Seborrheic eczema



Seborrheic eczema


Anja K. Weidmann, Jason D.L. Williams and Ian Coulson


Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports


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Seborrheic eczema (seborrheic dermatitis) is a chronic dermatosis affecting between 3% and 10% of adults becoming more prevalent with age. It is more common in patients with both idiopathic and neuroleptic-induced Parkinson’s disease, HIV, AIDS, and chronic alcoholics and accounts for up to 3.5% of dermatology specialist outpatient consultations.


The signs and symptoms comprise erythema, greasy scaling, pruritus, burning, and dryness in a typical distribution pattern affecting the scalp, face (particularly the nasolabial folds, eyebrows, and ears), upper trunk, and flexures. Blepharoconjunctivitis may occur alone or in conjunction with skin lesions. Seborrheic eczema can also affect infants up to the age of 3–4 months in the diaper area.


Although the etiology has yet to be fully elucidated, important factors are Malassezia yeasts, immune status, and individual susceptibility.




Management strategy


Seborrheic eczema is a chronic relapsing dermatitis which responds to a variety of immunosuppressive and antifungal therapies, but there is no cure.


Seborrheic eczema of the face is dry and flaky, so soap avoidance and substitution with a light emollient cleanser will help. Facial and flexural disease responds to mild topical corticosteroids alone or in combination with a variety of topical antipityrosporal agents such as miconazole, ketoconazole, bifonazole, itraconazole or ciclopiroxolamine. An ointment containing lithium gluconate/succinate may also be helpful.


Studies have demonstrated short-term efficacy with the topical calcineurin inhibitors tacrolimus and pimecrolimus. Terbinafine cream and metronidazole gel may also be beneficial while resistant cases may respond to short courses of oral itraconazole or terbinafine.


Scalp seborrheic dermatitis can be helped with topical ketoconazole, zinc pyrithione, selenium sulfide, corticosteroids and tar shampoos, or a propylene glycol preparation formulated for scalp use. Severe cases with marked hyperkeratosis (pityriasis amiantacea) may require topical keratolytics such as salicylic acid ointment or coconut compound ointment.



Specific investigations






In neonates and children consider acrodermatitis enteropathica or transient neonatal zinc deficiency as they may mimic recalcitrant seborrheic dermatitis. A similar eruption in parenterally fed adults can occur due to zinc deficiency.









Non-scalp disease


First-line therapies















image Topical ketoconazole A
image Mild/moderate topical corticosteroids A
image Emollients and soap substitutes D









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Aug 7, 2016 | Posted by in Dermatology | Comments Off on Seborrheic eczema

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