Seborrheic Dermatitis

Seborrheic Dermatitis

What is Seborrheic Dermatitis?

Seborrheic Dermatitis is a common chronic inflammatory condition of the skin. It is categorized as a type of chronic eczema, affecting the body area that has more sebaceous glands. characterized by red, greasy scaly patches.

Commonly, the rash manifestation of seborrheic dermatitis tends to affect the scalp, the center of the face, including the eye brows, the glabella, nasolabial fold, the skin over the front chest wall and upper back.

What causes Seborrheic Dermatitis?

Seborrheic Dermatitis is a combination of both genetic and environmental factors. The surface of the sebaceous region of the skin is a conducive environment for a yeast(fungus) known as Malassezia to grow and thrive.

When there is overgrowth of Malassezia, the fungus triggers to immune system to react on the skin area leading to inflammation and manifestation of itch, flakes and scales and greasy red rashes.

What are the symptoms of Seborrheic Dermatitis?

Patients commonly experience

  • Red greasy patchy rash
  • Itching
  • Scaling, flakiness
  • Dandruff

Commonly affected region includes the scalp, center of the face, the eye brows, glabella region, nasolabial fold, the chest wall and upper back.

What are the common triggers for Seborrheic Dermatitis?

Common triggers include

  • Stress
  • Acute illness
  • Hormonal changes
  • Change of temperature/ weather/ season
  • Strong detergent/ chemicals/ soaps
  • Medications such as mood control medication (lithium)
  • Underlying medical conditions such as HIV, parkinson’s disease

Who is at risk of developing Seborrheic Dermatitis in Singapore?

Seborrheic dermatitis can affect anyone, though it is more common in:

  • Infants
  • Adults between 30-60 years old
  • Males

Risk factors:

  • Stress
  • Patients with immunocompromised systems
  • History of retroviral disease
  • Parkinson’s disease

How is Seborrheic Dermatitis diagnosed?

Seborrheic Dermatitis is usually diagnosed clinically. Your doctor will review your rash history, known medical history and physically examine the rash to determine the diagnosis. Sometimes, when the diagnosis are uncertain, your doctor may offer you further tests such as fungal skin scrape test, bacterial swab tests, or skin biopsy sampling to evaluate and confirm the diagnosis.

How is Seborrheic Dermatitis treated in Singapore?

Depending on individual presentation, severity, expectation, your doctor may offer you treatment with topical creams and shampoo.

In more recalcitrant and severe cases your doctor may advise for oral medication together with topical medication. Counselling on lifestyle measures to avoid triggers are important in a holistic approach for managing seborrheic dermatitis.

Common medications that are used in treatment of seborrheic dermatitis include topical steroid, antifungal topical and oral, topical calcineurin inhibitors, anti-fungal shampoo, coal tar shampoo.

FAQS

Patients with Seborrheic Dermatitis may notice they have family members with similar skin contions. This is suggestive of seborrheic dermatitis to have a hereditary or genetic component in its cause/pathophysiology. The exact genetic link for seborrheic dermatitis still requires further clinical research evidence.

As Seborrheic Dermatitis can be attribute to various stress, infection temperature change, hormonal changes and etc, the skin condition can run a wax and wane chronic journey. It can cause frustration and have a negative impact on psychosocial aspect, you are advised and encouraged to discuss with your doctor on your condition if the rash keeps recurring.

Although there is no cure for Seborrheic Dermatitis, your doctor will discuss with you on holistic ways to manage the condition, targeting both lifestyle measures to avoid triggers and treatment to suppress and control the yeast load on the surface to minimize flare up of clinical symptoms.

Lifestyle measurements to relieve stress are important. You are advised to obtain adequate rest and sleep, regular exercises, engage in activities to improve self care.

Your doctor will guide you through during your follow up on topical options that can be obtain over the counter such as certain antifungal cream, wash, or emollients. Speak to your doctor during your consultation on Seborrheic dermatitis.

Most patients with thyroid nodules do not have any symptoms. However if the thyroid nodules size are enlarged, the airway or the throat can be affected and patients can develop compressive symptoms such as difficulty swallowing or breathing. In thyroid nodules which are ‘active’, patients can present with excessive thyroid hormone production (hyperthyroidism). Do speak to your doctor if you do experience any abnormal thyroid symptoms.

Seborrheic Dermatitis is not contagious and cannot be spread by touching or direct contact. It is important to educate both patient and close family/friends that although there is a role of yeast infection in seborrheic dermatitis, it will not be spread person to person.

Babies with seborrheic dermatitis develop a rash known as ‘cradle cap’, as the rash presents over the scalp (cap region). Interestingly seborrheic dermatitis can also present over the buttock region. The condition is benign and thankfully, in most infants, the condition clears on its own. If your infant is having a persistent rash, do bring your infant to seek medical advice.

Although the appearance of Seborrheic Dermatitis seems to appear ‘dirty’, and ‘unhygienic’, it is not due to cleanliness reasons. Instead, Seborrheic dermatitis is an inflammatory condition of the skin. Speak to your doctor to understand more on seborrheic keratosis.

Medical conditions such as HIV, Parkinson’s disease, psoriasis, acne, rosacea, epilepsy, mood disorders may be associated with Seborrheic Dermatitis. Your doctor will obtain a relevant targeted history. Depending on your condition and risks, you may be offered further blood tests to screen for underlying medical conditions.

Seborrheic Dermatitis is a benign skin inflammatory condition. It is not cancerous. However, a rash that does not improve warrants a repeat evaluation by the attending physician to ensure not missing diagnosis such as squamous cell carcinoma.

The clinical evidence against food triggers in seborrheic dermatitis is not robust. It is believed that ‘western’ diet consisting high protein/meat diet and processed food may be associated with seborrheic dermatitis. You are advised to consume a healthy balance diet and reduced excessive protein/meat diet and processed food.

Severe seborrheic dermatitis over the scalp can cause hair loss. This is secondary to the damage of the hair follicle on the scalp from an increased sebum production and Malassezia/yeast inflammation. The silver lining here is that the hair loss is reversible once the inflammation from seborrheic dermatitis subsides. Speak to your doctor for treatment of hair loss from seborrheic dermatitis.

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