with a high concentration of sebaceous follicles and active
including the face, scalp, ears, upper body and the flexure (inguinal, and axillary inframma).

B. Epidemiology
This disease can affect infants or in adults. Seborrheic dermatitis in infants occurs in the first
few months of age, then rare in affect infants or in adults. Seborrheic dermatitis in infants
occurs in the first few months of age, then rare in the age before puberty and the incidence
peaked at age 18-40 years, sometimes in old age. Seborrheic dermatitis more common in
men than women. Seborrheic dermatitis in patients with AIDS ( Acquired
Immunodeficiency common in men than women. Seborrheic dermatitis in patients with
AIDS ( Acquired Immunodeficiency Syndrome) have a high prevalence of up to 85%. Other
systemic diseases where the higher incidence of seborrheic dermatitis include acute
myocardial infarction, pancreatitis, alcoholism and addiction to alcohol.

C. Etiology and Pathogenesis

Definite pathogenesis of seborrheic dermatitis is not yet fully understood, but dermatitis is
commonly associated with fungi Malassezia, dermatitis is commonly associated with fungi
Malassezia, immunological disorders, sebaceous activity is increased and the patient's
susceptibility. Species Malassezia immunological disorders, sebaceous activity is increased
and the patient's susceptibility. Species Malassezia and Propionibacterium acne also has a
lipase activity which resulted in the transformation of triglycerides into free fatty acids. Free
fatty acids and reactive oxygen radicals produced has antibacterial activity that changes the
normal skin flora.
Seborrheic dermatitis sufferers usually have rich sebum and oily skin. As mentioned above,
sebum lipids essential for proliferation Malassezia and the synthesis of pro-inflammatory
factors sebum lipids essential for proliferation Malassezia and the synthesis of pro
inflammatory factors sebum lipids essential for proliferation Malassezia and the synthesis of
 pro-inflammatory factors so that create appropriate conditions for the development of
seborrheic dermatitis. Seborrheic dermatitis is most common in puberty and adolescence,
during this period the highest sebum production, this is associated with hormonal increased
at puberty, therefore dermatitis. Seborrheic more common in males than females, which
show the effect of androgens on pilosebum unit. Seborrheic dermatitis is an inflammatory
condition, which is mostly accompanied by the presence of the fungus Malassezia and
alleged that the inappropriate immune reaction could contribute to the pathogenesis of
seborrheic dermatitis.

D. Clinical Features
Typical seborrheic dermatitis lesions are patches of erythema with greasy scales. The
disease is like appearing in the rich parts of the sebaceous glands, such as the scalp, hairline,
eyebrows, glabela, nasolabial folds, ears, upper chest, back, armpits, navel and groin.
 Patients often complain of itching, especially on the scalp and the ear canal. Lessions on the
scalp can spread to the skin of the forehead and forms the boundary called the scaly
erythema "Seborrheica corona". Other common symptoms of seborrheic dermatitis is
blepharitis with a yellowish crust along the edge of the eyelid. If only this manifestation is
there, then the diagnosis is not difficult. Serious variant of this skin disease is exfoliative
Erythroderma (seborrheic Erythroderma).

