Seborrheic Dermatitis
Seborrheic dermatitis is a chronic inflammatory papulosquamous skin condition that commonly involves the sebum-rich areas of the scalp, ears, face, chest, and skinfolds. It typically has a chronic, relapsing course that can range in severity from asymptom
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Seborrheic Dermatitis Elizabeth Farhat and Linda Stein Gold
46.1
Introduction
Seborrheic dermatitis is a chronic inflammatory papulosquamous skin condition that commonly involves the sebum-rich areas of the scalp, ears, face, chest, and skinfolds. It typically has a chronic, relapsing course that can range in severity from asymptomatic dandruff of the scalp to extensive skin involvement resulting in exfoliative erythroderma. Patients are otherwise healthy, but it has been noted to be a marker for human immunodeficiency virus (HIV) infection as well as some neurologic diseases. It is thought to be linked to a reaction to Malassezia furfur (Pityrosporum ovale), but the relationship is complex.
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Background Epidemiology
Seborrheic dermatitis peaks during time periods of increased sebum production initially during infancy and later during adolescence and adulthood. It is generally divided into infantile seborrheic dermatitis and adult seborrheic dermatitis which generally occurs in those aged 30–60 years [1]. Up to 70 % of infants may develop seborrheic dermatitis within the first 3 months of life which usually resolves by 1 year of age [2]. The prevalence in healthy adults is between 1 % and 3 %, more commonly seen in males than females, and typically worsens during the winter E. Farhat, M.D. • L.S. Gold, M.D. (*) Department of Dermatology, Henry Ford Health System, 6530 Farmington Road, West Bloomfield, MI 48322, USA e-mail: [email protected]
J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_46, © Springer Science+Business Media New York 2014
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months [3]. Many consider dandruff, pityriasis simplex, to be the mildest form of seborrheic dermatitis which may affect up to 50 % of the population [4]. Seborrheic dermatitis has been noted to be a marker for HIV infection and may be the presenting sign [5, 6]. The prevalence of seborrheic dermatitis in early HIV infection is 36 % and 50–83 % in patients with acquired immunodeficiency syndrome (AIDS) [7–9]. Patients with Parkinson’s disease have increased sebum production as well as an increased prevalence of seborrheic dermatitis. Treatment with l-dopa results in with both quantitative sebum reduction and clinical improvement of seborrhea [10]. This increased prevalence also occurs in patients with neurolepticinduced Parkinsonism after the use of neuroleptic drugs such as chlorpromazine hydrochloride and haloperidol and in those with mood disorders such as schizophrenia, depression, and anxiety [11, 12]. Seborrheic dermatitis is seen in other genetic disorders including familial amyloidosis with polyneuropathy and Down’s syndrome [13–15]. The role of ultraviolet (UV) light on seborrheic dermatitis is unclear. Patients frequently report improvement after exposure to sunlight [16]. Also, seborrheic dermatitis is noted to flare during the winter months [17]. However, mountain guides who have increased UV exposure were noted to have increased prevalence of seborrhei
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