Seborrheic Dermatitis

Seborrheic dermatitis is a chronic skin condition that mainly affects the areas of your body with a high number of oil-producing glands. These areas include the scalp, face (particularly around the eyebrows, nose, and ears), and sometimes the chest and back. The condition is characterized by redness, inflammation, itching, and the presence of greasy or flaky patches on the skin.

Types

Main types and characteristics of seborrheic dermatitis in plain English to help you better understand this condition.

1. Scalp Seborrheic Dermatitis (Dandruff)

Most commonly known as dandruff, this type is what many think of when they hear “seborrheic dermatitis.”

• What is it? – Flaky white or yellowish scales that appear on the scalp.
• How does it feel? – It can be itchy and a bit uncomfortable.
• Common in? – Both adults and infants. In babies, it’s called ‘cradle cap.’

2. Facial Seborrheic Dermatitis

This type affects the face, especially in areas where the skin may be oilier.

• What is it? – Red, scaly patches on the face, often around the nose, eyebrows, ears, and eyelids.
• How does it feel? – The skin can be itchy and feel inflamed.
• Common in? – Adults, especially those with oily skin.

3. Seborrheic Dermatitis on the Body

It’s not just the face and scalp that can be affected. The condition can appear on other parts of the body.

• What is it? – Red patches with yellowish scales, often seen on the chest, back, or in skin folds.
• How does it feel? – Can be itchy, with a burning sensation at times.
• Common in? – Mostly in adults.

4. Ear Seborrheic Dermatitis

The ears, both inside and behind, can also be affected.

• What is it? – Itchy, scaly patches inside the ear canal or behind the ear.
• How does it feel? – It can be quite itchy and even cause a feeling of fullness in the ear.
• Common in? – Both adults and children can have it.

5. Seborrheic Dermatitis in Infants

Called a ‘cradle cap’ when it’s on the scalp, but infants can have it in other places too.

• What is it? – Thick, crusty, yellowish scales on the scalp, face, or even diaper area.
• How does it feel? – It might be itchy for the baby, leading them to be fussy.
• Common in? – Infants under 3 months but can last up to a year or longer.

Causes

Common causes of seborrheic dermatitis in simple terms to help you grasp the root issues behind this condition.

1. Oily Skin: Excess oil production by your skin can clog pores, leading to inflammation and flakes.

2. Yeast Overgrowth: A type of yeast called Malassezia can grow too much, irritating your skin.

3. Genetics: Family history can increase your likelihood of developing seborrheic dermatitis.

4. Hormonal Changes: Fluctuations in hormones, like during puberty or pregnancy, can trigger flare-ups.

5. Stress: High stress levels can influence your immune system and worsen symptoms.

6. Weather Conditions: Cold, dry weather or excessive humidity can impact your skin’s health.

7. Poor Diet: A lack of nutrients can weaken your skin’s defenses against inflammation.

8. Irritating Skincare Products: Certain products with harsh chemicals can trigger reactions.

9. Improper Hygiene: Infrequent washing can lead to excess oil and dead skin buildup.

10. Medical Conditions: Parkinson’s disease, HIV, and other conditions can increase your risk.

11. Obesity: Extra weight can contribute to skin folds where seborrheic dermatitis develops.

12. Neurological Conditions: Conditions like epilepsy have a link to this skin problem.

13. Immune System Issues: A weakened immune system may struggle to keep the condition in check.

14. Alcohol-Based Products: Using products with alcohol can dry out your skin and worsen symptoms.

15. Certain Medications: Some medicines might increase your vulnerability to seborrheic dermatitis.

16. Sweat: Sweating heavily can lead to skin irritation and flare-ups.

17. Allergies: Allergic reactions to certain foods or substances could contribute.

18. Harsh Shampoos: Using strong shampoos or over-shampooing can disrupt your skin’s balance.

19. Lack of Sleep: Poor sleep can weaken your immune system and exacerbate symptoms.

20. Personal Habits: Frequently scratching or picking at your skin can worsen inflammation.

21. Airborne Allergens: Exposure to pollen, mold, or dust could trigger flare-ups.

22. Hormone-Based Cosmetics: Certain makeup or skincare products can interfere with hormone levels.

23. Inflammatory Diseases: Other inflammatory conditions like acne can make seborrheic dermatitis more likely.

24. UV Exposure: Excessive sun exposure can inflame the skin and lead to outbreaks.

25. Environmental Pollutants: Exposure to pollutants in the air can irritate your skin.

26. Excessive Washing: Washing your skin too often can strip away natural oils.

27. Hot Showers: Hot water can dry out your skin, worsening symptoms.

28. Humidity: High humidity levels can encourage yeast growth and inflammation.

29. Alcohol Consumption: Excessive alcohol intake might contribute to skin problems.

30. Certain Health Conditions: Medical issues like depression can impact your skin’s health.

Symptoms

Let’s dive into its top symptoms, explained in straightforward language.