E. Diagnosis
Typical features in the form of yellowish scales that appear soon after birth. This condition
can also develop on the face and the body folds such as the retroaurikular area, neck, armpit
and thigh area. In adults, seborrheic dermatitis is a chronic dermatosis recurrent erythema
which starts from mild to moderate to papular lesions, exudative and scaly, worsened if
accompanied by stress or lack of sleep. With puritus level varies. Lesions mainly grown in
areas with high sebum production such as the scalp, face, external ear, the area
retroaurikular and pre-sternal region, eyelids and body folds.
Lesions on the scalp starting from mild exfoliation to kerakkerak yellowish attached to the
scalp and hair, which may trigger or not the area of alopecia ( pseudo tinea amiantacea).
Involvement of eyelid cause blepharitis, in men mustache area may also be affected with
seborrheic dermatitis lesion.
F. Treatment
A. Systemic treatment
B. Kortikosteorid used in its severe form, a dose of 20-30 mg daily prednisone. If there has been
improvement, the dose lowered slowly. When accompanied by secondary infection antibiotics.
The effect reduces the activity of sebaceous glands. The gland size can be reduced up to 90%,
resulting in a reduction of sebum production. In severe seborrheic dermatitis can also be treated
with narrow band UVB (TL-1) is reasonably safe and effective. When the direct preparation
contained Pityrosporum ovale that many could be given ketoconazole, the dose is 200 mg per
day for 1-3 weeks. The effect of anti-inflammatory and antifungal activity against Malassezia
showed that oral itraconazole would be the first-line treatment for seborrheic dermatitis oral
choice in the future. These drugs do not have the same potential to cause hepatotoxicity as
ketoconazole and may, therefore, be a safer alternative for patients requiring oral medication.
C. Pengobatan Topikal
1. Anti-Inflammatory (immunomodulators)
Tacrolimus and pimecrolimus including immunomodulatory topical nonkortikosteroid.
How it works affects the immune system. This topical calcineurin inhibitors exert anti-
inflammatory effects by inhibiting T lymphocyte activation and proliferation, also showed
anti-fungal and anti-inflammatory properties without the risk of cutaneous atrophy
associated with topical steroids. And may be an appropriate alternative for for seborrheic
dermatitis with corticosteroids because it has no long term side effects.
2. Keratolytic
Other therapies for seborrheic dermatitis by using keratolytic. Keratolytic which is widely
used for seborrheic dermatitis is tar, salicylic acid and zinc shampoo pyrithion. Zinc
pyrithion have the specific properties of the non keratolytic and antifungal properties and
can be applied two or three times per week. The patient must leave the shampoo on the hair
for at least five minutes to ensure that the shampoo reach the scalp. Patients can also use it
in other places affected, such as the face.
3. Topical Antifungals
Topical antifungals are the mainstay of treatment of seborrheic dermatitis. Well-studied
agents include ketoconazole, bifonazole, and ciclopiroxolamine (also called ciclopirox),
which is available in different formulations such as creams, gels, foams and shampoos.
Ketoconazole cream 2% can be applied, if the direct preparation there are many
Pityrosporum ovale. Use intermittent ketoconazole could maintain remission. No side
effects in the use of topical antifungal.
 4. Topical Corticosteroids
Topical corticosteroids are helpful in the treatment of short term mainly to control
erythema and itching, eg 2 1/2% hydrocortisone cream. In cases of severe inflammation
that can be used corticosteroids are more powerful, such as betamethasone valerate,
provided it's not used for too long because it can happen skin atrophy and hypertrichosis in
a long-term corticosteroid use.
5. Selenium Sulfide Mixture
In pityriasis sika and oleosa, use a week 2-3 times on the scalp washed for 5-15 minutes,
for example with selenium sulfide (Selsun). Other topical medications that can be used :
 Ter, eg karbonas detergens liquor 2-5% or cream pragmatar
 Resorsin 1-3%
 Sulfur Praesipitatum 4-20%, can be combined with salicylic acid 3-6%

These drugs should be used in creams.

The scales are attached to the baby can be given a warm mineral oil, allowed to 8-12 hours, then
scaling removed with a soft brush, then continued with the right shampoo. Ketoconazole
shampoo is a safe and efficacious treatment for infants with cradle cap. Using a mild shampoo
and gently massage the scalp will help remove scales. Seborrheic dermatitis which goes beyond
the scalp, drugs such topical antifungal cream or mild corticosteroid is required, for example,
hydrocortisone 1%. For severe cases topical corticosteroids should be limited because of
possible systemic absorption.

G. Differential Diagnosis
H. Prognosis
Seborrheic dermatitis does not affect your overall health, but sometimes gives discomfort. Seborrheic
dermatitis is not contagious, and is not a sign of poor hygiene. Seborrheic dermatitis usually require
treatment for many years, because there is no treatment that can completely cure the disease., P This
is important in educate patients where treatment is given do not give the results with the total
healing, but can be controlled.