seborrheic dermatitis; seborrhea; cradle cap (infants)
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Introduction
Common, chronic, largely non-infectious skin disorder characterized by greasy, yellow scales overlying erythematous plaques or patches.
Etiology
- idiopathic
- overgrowth of Pityrosporum ovale may be contributory
- if severe, may be initial manifestation of HIV1 infection[2]
- exacerbations may be triggered by stress or infection[3]
Epidemiology
- rarely occurs in children past infancy
- occurs in adults
- most affected individuals have no underlying disorder
- occurs frequently in patients with Parkinson's disease, stroke, HIV1
- common in men, especially with Parkinson's disease[10]
Genetics
- one form associated with defects in ZNF750 gene
Clinical manifestations
- inflammatory rash
- distribution (hair-bearing areas)
- may be papules & pustules
- generally symptomatic with itching (pruritus) &/or burning
- may occur within 1st few weeks of life on scalp, face or groin
- blepharitis may occur[3]
Differential diagnosis
- within ear may be confused with otomycosis
- on scalp may be confused with severe dandruff
- central facial erythema may be confused with an acute flare of systemic lupus erythematosus (SLE spares nasolabial folds)
- abrupt onset (several months)[15] with wide distribution (face, scalp)[15] may be a sign of HIV1 infection[2]
Management
- selenium sulfide shampoo[2][3]
- zinc pyrithione shampoo[2]
- topical ketoconazole-containing shampoo or cream left on for at least 10 minutes twice weekly is helpful[2]
- low-potency topical steroids plus shampoos containing coal tar &/or salicylic acid
- high potency topical glucocorticoids for scalp involvement
- fluorinated topical glucocorticoids should not be used on face
- oral ketoconazole may be tried in cases refractory to topical treatment - MKSAP19 discourages use of oral ketoconazole[2]
- systemic immunosuppression for severe cases
More general terms
More specific terms
Additional terms
- betamethasone dipropionate; betamethasone valerate (Celestone, Soluspan, Betasone)
- fluocinonide (Fluonex)
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 300
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 17, 19. American College of Physicians, Philadelphia 1998, 2006, 2009, 2015, 2022
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 3.0 3.1 3.2 3.3 3.4 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ Takahashi S, In: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ 5.0 5.1 Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
- ↑ Gupta AK, Bluhm R. Seborrheic dermatitis. J Eur Acad Dermatol Venereol. 2004 Jan;18(1):13-26 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14678527
- ↑ Naldi L1, Rebora A. Clinical practice. Seborrheic dermatitis. N Engl J Med. 2009 Jan 22;360(4):387-96 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19164189
- ↑ 8.0 8.1 Selden ST, James WD (images) Medscape: Seborrheic Dermatitis http://emedicine.medscape.com/article/1108312-overview
- ↑ DeAngelis YM, Gemmer CM, Kaczvinsky JR et al Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity. J Investig Dermatol Symp Proc. 2005 Dec;10(3):295-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16382685
- ↑ 10.0 10.1 Martignoni E, Godi L, Pacchetti C Is seborrhea a sign of autonomic impairment in Parkinson's disease? J Neural Transm (Vienna). 1997;104(11-12):1295-304. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9503275
- ↑ Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol. 2013 Jul-Aug;31(4):343-51 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23806151
- ↑ 12.0 12.1 DermNet NZ. Seborrhoeic dermatitis (images) http://www.dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html
- ↑ Karalezli A, Borazan M, Dursun R et al Impression cytology and ocular surface characteristics in patients with seborrhoeic dermatitis. Acta Ophthalmol. 2011 Mar;89(2):e137-41. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19958291 Free Article
- ↑ Piquero-Casals J, Hexsel D, Mir-Bonafe JF, et al. Topical non-pharmacological treatment for facial seborrheic dermatitis. Dermatol Ther (Heidelb). 2019;9:469-77. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31396944
- ↑ 15.0 15.1 15.2 NEJM Knowlege+ Question of the Week. April 2, 2024 https://knowledgeplus.nejm.org/question-of-week/529/
Chan S, Aronowitz P. A cutaneous clue to HIV infection. Cleve Clin J Med 2021 Mar 1; 88:145. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33648964 Free article