Seborrheic Dermatitis

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Seborrheic Dermatitis:

Seborrheic Dermatitis Family Nurse Practitioner I K. Michelle Pendergrass PhD(c), PNP, FNP-BC

Definition:

Definition “Common, chronic, inflammatory skin disorder with a characteristic pattern for different age groups” Non-contagious Yeast variations have been linked

In Infants-Cradle Cap:

In Infants-Cradle Cap Begins in first month Idiopathic-most likely yeast No weeping or oozing May have diaper involvement Overproduction of skin cells leading to flaking, and inflammation leading to redness & itching

Contradictions in literature:

Contradictions in literature Some say this is non- pruritic , while others say mild to moderate pruritis . Infants may rub or scratch (U&G, FPN, SS, AAD)

Signs:

Signs Scalp (Cradle Cap) Diffuse or focal thick greasy Scaling and crusting dermatitis No weeping or oozing Face, Neck, Retro-auricular, Axillae (flexural folds and intertriginous areas) Dry, scaly, erythematous papules

Differential Diagnosis:

Differential Diagnosis Psoriasis Tinea capitis / faciale Atopic Dermatitis Scabies Diagnostic tests: usually none

Plan/Management:

Plan/Management Be conservative. This is a benign condition that resolves spontaneously Wet compresses (saline) to affected area Baby shampoo and Soft brush to remove scales from scalp. Repeat 2-3x/wk Course is self limited and resolves within first few months of life (FPN, U&G)

Seborreic Dermatitis Adults:

Seborreic Dermatitis Adults Idiopathic cause-yeast plays a role Symptoms Greasy, scaling rash on face and scalp Pruritis , burning May report improvement over summer months

Signs:

Signs Erythema Scaling Greasy or oily skin Distribution: Head & Face Scalp Nasolabial fold Behind the ear Central face Beard area Eyebrows

Signs (continued):

Signs (continued) Distribution (continued) Chest Involvement Under the breast Petaloid seborrhea (flower petal-like) Red-brown Papules with scale Papules evolve into contiguous patches Pityriasiform seborrhea ( Pityriasis Rosea -like) Generalized Macules and patches

Associated Findings:

Associated Findings Blepharitis Otitis Externa Acne Vulgaris Pityriasis versicolor

Associated Conditions:

Associated Conditions Immunodeficiency Most common early cutaneous manifestations of HIV infection Nutritional deficiency Impaired essential fatty acid metabolism Neurological conditions (Parkinsonism, CVA, Epilepsy) (FPN)

Differential diagnosis:

Differential diagnosis Contact dermatitis Atopic dermatitis Psoriasis Tinea capitis / faciale Acne rosacea Candidiasis Dermatophytosis Systemic Lupus Erythematosus

Management:

Management Topical antifungals Nizoral shampoo ( ketocanazole 2%), qd then taper with improvement Nizoral cream bid to body Oral antifungals in more resistant cases; ketoconazole 200 mg po qd x 10d Topical steroids (mild and often in comb. w/ antifungals Maintenance: Tar, zinc, sulfur, selenium sulfide,and saicylic acid shampoos regularly used and applied for 5-15min prior to washing

Referral and Follow-up:

Referral and Follow-up Recalcitrant cases-refer to specialist Follow-up not needed except for treatment failure

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