Seborrheic dermatitis

Definition

Seborrheic dermatitis is a common inflammatory disease of the scalp and skin characterized by scaly lesions usually on the scalp, hairline, face and body. In infants, it is sometimes called cradle cap.

Description

Seborrheic dermatitis appears as red, inflamed skin covered by greasy or dry scales that may be white, yellowish, or gray. It can affect the scalp, eyebrows, forehead, face, folds around the nose and ears, the chest, armpits, and groin. In infants it appears most commonly on the scalp and is called cradle cap. Dandruff is a mild form of seborrheic dermatitis and appear as fine white scales without red skin or inflammation. Dandruff can also be caused by other skin conditions, especially in children.

Seborrheic dermatitis is a common, mild disease of newborns. The red, scaly rash can spread to the forehead, behind the ears, and in the creases of the neck and armpits. The rash is not itchy and usually does not bother babies. Occasionally babies also develop this skin disease in the diaper area. When seborrheic dermatitis occurs in the diaper area, it is often accompanied by a yeast infection. When yeast is present, the rash is itchy and uncomfortable. Seborrheic dermatitis usually disappears by the end of the first year and does not reappear until puberty .

Transmission

Seborrheic dermatitis is not an infection and is not transmitted from individual to individual.

Demographics

Seborrheic dermatitis is a very common among newborns. It usually appears the first six weeks of life and rarely after the age of nine to 12 months. It affects babies of all races and both genders. Seborrheic dermatitis can reappear at puberty and into adulthood.

Causes and symptoms

As of 2004 the cause of seborrheic dermatitis was not clear. However, it is not an infection or an allergy, it is not contagious, and it is not caused by poor hygiene. Seborrheic refers to the sebaceous, or oil producing, glands of the skin. It appears that in pregnancy, hormone changes in the mother may cause these glands to produce too much oil. When this happens, scales develop in the area where the oil glands are most dense. Seborrheic dermatitis may also be linked to genetic factors.

Babies exhibit a characteristic non-itchy greasy red scaly rash or dry whitish or grayish scales on the scalp and possibly on other areas.

When to call the doctor

If the rash does not improve after regular washings with baby shampoo or if the rash spreads and becomes red and itchy, especially in the diaper area, the doctor should be consulted.

Diagnosis

Diagnosis is made on visual inspection of the rash.

Treatment

Frequent washing of the scalp with a mild baby shampoo followed by brushing with a soft brush to remove scales usually clears up cradle cap. In stubborn cases, a special shampoo containing sulfur and salicylic acid can be used. This treatment should be done only after consultation with a pediatrician, since this shampoo may be irritating to babies. Sometimes an ointment containing cortisone, an anti-inflammatory medication, is prescribed. If the seborrheic dermatitis is complicated by a yeast infection, an ointment containing anti-yeast medications such as nystatin is applied to the infected area three or four times daily.

Alternative treatment

Parents may rub mineral oil into their child's scalp to soften and loosen the scales, but the oil should be brushed or shampooed out and not left to accumulate.

Prognosis

Seborrheic dermatitis normally resolves without difficulty, usually by the age of six months and almost always by the end of the first year. The rash does not leave scars.

Prevention

Seborrheic dermatitis cannot be prevented from developing, although it may be controlled through frequent hair washings with a mild baby shampoo.

Parental concerns

Parents are often concerned that the rash will leave a scar on their baby's skin. However, scarring does not occur.

KEY TERMS

Cortisone —Glucocorticoid produced by the adrenal cortex in response to stress. Cortisone is a steroid with anti-inflammatory and immunosuppressive properties.

Dermatitis —Inflammation of the skin.

Salicylic acid —An agent prescribed to treat a variety of skin disorders, such as acne, dandruff, psoriasis, seborrheic dermatitis, calluses, corns, and warts.

Sebaceous —Related to the glands of the skin that produce an oily substance called sebum.

Resources

WEB SITES

"Cradle Cap." Pediatric Advisor. Available online at <www.pmhs.org/crs/pa/hhg/cradlcap.htm> (accessed November 13, 2004).

"Cradle Cap (infantile seborrhoeic dermatitis)." DermNet NZ. Available online at <http://dermnetnz.org/dermatitis/cradle-cap.htlm> (assessed November 13, 2004).

Tish Davidson, A.M. Kathleen D. Wright, RN

Seborrheic Dermatitis

Definition

Seborrheic dermatitis is a common inflammatory disease of the skin characterized by scaly lesions usually on the scalp, hairline, and face.

Description

Seborrheic dermatitis appears as red, inflamed skin covered by greasy or dry scales that may be white, yellowish, or gray. It can effect the scalp, eyebrows, forehead, face, folds around the nose and ears, the chest, armpits (axilla), and groin. Dandruff and cradle cap are mild forms of seborrheic dermatitis, and appear as fine white scales without inflammation.

