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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin condition primarily affecting the scalp, causing scaly, itchy, red skin and stubborn dandruff. In infants, this inflammatory disease usually appears in the first 3 months of life and is known as cradle cap. Seborrheic dermatitis can also affect the face, upper chest, back and other oily areas of the body. It is more common among men, tends to run in families, and is often worse in cold weather. Although seborrheic dermatitis is not harmful, it may be unsightly and uncomfortable (Merck & Co., Inc., 2009-2010; MFMER, 1998-2011).

Symptoms:

In infants, younger than 1 month, seborrheic dermatitis has the following signs and symptoms;

  • Cradle cap- a thick, yellow crusted scalp rash
  • Yellow scaling behind the ears
  • A stubborn diaper rash frequently accompanies the scalp rash
  • In most cases, the condition isn't itchy for infants, in the same way as it is for adults and older children (Merck & Co., Inc., 2009-2010).
  • In older children and adults, seborrheic dermatitis presents with;
  • Patchy scaling or thick crusts on the scalp, without hair loss
  • Yellow or white scales that attach themselves to the hair shaft
  • Red, greasy skin covered with flaky white or yellow scales
  • Reddish scaly pimples along the hairline, behind the ears, around the nose, on the chest, and on the upper back.
  • Itching or soreness
  • Skin flakes or dandruff (Merck & Co., Inc., 2009-2010; MFMER, 1998-2011).

Although seborrheic dermatitis primarily affects the scalp, it can occur between the folds of the skin or on skin rich in oil glands. It is commonly found in and between the eyebrows, on the sides of the nose, behind the ears, over the breastbone, in the groin area and sometimes under the arms. The symptoms of seborrheic dermatitis may show improvements and then alternate with times when they are worse (CNN, 2010).

Causes:

Although the exact cause of seborrheic dermatitis is unknown, a number of factors have been implicated as playing a role in the illness;

  • Predisposition- some people are predisposed to developing seborrheic dermatitis. These individuals have what is known as a seborrheic diathesis or an increased sebum secretion in the sebaceous gland rich areas of the body, namely the scalp, face, front of the chest, and in-between the shoulder blades.
  • Yeast colonization- a yeast (fungus) called malassezia that grows in the oily secretions that are found on the skin (sebum), along with bacteria. These yeasts breakdown and alter the composition of the sebum, triggering an inflammatory response of the skin. This in turn results in increased sebum production and the cycle begins again.
  • Stress and fatigue- lowered immunity and hormonal stimulation are reasons for seborrheic dermatitis in stressed and fatigued conditions.
  • Seasonal changes- seborrheic dermatitis tends to appear more frequently in low humid conditions and winter.
  • Low immune states- either due to medications or disease.
  • Hormonal triggers- androgen hormones control the sebaceous activity in humans. Seborrheic dermatitis is commonly seen in the first few months of life when maternal androgens are still present in the blood. The disease then recurs in susceptible individuals, when the sebaceous glands become active during puberty.
  • Food- excessive sugar, fast food and alcohol consumption, as well as vitamin and mineral deficiencies, have been found to increase the incidence of seborrheic dermatitis.
  • Drugs- certain medications such as antibiotics, systemic steroids, haloperidol, lithium, etc. have been found to increase seborrheic dermatitis.
  • Neurological conditions- seborrheic dermatitis is more common in people who have certain neurological conditions, such as Parkinson's disease
  • HIV/AIDS- people with HIV/AIDS are at a greater risk of developing seborrheic dermatitis. (CNN, 2010; suite 101.com).

Diagnosis:

 

Your doctor will make a diagnosis on the basis of a physical examination, by examining the skin and scalp and possibly doing a biopsy or other tests, to confirm the diagnosis and rule out other forms of dermatitis (MFMER, 1998-2011).

Types of seborrheic dermatitis:

It is important to differentiate seborrheic dermatitis from other conditions that also cause an itchy, scaly scalp, such as scalp dryness, contact allergies and psoriasis.

