Seborrheic Dermatitis

Posted by e-Medical PPT Sunday, May 6, 2012
Seborrheic dermatitis is a papulosquamous disorder
patterned on the sebum-rich areas of the scalp, face and trunk.
linked to Pityrosporum ovale
immunologic abnormalities and activation of complement.
 aggravated by changes in humidity, by trauma (scratching), seasonal change and by emotional stress.
Severity varies from mild dandruff to exfoliative erythroderma.
Seborrheic dermatitis may worsen in Parkinson disease and in AIDS.
Seborrheic dermatitis is associated with normal levels of Pityrosporum ovale, but an abnormal immune response.
The contribution of P. ovale may come from its lipase activity—releasing inflammatory free fatty acids (FFA)—and from its ability to activate the alternative complement pathway.

Generalized seborrheic erythroderma is rare. It is more often seen in AIDS, CHF, Parkinson disease, and in immunocompromised premature infants.

Differential Diagnosis
Asteatotic Eczema
Atopic Dermatitis
Candidiasis, Cutaneous
Contact Dermatitis, Allergic
Contact Dermatitis, Irritant
Dermatomyositis 
Drug Eruptions
Drug-Induced Photosensitivity

Physical Exam
Scalp appearance varies from mild, patchy scaling to widespread thick adherent crusts. Plaques are rare.
From the scalp, seborrheic dermatitis can spread onto the forehead, posterior neck and postauricular skin, like psoriasis.
Skin lesions present as branny or greasy scale over red, inflamed skin.
Hypopigmentation is seen in blacks.
Infectious eczematoid dermatitis, with its oozing and crusting, suggests secondary infection.
A seborrheic blepharitis may occur independently
Distribution follows the oily and hair-bearing areas of head and neck, such as the scalp, forehead, eyebrows, lash line, nasolabial folds, beard and postauricular skin.
Presternal or interscapular involvement is more common than the nonscaling intertrigo of the umbilicus, axillae, inframammilae inguinal fold, perineum or anogenital crease that may also be present...

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