TOPIC: SEBORRHEIC DERMATITIS

ETIOLOGY: Focused on the role of Malassezia (previously Pityrosporum) yeasts in the

development of Seborrheic Dermatitis. Some hypothesized that there is an
immunological component to Seborrheic Dermatitis and that this disease
is caused by an altered immune response to Malassezia yeasts. However,
other condition as the result of hyperproliferation.
PATHOLOGY: There is a follicular plugging, shoulder parakeratosis and prominent
lymphocytic exocytosis were significantly more common in
seborrheic dermatitis. 

LABORATORY DIAGNOSE: Seborrheic dermatitis is diagnosed based on the

appearance of the affected skin and where it appears
on the body. There is usually no need for blood, urine,
or allergy tests. If the condition does not respond to
treatment, a skin biopsy or other test may be
performed to rule out another disease.

CLINICAL MANIFESTATIONS: Erythematous scaling papules and plaques,

sometimes with a greasy yellow appearance, with a
characteristic distribution on scalp, ears, eyebrows,
eyelid margin, and nasolabial area - the so-called
"seborrheic areas".

MANAGEMENT: Low-potency topical corticosteroids, such as hydrocortisone,

desonide, and mometasone furoate, have shown to be efficacious
on the face. Topical steroids have been associated with the
development of telangiectasias and thinning of the skin.   Although
the levels of Malassezia yeast does not correlate with the severity
of seborrheic dermatitis, antifungal therapies are first-line therapies.
Ketoconazole, naftitine or ciclopirox creams and gels are effective
therapies. Systemic fluconazole may help if seborrheic dermatitis is
severe or unresponsive. Dandruff responds to more frequent
shampooing or a longer period of lathering. Use of hair spray or
hair pomades should be stopped. Shampoos containing salicylic
acid, tar, selenium, sulfur, or zinc are effective and may be used in
an alternating schedule. An alternative to a shampoo with zinc is a
conditioner rinse with zinc, 0.01% fluocinolone, and acetonide
topical oil. Overnight occlusion of tar, bath oil, or Baker's P&S
solution may help to soften thick scalp plaques.