  • Infantile seborrheic dermatitis
  • Cradle cap
  • Trunk: Flexural, napkin (diaper) area
  • Leiner's disease
  • Adult seborrheic dermatitis
  • Scalp: Dandruff and inflammatory types
  • Face: Inflammatory and non inflammatory, with blepharitis (eyelid)
  • Trunk: Petaloid, pityriasiform, follicular, eczematous type
  • Generalized exfoliative erythroderma (suite 101.com).

Treatment:

Treatment is dependent on your child's skin type, the severity of the condition and where it appears on the body. The aim of the treatment is to control the signs and symptoms of seborrheic dermatitis and it must often be continued for several weeks in order to be effective. Hygiene plays a key role in controlling seborrheic dermatitis. Frequent cleansing with soap removes oil from affected areas and improves seborrhea (afar.org, 2000).

In infants and young children, a thick, scaly scalp rash, can be treated by gently rubbing 2% salicylic acid, mixed in mineral oil onto the scalp at bedtime.

Shampoo the scalp with a mild baby shampoo on a daily basis and gently brush with a soft brush to remove scales.

Rub 1% hydrocortisone cream into the scalp, to reduce inflammation

If the seborrheic dermatitis is complicated by a yeast infection, an ointment containing anti-yeast medication, such as nystatin, can be applied to the affected areas 3-4 times per day (Advameg, Inc., 2011; Merck & Co., Inc., 2009-2010).

In older children and adults, use a medicated shampoo every other day, until the condition is under control and then twice weekly. These shampoos can be bought over the counter and should contain ingredients such as, Ciclopirox, Tar, Selenium sulfide, Salicyclic acid, etc. It may be necessary to alternate between 2 different types of shampoo, especially if 1 appears to work for some time and then lose its effectiveness. Leave the shampoo on for 3-5 minutes, in order to allow the ingredients to work.

Thick crusty scales on the scalp can be loosened by applying corticosteroids and salicylic acid, under a shower cap at night.

Honey, 90% diluted in water, may be helpful in treating dermatitis and dandruff.

Non-prescription anti-fungal and anti-itch creams may help to control symptoms.

Topical steroids are prescribed for use on the head and other affected areas. Only mild corticosteroids may be used on the face, such as 1% hydrocortisone, because long term use can thin the skin and cause other problems (aisetc.org, 2011; MFMER, 1998-2011).

Other self help measures include; avoiding the use of harsh soaps and detergents, wearing cotton clothing to avoid irritation to the skin, and encouraging your child not to scratch whenever possible. Ensure that their nails are short, cover severely itchy areas with a cloth to prevent scratching and allow them to sleep with a pair of cotton gloves at night (MFMER, 1998-2011).

Complications:

Seborrheic dermatitis can have a psychosocial impact on your child's development. The diseases chronic visibility may have an effect on their self esteem. It is also possible for a secondary bacterial infection with Staphyloccocus aureus to occur, with typical impetigo. This involves increased redness, oozing and crusting (suite101.com).

Leiner's disease is a complication of seborrheic dermatitis in infants with a C5 complement deficiency. It is characterized by a sudden confluence of lesions leading to generalized scaling and redness of the skin. The child is severely ill with symptoms that include diarrhea, anemia and vomiting. there is a high risk for the development of a secondary bacterial infection (suite101.com).

Contact your doctor immediately if:

  • Your child's condition is causing them to lose sleep or is distracting them from their daily activities
  • Their skin is causing them pain
  • You suspect that your child has an infection
  • The rash does not improve after regular washings of baby shampoo
  • The rash spreads, becoming sore, red and itchy
  • The rash simultaneously appears in the diaper area
  • You have tried self-care steps without having any success or your child has very thick flakes. Your doctor may prescribe a stronger steroid or a combination medication to remove the dead skin. (About.com, 2011; Advameg, Inc., 2011; CNN, 2010).