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Seborrhoeic dermatitis

Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated July 2014.

What is seborrhoeic dermatitis?

Seborrhoeic dermatitis (American spelling is ‘seborrheic’) is a common, chronic or relapsing form of eczema/dermatitis that mainly affects the scalp and face. There are infantile and adult forms of seborrhoeic dermatitis. It is sometimes associated with psoriasis (sebopsoriasis). Seborrhoeic dermatitis is also known as seborrhoeic eczema.

Dandruff (also called ‘pityriasis capitis’) is an uninflamed form of seborrhoeic dermatitis. Dandruff presents as bran-like scaly patches scattered within hair-bearing areas of the scalp.

What causes seborrhoeic dermatitis?

The cause of seborrhoeic dermatitis is not completely understood. It is associated with proliferation of various species of the skin commensal Malassezia in its yeast form. Its metabolites cause an inflammatory reaction. Differences in skin barrier function may account for individual presentations.

Who gets seborrhoeic dermatitis?

Infantile seborrhoeic dermatitis affects babies under the age of 3 months and usually resolves by 6–12 months of age.

Adult seborrhoeic dermatitis tends to begin in late adolescence. Prevalence is greatest in young adults and in the elderly. It is more common in males than in females.

The following factors are sometimes associated with severe adult seborrhoeic dermatitis:

What are the clinical features of seborrhoeic dermatitis?

Infantile seborrhoeic dermatitis

Infantile seborrhoeic dermatitis causes cradle cap (diffuse, greasy scaling on scalp). The rash may spread to affect armpit and groin folds (a type of napkin dermatitis).

Adult seborrhoeic dermatitis

Seborrhoeic dermatitis affects scalp, face (creases around the nose, behind ears, within eyebrows) and upper trunk.

Typical features include:

Extensive seborrhoeic dermatitis affecting scalp, neck and trunk is sometimes called pityriasiform seborrhoeide.

How is seborrhoeic dermatitis diagnosed?

Seborrhoeic dermatitis is diagnosed by its clinical appearance and behaviour. As Malassezia is a normal component of skin flora, its presence on microscopy of skin scrapings is not diagnostic. Skin biopsy may be helpful but is rarely indicated.

What is the treatment for seborrhoeic dermatitis?

Treatment of seborrhoeic dermatitis often involves several of the following options.

In resistant cases in adults, oral itraconazole, tetracycline antibiotics or phototherapy may be recommended.

Scalp treatment

Face, ears, chest and back

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