1. SEBORRHOEIC DERMATITIS

2. INTRODUCTION
• Chronic Papulo-Squamous Dermatitis with
Yellowish, Waxy, Branny Scaling
• Syn : SEBORRHOEIC ECZEMA
• Associated with SEBORRHOEA
• Along distribution of Sebaceous Glands
(Primarily Scalp / Face / Trunk)

3. ETYMOLOGY
Seborrhoeic
(Latin : ‘Sebum’ – Oil/Wax + ‘Orrhoea’ – Flow)
Dermatitis
(Greek: ‘Derma’ – Skin + ‘itis’ – Inflammation)

4. HISTORY
• Described in 16th Century by Greek Physician
Paulus Aeginata ( Paul of Aegina)
• Pityriasis Spectrum
• Implication of ‘Furfur fungus’
• Medica Operi (Published in 1542)

5. EPIDEMIOLOGY
• Bimodal Age Incidence
0-3 Months of life
4th – 7th Decade of life
• Common in HIV/AIDS & PARKINSONISM
• Men > Women
• 03 – 05 % Prevalence

6. ETIOPATHOGENESIS
• EXACT CAUSE UNKNOWN
• SEBORRHOEA
No Sebaceous Gland Pathology
Sebum Production Infancy  Puberty
Retention of Skin Surface Lipids
(Eczema Flanneraire)

7. ETIOPATHOGENESIS
• Sebum =  CHOLESTEROL / TRIGs
 SQUALENE / WAX ESTERS / FFAs
Thought to be an Aberration in
EPIDERMAL PROFILERATION

8. ETIOPATHOGENESIS
• MICROBIAL EFFECTS
• Candida Albicans
• Staphylococcus Aureus Previously
• Propionibacterium Acne

9. ETIOPATHOGENESIS
• Malassezia Furfur (erst Pityrosporum Ovale)
• Lipophilic Yeast / 665,000 Org per sq cm
(500,000 in Normal Skin)
• Aggravating > Causative
• T-Cell Activation +/- Complement Activation

10. ETIOPATHOGENESIS
• DRUGS (Gold / Arsenic / Methyl DOPA)
• SEASONAL PREDILECTION (Winters)
• EMOTIONAL LABILITY / STRESS
• NUTRITIONAL DEFICIENCY (Zn / BIOTIN)
• ??GENETIC

11. CLINICAL PATTERNS : INFANTS
CRADLE CAP
TRUNCAL LESIONS
LENIER’S DISEASE (FAM / NON-FAM)

12. CLINICAL PATTERN : ADULTS
• SCALP
• FACE
• TRUNK
PETALOID / PITYRIASIFORM / FLEXURAL
EZCEMATOUS PLAQUES / FOLLICULAR
• GENERALIZED

13. SEBACOUS GLANDS : DISTRIBUTION

14. INFANTILE SEB DERM
• SCALP
Initially Sparse Inflammatory Yellowish, Oily Flakes

Thick Crusted, Grayish-Yellow Scales over an
Erythematous Plaque (Extn beyond Hairline)
without Alopecia - Crusta Lactea / Cradle Cap

15. INFANTILE SEB DERM

16. INFANTILE SEB DERM

17. INFANTILE SEB DERM
• S

18. INFANTILE SEB DERM

19. INFANTILE SEB DERM

20. LEINER’S DISEASE
• Syn : Erythroderma Desquamativum
Dermatitis Seborrhoides Infantum
Discovered by Leiner in 1908
Complication of Infantile Seb Derm with
Confluent Scaly Erythema > 90 % BSA
+ GI Manifest + Anemia
C5 Deficiency (Familial)

21. LENIER’S DISEASE

22. LENIER’S DISEASE

23. DIFFERENTIALS : INF SEB DERM
• ATOPIC DERMATITIS
• PSORIASIS
• SCABIES

24. TREATMENT
• SCALP
WARM OIL COMPRESSES
3 % SALICYLIC ACID SHAMPOO / OIL
DESONIDE LOT 0.05 %
HYDROCORTISONE CREAM 1 %
IMIDAZOLE SHAMPOOS