1. Red Skin: The skin might appear reddish. It’s like when you blush, but it doesn’t go away quickly.
2. Flaky White or Yellow Scales: It looks like dandruff or the thin flakes you sometimes see on dry skin.
3. Itchy Skin: It can make you want to scratch. Sometimes, it’s just a little itch, but other times it might feel really strong.
4. Greasy Skin: The affected areas may feel oily or greasy to touch.
5. Swelling: The skin can puff up a bit in areas where you have seborrheic dermatitis.
6. Stinging or Burning: Some people feel a stinging or burning sensation, like a mild sunburn.
7. Hair Loss: The condition can be on the scalp too, causing hair to fall out more than usual.
8. Ear Crust: If it affects the ears, you might notice crusty or flaky skin there.
9. Eyebrow and Eyelash Dandruff: Yes, dandruff isn’t just for your head. It can appear on eyebrows and eyelashes too!
10. Red Spots on the Chest and Back: Seborrheic dermatitis isn’t just a face and scalp thing. It can show up on the chest and back as red spots.
11. Crusting: It’s when the skin forms a crust-like layer. Imagine when a wound dries up, but in this case, it’s due to the skin condition.
12. Oily Scalp: Just like greasy skin, the scalp can also become oily.
13. Pink Patches: Sometimes, the red areas might look pinkish, especially in lighter-skinned people.
14. Dryness: Even if it can be oily, some areas might also appear dry and chapped.
15. Bad Odor: In some cases, affected areas might give off a mild smell.
16. Eyelid Redness or Dandruff: It can even affect the eyelids, making them look reddish or flaky.
17. Thick Patches: In severe cases, the skin might form thick patches, which can be uncomfortable.
18. Pimples: Tiny pimples might pop up around the affected areas.
19. Sensitive Skin: Skin becomes more sensitive, so some products or fabrics might cause irritation.
20. Bleeding: If you scratch a lot, the skin might break and bleed.

Diagnosis

Here’s a simple guide to understanding seborrheic dermatitis better.

1. Clinical Examination: This is the first step. A doctor looks at your skin and asks questions about your symptoms. If you have flaky skin or red patches, especially on the scalp, face, or chest, you might have seborrheic dermatitis.

2. Medical History: Your doctor will ask about your health history to see if there’s a pattern or any triggers that might cause the condition.

3. KOH Test: This involves taking a skin scraping and placing it under the microscope with potassium hydroxide. It helps rule out fungal infections.

4. Biopsy: In rare cases, a small piece of skin is taken to examine it closely. This helps in confirming the diagnosis.

5. Patch Testing: Sometimes, you might be allergic to something. A patch test can identify if allergies play a role in your skin condition.

6. Blood Tests: These are uncommon, but they can rule out other conditions or infections that might look like seborrheic dermatitis.

7. Hormone Tests: As hormones can influence your skin, sometimes a test might be done to check their levels.

8. Fungal Culture: This checks if a yeast or fungus is causing the problem.

9. Sebum Production Test: Some people produce more oil on their skin. This test measures that.

10. Allergy Testing: This will rule out other allergic reactions that might be causing skin problems.

11. Skin pH Test: It measures the acidity or alkalinity of your skin, which can influence seborrheic dermatitis.

12. Hair Pull Test: If you’re losing hair, this test helps understand why.

13. Trichoscopy: This is a close-up look at your scalp using a special device. It can reveal signs of seborrheic dermatitis.

14. Dermatoscopy: A device that magnifies the skin area to help doctors see it better.

15. Dandruff Check: A simple look to see if you have dandruff, which is a mild form of seborrheic dermatitis.

16. Diet Review: Sometimes, what you eat can influence your skin. Your doctor might review your diet.

17. Lifestyle Assessment: Factors like stress or lack of sleep can play a role. A lifestyle assessment can uncover such triggers.