Causes and symptoms

The cause of seborrheic dermatitis is unclear, though it is has been linked to genetic or environmental factors. Pityrosporum ovale, a species of yeast normally found in hair follicles, has been proposed as one possible causative factor. A high fat diet and alcohol ingestion are thought to play some role. Other possible risk factors include:

• stress and fatigue
• weather extremes (e. g. hot, humid weather or cold, dry weather)
• oily skin
• infrequent shampoos
• obesity
• Parkinson's disease
• AIDS
• use of drying lotions that contain alcohol
• other skin disorders (for example acne, rosacea, or psoriasis)

Mild forms of the disorder may be asymptomatic. Symptoms also disappear and reappear, and vary in intensity over time. When scaling is present, it may be accompanied by itching that can lead to secondary infection.

Diagnosis

The diagnosis of seborrheic dermatitis is based on assessment of symptoms, accompanied by consideration of medical history.

Treatment

Treatment consists of vigorous shampoos with preparations that assist with softening and removing the scaly accumulations. For mild cases, a nonprescription shampoo with selenium sulfide or zinc pyrithione may be used. For more severe problems, the doctor may prescribe shampoos containing coal tar or scalp creams containing cortisone. The antiseborrheic shampoo should be left on the scalp for approximately five minutes before rinsing out. Hydrocortisone cream may also be ordered for application to the affected areas on the face and body. Application of the hydrocortisone should be discontinued when the condition clears and restarted with recurrence.

Prognosis

This chronic condition may be characterized by long periods of inactivity. Symptoms in the acute phase can be controlled with appropriate treatment.

KEY TERMS

Acne— A chronic inflammation of the sebaceous glands that manifests as blackheads, whiteheads, and/or pustules on the face or trunk.

Psoriasis— A skin disorder of chronic, itchy scaling most commonly at sites of repeated minor trauma (e.g. elbows, knees, and skin folds). It affects up to 2% of the population in Western countries—males and females equally.

Rosacea— A chronic inflammation of the face, with associated scattered round nodules and increased reactivity of the facial capillaries to heat. It is most common in females, aged 30-50 years.

Prevention

The condition cannot be prevented. The severity and frequency of flare-ups may be minimized with frequent shampoos, thorough drying of skin folds after bathing, and wearing of loose, ventilating clothing. Foods that appear to worsen the condition should be avoided.

Resources

BOOKS

Monahan, Frances, and Marianne Neighbors. Medical Surgical Nursing: Foundations for Clinical Practice. Philadelphia: W. B. Saunders, 1998.

Seborrheic dermatitis

Definition

Seborrheic dermatitis is a common inflammatory disease of the skin characterized by scaly lesions usually on the scalp, hairline, and face.

Description

Seborrheic dermatitis appears as red, inflamed skin covered by greasy or dry scales that may be

white, yellowish, or gray. It can effect the scalp, eyebrows, forehead, face, folds around the nose and ears, the chest, armpits (axilla), and groin. Dandruff and cradle cap are mild forms of seborrheic dermatitis, and appear as fine white scales without inflammation.

Causes and symptoms

The cause of seborrheic dermatitis is unclear, though it is has been linked to genetic or environmental factors. Pityrosporum ovale, a species of yeast normally found in hair follicles, has been proposed as one possible causative factor. A high fat diet and alcohol ingestion are thought to play some role. Other possible risk factors include:

• stress and fatigue
• weather extremes (e. g. hot, humid weather or cold, dry weather)
• oily skin
• infrequent shampoos
• obesity
• Parkinson's disease
• AIDS
• use of drying lotions that contain alcohol
• other skin disorders (for example acne, rosacea, or psoriasis)

KEY TERMS

Acne —A chronic inflammation of the sebaceous glands that manifests as blackheads, whiteheads, and/or pustules on the face or trunk.

Psoriasis —A skin disorder of chronic, itchy scaling most commonly at sites of repeated minor trauma (e.g. elbows, knees, and skin folds). It affects up to 2% of the population in Western countries—males and females equally.

Rosacea —A chronic inflammation of the face, with associated scattered round nodules and increased reactivity of the facial capillaries to heat. It is most common in females, aged 30–50 years.

Mild forms of the disorder may be asymptomatic. Symptoms also disappear and reappear, and vary in intensity over time. When scaling is present, it may be accompanied by itching that can lead to secondary infection.

Diagnosis

The diagnosis of seborrheic dermatitis is based on assessment of symptoms, accompanied by consideration of medical history.

Treatment

Treatment consists of vigorous shampoos with preparations that assist with softening and removing the scaly accumulations. For mild cases, a non-prescription shampoo with selenium sulfide or zinc pyrithione may be used. For more severe problems, the doctor may prescribe shampoos containing coal tar or scalp creams containing cortisone. The antiseborrheic shampoo should be left on the scalp for approximately five minutes before rinsing out. Hydrocortisone cream may also be ordered for application to the affected areas on the face and body. Application of the hydrocortisone should be discontinued when the condition clears and restarted with recurrence.

Prognosis

This chronic condition may be characterized by long periods of inactivity. Symptoms in the acute phase can be controlled with appropriate treatment.

Prevention

The condition cannot be prevented. The severity and frequency of flare-ups may be minimized with frequent shampoos, thorough drying of skin folds after bathing, and wearing of loose, ventilating clothing. Foods that appear to worsen the condition should be avoided.

Resources

books

Monahan, Frances, and Marianne Neighbors. Medical Surgical Nursing: Foundations for Clinical Practice. Philadelphia: W. B. Saunders,1998.

Kathleen D. Wright RN