25. TREATMENT
• BODY/ INTERTIGO
CLIOQUINOL 0.2 – 0.5% IN Zn OIL
KETOCONAZOLE 2% CREAM / SOFTPASTE
DESONIDE LOT 0.05%

26. ADULT SEB DERM

27. SCALP IN SEB DERM
• PITYRIASIS SICCA
• PATCHY SEB DERM + CORONA SEBORRHEICA
• PITYRIASIS AMIANTACEA

28. PITYRIASIS SICCA (DANDRUFF)

29. SEB DERM : SCALP
• Perifollicular, Erythematous Plaques with
Branny Gray-Yellow, Greasy Scales
• CORONA SEBORRHOEICA
• May cause reversible Alopecia

30. SEB DERM : SCALP
• s

31. SEB DERM : SCALP

32. SEB DERM : SCALP
• A

33. PITYRIASIS AMIANTACEA
• Syn : Tinea Amiantacea / Asbestos Scalp
• Heavy Micaceous, Crusted Scaling extending
to Follicle
• Binding of Proximal Portions of Hair
• Assoc with Strep / AD / LS / PSOR

34. PITYRIASIS AMIANTACEA

35. ADULT SEB DERM
• Wide Spectrum
• SEBORRHOEIC ECZEMATID
Erythema NASOLABIAL / RETROAURICULAR
Seborrhoea PRESTERNAL / SHOULDER BLADES
White, Fluffy Scaly Scalp - Pityriasis Sicca
(Dandruff)

36. SEBORRHOEIC ECZEMATID

37. SEB DERM : FACE
• PRURITIC ERYTHEMATOUS PLAQUES, POWDERY
to GREASY SCALES seen over
GLABELLA
EYEBROWS
NASOLABIAL / PARANASAL FOLD
RETROAURICULAR FOLD
BEARD REGION
Assoc with BLEPHARITIS / OTITIS EXTERNA

38. SEB DERM : FACE

39. SEB DERM : FACE

40. SEBORRHOEIC BLEPHARITIS

41. SEBORRHOEIC BLEPHARITIS

42. SEBORRHOEIC OTITIS EXTERNA

43. SEB DERM : TRUNK

44. SEB DERM : TRUNK

45. SEBORRHOEIC ERYTHRODERMA
• Confluent Erythema
• Yellowish – Gray Scaling + Exfoliation
• Covering > 90 % BSA
• Differential Diagnoses

46. SEBORRHOEIC ERYTHRODERMA

47. DIFFERENTIALS : SEB DERM

48. TREATMENT
• TOPICALS
SELENIUM SULFIDE SHAMPOO 1 – 2.5%
COAL TAR 1-5% OINT / SHAMPOO
MILD – MODERATE CORTICOSTEROIDS
DESONIDE LOT 0.05% LOT
MOMETASONE 0.1 % CR
FLUCINOLONE ACET 0.01% SH

49. TREATMENT : TOPICALS
ANTIFUNGALS
ZPTO 1-2% SHAMPOO
KETOCONAZOLE 2 % SHAMPOO/
CREAM
CICLOPIROX OLAMINE 1% SH / CR
TERBINAFINE 1% CREAM / SOLUTION
METRONIDAZOLE 1% GEL
KERATOLYTICS (SALICYLIC ACID 5-6% OINT)

50. TREATMENT : TOPICALS
• IMMUNOMODULATORS
TACROLIMUS OINT 0.1 %
PIMECROLIMUS OINT 1%
OTHERS - BENZOYL PEROXIDE 2.5 – 5%

51. TREAMENT
• SYSTEMIC
KETOCONAZOLE 200MG / DAY X 07D
ITRACONZAOLE 200 MG / DAY X 07D
TERBINAFINE 250 MG OD X 28 D
ISOTRETINOIN

52. THANK YOU