Seborrheic eczema

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Classification according to ICD-10
L21.0 Seborrhoea capitis
- seborrheic cradle cap
L21.1 Children's seborrheic eczema
L21.9 Seborrheic eczema, unspecified
ICD-10 online (WHO version 2019)
Seborrheic eczema on the face
Acute seborrheic eczema on the scalp

As seborrheic dermatitis or seborrheic dermatitis or Crohn Unna a rash (is eczema ) denotes that occurs especially on the scalp and face and is usually associated with flaking. The special form of the rash in newborns is known under the popular name grind or head gneiss and is often confused with or equated with cradle cap .

Epidemiology

The condition often occurs in infants less than three months of age. In addition, seborrheic eczema occurs preferentially around the 4th decade of life. Approx. 5% of the total population suffer from a form that requires treatment. The prevalence in Central Europe is 3–10% of the population. More men than women are affected. In patients with acquired immunodeficiency (e.g. AIDS ), the incidence increases significantly to 30–80%. The skin disease is characterized by periods of aggravation and improvement.

Symptoms and ailments

A rash develops (often with yellowish scales ) that can affect the hairy scalp (gneiss) and adjacent areas, the skin around the nose, chin, eyebrows, eyelids, and the skin around the ears. In severe cases, the sternum and back along the spine can also be affected. Severe itching can occur, but it can also be completely absent.

Consequences and complications

Scratching can damage the weakened skin and also become inflamed and bleed. An additional bacterial colonization is possible. The affected areas can have a cosmetic effect, but usually heal without scarring.

causes

The pathogenesis of seborrheic eczema is not fully understood. Several causes are believed.

A main cause can be increased sebum production and the resulting increase in the colonization of Malassezia yeasts . It was assumed that the rashes are a reaction to metabolic products of the yeast Malassezia furfur (formerly called Pityrosporum ovale ). It is now known that several Malassezia yeasts are involved. These actually harmless colonists of the human skin reproduce excessively in those affected and thus achieve disease value by leading to inflammation and eczema.

The condition of the central nervous and immune systems appear to be important. Seborrheic eczema occurs more frequently in Parkinson's disease and in AIDS patients. Stress factors also seem to play a role.

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

It is estimated that around half of all people are genetically predisposed to the disease. However, this does not mean that they actually get sick.

Sweating, non-breathable clothing or occlusion due to unsuitable, ie too greasy, skin care products favor the symptoms of the sick.

diagnosis

Due to the characteristically affected areas of the skin and the typically changing course of the disease, the dermatologist can usually quickly draw conclusions about seborrheic dermatitis. If in doubt, a biopsy can provide clarity.

therapy

The goals of treatment are to remove the visible signs and to reduce or eliminate other symptoms such as erythema and pruritus . This includes reducing sebum production, lessening Malassezia yeast colonization, and controlling inflammation. Since the disease is mostly chronic, maintenance therapy is often indicated. In babies, on the other hand, the course is rarely chronic.

Antifungal drugs

Antifungal drugs have a therapeutic effect by reducing the colonization with Malassezia.

Active ingredients:

Azoles : Ketoconazole , Bifonazole , Clotrimazole , Econazole , Isoconazole and Sertaconazole

Ciclopirox

Calcineurin inhibitors

Calcineurin inhibitors have an immunosuppressive and anti-inflammatory effect.

Active ingredients:

Pimecrolimus: The externally applied immunomodulator pimecrolimus works against the inflammatory reaction and has shown an improvement in seborrheic eczema in studies. It is recommended as a therapeutic measure in conjunction with lithium succinate and zinc sulfate.

Tacrolimus: The externally applied immunomodulator tacrolimus has shown an improvement in seborrheic eczema in studies, with an anti-inflammatory as well as a fungicidal effect against Malassezia furfur being demonstrated.

Sodium bituminosulfonate

Sodium bituminosulphonate has antiseborrheic, antifungal, anti-inflammatory and antibacterial effects .

Corticoids

This article or the following section is not adequately provided with supporting documents ( e.g. individual evidence ). Information without sufficient evidence could be removed soon. Please help Wikipedia by researching the information and including good evidence.

Glucocorticoid creams are a therapeutic option that provides rapid relief from the symptoms of seborrheic eczema. If they are only used for a short time, the side effects are limited. Long-term (e.g. months or more than 14 days at a time) or uncontrolled use of such preparations can have undesirable consequences, especially for the treated skin.

Pansy herb (Viola tricolor)

Pansy herb has anti- inflammatory , antioxidant and cortisone-like effects . The effectiveness against eczema could be confirmed in animal experiments, it is evaluated positively for the treatment of mild seborrheic skin diseases. During the flowering period between May and August, the above-ground parts of the plant are collected and processed into the drug. It can be used internally and externally as a tea infusion; shampoo and skin oil also exist as finished medicinal products. Unwanted effects , contraindications and sensitizations are not known.

Apple Cider Vinegar

Daily application of a solution of apple cider vinegar and water (ratio 1: 1) after washing shifts the pH value of the skin to acidic. This will make the symptoms go away after about 4 weeks. The therapy is well tolerated and can be used permanently.

Topical therapy - hairy scalp

The scalp should always be treated as well, as Malassezia are also found here.

Special shampoos or creams are used for the hairy scalp. Active ingredients:

Ketoconazole has an antifungal effect.

