Dermatitis Seborroeik FK UNTAR 2011

Dermatitis SeborroeikOleh Dr Maria Dwikarya SpKKFK UNTAR Jakarta

DEFINISISeborrheic dermatitis is a common, inflammatory skin condition that causes flaky,white to yellowish scales to form on oily areas such as the scalp or inside the ear It can occur with or without reddened skinCradle cap is the term used when seborrheic dermatitis affects the scalp of infants

Incidence Internationally: The prevalence rate of Seborrheic Dermatitis is 3-5%, with a worldwide distributionDandruff, the mildest form of this dermatitis, is probably far more common and is present in an estimated 15-20% of the populationRace: Seborrheic dermatitis occurs in persons of all races

Sex:

Age: Infants + Adults

Seborrhoeic dermatitis can not be passed from person to personTiredness and Stress can sometimes trigger a flare of seborrhoeic dermatitisIt is not related to dietIt is more common in cold than in warm weatherHereditary

Pathogenesis

The scalpthe scalp margineyebrowsnasolabial foldsexternal ear canalspostauricular creasesnavelanogenital areasgroininframammary

PATHOPHYSIOLOGYSEBORRHEIC DERMATITIS

Immunosupressan

ParkinsonDrugsP. Ovale

Niacin DeficiencyNutritional DeficiencyHormon( Androgen)

On the scalp: seborrhoeic dermatitis here ranges from a mild dandruff to a redder, scalier, and sometimes oozy rash, which can extend out onto nearby parts of the forehead and around the ears. Cradle cap in infants may be part of a seborrhoeic dermatitis

Seborrhoeic DermatitisOn the face: It often affects the inner parts of the eyebrows, the creases beside the nose & adjacent parts of cheeksThe eyelids may also be red and irritable (blepharitis)

Area Naso Labial : Inflamasi , Eritema, Skuama kuning & Fissura Area RetroAurikular : Eritema, Skuama kuning,Fissura & KrustaInflamasi di dalam Liang telinga timbul Cerumen Probe

Area Infra-Mammary and Axillar

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LaboratoryYeast cells sometimes are visible within keratinocytes on special stains. If hyphae are present, dermatomycosis is the diagnosis. Shorter hyphae with spores ("spaghetti and meatball pattern") are present with Tinea VersicolorSkin biopsies may effectively distinguish seborrheic dermatitis from similar disordersSeborrheic dermatitis should have neutrophils in the scale crust at the margins of follicular ostiaAIDS-associated seborrheic dermatitis more commonly presents as parakeratosis, a few individually necrotic keratinocytes within the epidermis, and plasma cells in the dermis

Schwartz RA. Superficial fungal infections. Lancet 2004;364:1173-82

Differential Diagnosis

Ds SeborhoeicDs Foto kontakPsoriasisVulgarisLupusEritematosusDermatoFitosisYellow scaleFold areaScalpFace AxillaChestNavelAnogenital

Hair LossEritemEdemaSunExpAreaCosmoCeuticalused

No Hair LossDry scaleTraumaAreaScalpFaceNail PitOnikolisisPalmoPlantar

No Hair LossButterfly appSunExpAreaArthritisGNCarditisPleuritisAnemiaLeukopeniaTrombosit

Hair LossPolicyclicFoldAreaCentralHeal

IntrdigitPedis

Hair Loss

Seborrheic Dermatitis can occur in patient with Stroke

http://www.aocd.org/skin/dermatologic_diseases/seborrheic_dermati.htmlIN

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TODAYUNTAR NEWSToday headline : Dermatology

I N T E L E V I S I O N T O D A Y

General TreatmentHygiene issues play a key role in controlling seborrheic dermatitis, patients should be counseled that good hygiene must be a lifelong commitmentThe secondary infection must be handled first by oral antibioticsFrequent cleansing with soap removes oils from affected areas and improves seborrheaOutdoor recreation, especially during summer, will also improve seborrhea, although caution should be taken to avoid sun damage.

Treatment for Cradle CapLoosen the scales and improve scalp circulation: Massage your baby's scalp gently with your fingers or a soft brush to

Give your child daily, gentle shampoos while scales are present. Scales`ve been disappeared, you may reduce shampoos 2x weekly.

Be sure to rinse off all soap. Brush your child's hair with a clean, soft brush after each shampoo.

If scales do not easily loosen and wash off, apply some mineral oil to the baby's scalp and let it on for 1- 2 hour. Please rinse the scalp then

If the scales continue to be a problem or to be scratched by him, please contact your physician. He may prescribe oral antibiotics and

lotion to apply to your baby's scalp before shampooing .

Treatment of the FaceAntidandruff shampoos for Facial washKetoconazole 2% + Hydrocortisone 1 % cream

twice daily to affected areas ( several days ) once daily when Erythema and Itching

Treatment of the BodySeborrhea of the trunk may be treated with frequent application of antidandruff shampoos or by washing with zinc soapsAdditionally, topical

ketoconazole 2%+corticosteroid cream, lotion or solution applied once / twice daily will be useful Benzoyl peroxide 5 % gel

helpful in controlling seborrhea of the trunk

ShampoosSelenium sulfide 1% - 2.5% (Selsun Blue) Pyrithione zinc, 1% / 2% (Head&Shoulders) Instruction :

5 -10 minute apply before taking bath application daily initially one week; then once weekly for one month

Psychological distressLow self esteemEmbarrassment Secondary bacterial or fungal infections

Seborrheic dermatitis is a chronic (life-long) condition that can be controlled with treatmentPrognosis