Seborrheic Dermatitis

Abstract

Seborrheic dermatitis is a chronic, recurring skin disorder that has no cure. Current clinical research has implicated Malassezia yeast in the etiology. Using a clear, concise clinical picture and a thorough patient history, even the novice NP can formulate an effective treatment plan.S eborrheic dermatitis is an acute and chronic inflammatory disorder of the sebaceous glands. It is primarily confined to the areas of the body that contain the most sebaceous glands such as the head and trunk, but it occasionally involves intertriginous areas of the body. 1 The disorder is estimated to affect between 1% and 3% of the immunocompetent population. 2,3 Seborrheic dermatitis causes social embarrassment and may lead to a reduction in quality of life for those afflicted by this disorder. 2,4 It occurs throughout one_s lifetime, and certain populations are at increased risk.Seborrheic dermatitis follows a specific pattern throughout the life span. It is more prevalent in male than in female patients, and its incidence peaks in infants, adolescents, and adults over the age of 50. 5 Infantile seborrheic dermatitis can affect as many as 70% of newborns up to 3 months of age, and usually disappears by age 1. 4 It generally skips school-aged children, and reappears in adolescents due to the increased amount of skin lipids because of rising hormonal levels. 6 A cross-sectional study of 300 children with scalp scaling found a 7.3% prevalence rate for seborrheic dermatitis between the ages of 2 and 10. 7 It is most notably seen in the fourth through seventh decades of life. Rates as high as 31% are seen in the older adults. 8 Among high-risk patients for seborrheic dermatitis are those with neurologic disorders such as parkinsonism, poststroke, epilepsy, spinal injuries, depression, nervous system trauma, and facial nerve palsy. 2,3,6 The occurrence in this population appears to be related to immobility, which leads to excessive pooling of sebum that increases the growth of yeasts. 9 Seborrheic dermatitis is also one of the most common dermatoses found in patients with HIV, affecting up to 85% of them. 2,10 Typically, the onset of its clinical features occurs before the development of AIDS symptoms. The severity of skin manifestations correlates with the degree of clinical deterioration such as the appearance of AIDS-defining illnesses. 1 Prescribing patterns and practices differ depending on the NP_s area of specialty. A study analyzing outpatient visits over a several-year period in different specialties including family practice and dermatology found that family practice providers were under or incorrectly treating seborrheic dermatitis. 11 Furthermore, it was noted that the evidenced-based medicine found in specialty journals had not made its way into the mainstream literature. 11 Therefore, it is important for all NPs to gain an understanding of the etiology and treatment modalities of seborrheic dermatitis based on location and severity. ETIOLOGYMalassezia yeasts were first described in the 19th century, and were named after...