Octopirox (or piroctone olamine ) has an antifungal , antibacterial and also anti-inflammatory effect .

Sodium bituminosulphonate has antiseborrheic, antifungal , anti-inflammatory and antibacterial effects .

In milder cases, anti-dandruff hair shampoos, for example with zinc pyrithione, help .

Shampoos with the active ingredient salicylic acid are recommended. This softens the horny layers and makes peeling (rubbing off dead skin layers) easier. The home remedy apple cider vinegar has the same effect .

Systemic treatment

The therapy of seborrheic eczema is primarily local . When pronounced findings and frequent recurrences is on systemic resorted antifungal agents.

Medical skin care

A soap-free syndet with a slightly acidic pH should be used for cleaning . A light emulsion, cream or gel with a low fat content can generally be selected for facial care.

Cosmetic products (e.g. creams, lotions) with the active ingredient urea (urea) also show success, depending on their severity. They help to alleviate acute conditions or to let them subside without further medication.

prevention

Regular stays in the sun are very beneficial in healing the symptoms, and UV radiation (especially in winter) is recommended by many doctors. The reason for this is that UV radiation inhibits the growth of the yeast Malassezia furfur, which is suspected to be the cause of the rash.

The symptoms can be alleviated by a very short haircut (this brings more air and sun to the affected areas) and by frequent hair washing, at least every two days.

Trade names

Monopreparations

  • Calcineurin inhibitors (prescription only, off-label): Protopic®, Elidel®
  • Sodium bituminosulfonate: Ichthoderm® (D), Ichthomed
  • Antimycotics : Nizoral® (CH, D) ( off-label ), Terzolin® (D), Selergo® (D)

See also

Individual evidence

  1. ↑ a b c G. Plewig et al .: Braun-Falco's Dermatology, Venereology and Allergology . Volume 1. 6., revised and expanded edition. Springer, 2012, pp. 531-536.
  2. ↑ eczema seborrheic adult - Department of Dermatology - Altmeyers Encyclopedia. Retrieved October 27, 2017 .
  3. ↑ a b c J.Q. Del Rosso: Adult seborrheic dermatitis: a status report on practical topical management. J Clin Aesthet Dermatol, May 2011, 4 (5), pp. 32-38.
  4. ↑ a b V.S. Arsic Arsenijevic, D. Milobratovic, AM Barac, B. Vekic, J. Marinkovic, VS Kostic: A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production. BMC dermatol. March 2014, 14: 5.
  5. ^ S2 guideline for psychosomatic dermatology (psychodermatology) of the German Dermatological Society (DDG). In: AWMF online (as of 2006)
  6. ^ GW Clark: Diagnosis and treatment of seborrheic dermatitis . In: American Family Physician , 91 (3), 2015, pp. 185-190.
  7. ↑ http://www.enzyklopaedie-dermatologie.de/artikel?id=1117
  8. ↑ JR Schwartz et al .: A comprehensive pathophysiology of dandruff and seborrheic dermatitis - towards a more precise definition of scalp health. Acta Derm Venereol 93 (2), 2013, pp. 131-137.
  9. ↑ M. Goldust, MR Ranjkesh, M. Amirinia, F. Golforoushan, E. Rezaee, MA Rezazadeh Saatlou: Sertaconazole 2% cream versus hydrocortisone 1% cream in the treatment of seborrheic dermatitis. In: The Journal of dermatological treatment. [Electronic publication before printing] February 2013, doi : 10.3109 / 09546634.2012.755251 , PMID 23210976 .
  10. ↑ GD - Online | Annual conference Hamburg | K.-H. Nietsch: Effectiveness of ciclopirox in seborrheic eczema. Retrieved October 24, 2017 .
  11. ↑ a b c d W. Hort, M. Nilles, P. Mayser: Malassezia yeasts and their importance in dermatology. In: Der Hautarzt 07/2006, Springer Medizin Verlag, p. 641 ( summary and full text ).
  12. ↑ a b D. Kulenkamp, ​​J. Warnecke: Light sulfonated shale oil in the therapy of seborrheic eczema of the scalp. derm (2), 1996, pp. 394-401.
  13. ^ Matthias Augustin: 6.46 pansies. In: Phytotherapy for skin diseases. Elsevier, Urban & Fischer, 2004, ISBN 9783437561207 , pp. 226-227 ( full text ).
  14. ↑ S. Meyer, T. Vogt, M. Landthaler, S. Karrer: Use of phytopharmaceuticals in dermatology - indications, therapeutic advice and side effects. In: The dermatologist 05/2005. Springer Medizin Verlag, p. 494 ( summary and full text ).
  15. ↑ Lasinger F. Reader Forum, Naturopathic Advice: Disruptive eczema on the head. Naturarzt, 2016, 6th year, p. 7.
  16. ↑ Y. Adler: Skin diseases in view. A photo atlas. 3rd, revised. and exp. Edition. 2016, pp. 91–93.
  17. ↑ S. Bender: body care. 4th edition. Wissenschaftliche Verlagsgesellschaft mbH, Stuttgart 2014.
  18. ↑ JR Wikler, N. Janssen, DP Bruynzeel, C. Nieboer: The effect of UV-light on pityrosporum yeasts: ultrastructural changes and inhibition of growth. In: Acta Dermato-Venereologica . 1990, 70, pp. 69-71, PMID 1967880 .

literature

Web links