18. Immune System Evaluation: On rare occasions, an immune system check is done to rule out related conditions.

19. Family History: As this condition can run in families, it’s good to know if others in your family have it.

20. Medication Review: Some medicines can affect your skin. Your doctor will check if any drugs you’re taking might be the cause.

21. Stress Test: Since stress can trigger seborrheic dermatitis, a test or questionnaire might be used to gauge your stress levels.

22. Bacterial Culture: This checks if bacteria might be causing your skin issues.

23. Environmental Assessment: Sometimes, your surroundings, like where you live or work, can affect your skin.

24. Chemical Exposure Review: To see if you’ve been in contact with chemicals that might be causing the condition.

25. Hygiene Habits Review: Your doctor will ask about your skincare routine to see if it might be contributing.

26. Ultraviolet (UV) Light Examination: Sometimes, exposing the skin to UV light can help in diagnosing the condition.

27. Moisture Test: Measures the moisture levels of your skin.

28. Skin Friction Test: Checks how your skin reacts to friction, as it can worsen the condition.

29. Response to Treatment: Sometimes, the best way to diagnose is to give treatment and see if it helps.

30. Second Opinion: If unsure, always get another doctor to take a look.

Treatment

Here are the top treatments, described simply:

1. Topical Steroids: These are creams applied to the skin to reduce inflammation. They help lessen redness and itchiness.
2. Oral Steroids: These are pills, like prednisone, taken to control severe outbreaks.
3. Dapsone: An oral medication, it helps decrease the number of blisters.
4. Tetracycline Antibiotics: Pills taken to reduce inflammation. Not for fighting infections in this case.
5. Isotretinoin: A pill often used for acne, but it can help SWD by reducing the size and number of blisters.
6. Methotrexate: An oral or injectable drug that controls the immune system. This can help reduce skin symptoms.
7. Colchicine: A pill that helps decrease inflammation and blistering.
8. Nicotinamide: This is a form of Vitamin B3. It can be taken as a pill and can reduce blisters.
9. Etretinate: Another oral pill that can reduce the formation of pustules or blisters.
10. Phototherapy: This is a special kind of light treatment. The skin is exposed to ultraviolet (UV) light, which can help reduce symptoms.
11. Cyclophosphamide: A strong drug, often used in cancers, but it can help severe cases of SWD by controlling the immune system.
12. Azathioprine: Another medication to control the immune system. It can be very effective for some people.
13. Mycophenolate Mofetil: A pill that adjusts the immune system and can lessen the number of blisters.
14. Tacrolimus: A cream that controls the immune system and reduces inflammation when applied to the skin.
15. Intravenous Immunoglobulin (IVIG): A treatment where good antibodies are given through a vein. It can help boost the immune system and treat SWD.
16. Biologics: These are newer drugs that target specific parts of the immune system. Examples include adalimumab and infliximab.
17. Retinoids: These are derivatives of Vitamin A. They can be applied to the skin or taken as pills to help control blistering.
18. Cyclosporine: An oral medication that can adjust the immune system and help reduce symptoms.
19. Plasmapheresis: A process where the blood is cleansed to remove harmful antibodies. It can help severe cases.
20. Gold Therapy: Using gold salts as medicine can sometimes help reduce the number of blisters. However, it’s not very common now due to side effects.
21. Chlorambucil: A strong medication sometimes used in severe cases to control the immune system.
22. Thalidomide: Used in some severe cases, but it comes with risks and needs careful monitoring.
23. Omalizumab: A newer drug that can help control the immune response and reduce symptoms.
24. Erythromycin: An antibiotic that can help reduce inflammation and pustules.
25. Clofazimine: This drug, often used for leprosy, can help control SWD in some cases.
26. Sulfapyridine: A medication that can reduce the number and severity of pustules.
27. Potassium Iodide: Sometimes, taking this can lead to an improvement in SWD symptoms.
28. Acitretin: A pill that can reduce the formation of pustules or blisters.
29. Laser Therapy: Targeted laser treatments can reduce certain skin lesions and improve appearance.
30. Surgery: In rare cases, if there’s a large area of damaged skin, surgery might be needed.

In Conclusion

Sneddon-Wilkinson’s Disease can be a challenging condition. However, numerous treatments are available, from creams and pills to more advanced therapies. It’s essential for patients to discuss these options with a dermatologist to find the most suitable treatment.

Remember, everyone’s body is different. What works for one person might not work for another. Always consult with a medical professional before starting any treatment.

References