Seborrheic eczema is a chronic dermatosis, manifested by rashes of small nodules, gradually forming plaques covered with dense fatty scales and crusts, when removed, a moist surface opens. Rashes are localized on the head, behind the auricles, on the face, in the natural folds of the skin, in the umbilical region, on the skin of the trunk and flexor surfaces of the arms and legs. Diagnosis of the disease includes dermatoscopy, scraping for pathogenic fungi, consultations with other specialists, examination of the gastrointestinal tract, examination of hormonal and immunological status. Treatment is carried out with local antimicrobials, vitamins and physiotherapy methods.
ICD 10
L21 Seborrheic dermatitis
General information
Seborrheic eczema is one of the clinical forms of eczema, which also includes true, occupational and microbial eczema. The disease can occur equally in persons of both sexes and of any age. Often seborrheic eczema develops against the background of seborrhea or as a complication of seborrheic dermatitis. In HIV-infected people, it can be one of the first manifestations of AIDS. A feature of seborrheic eczema in such patients is its spread throughout the skin.
Causes
Modern dermatology adheres to the infectious-allergic theory of the development of seborrheic eczema. According to various clinical studies, in 50-80% of cases of seborrheic eczema, Pityrosporum ovale is present in the lesions. Fungi of the genus Candida or staphylococci are less often detected.
Factors predisposing to the development of seborrheic eczema are increased secretion by the sebaceous glands, gastrointestinal diseases (gastritis, peptic ulcer), liver disorders (hepatitis, cirrhosis of the liver), hormonal abnormalities (diabetes mellitus, imbalance of estrogens and androgens, obesity), vegetative-vascular dystonia. It is noted that seborrheic eczema often occurs against a background of reduced immunity, which in turn may be due to frequent acute respiratory infections, a serious illness, a chronic infectious focus (sinusitis, sinusitis, otitis, tonsillitis, etc.).
Symptoms
Seborrheic dermatitis begins with the appearance of small pink-yellow nodules on the skin. The nodules increase and merge with each other, which leads to the formation of infiltrated disc-shaped plaques. The plaques have a diameter of 1-2 cm and are covered with numerous dense fatty scales. When removing the scales, a slightly moist surface opens under them, pronounced wetness is not characteristic.
The lesions of seborrheic eczema have clear borders and uneven edges. At the beginning of the disease, they may be dry, but then they acquire a typical “greasy” appearance. Itching, as a rule, is weakly expressed and does not bother patients much. The resolution of the elements of seborrheic eczema occurs starting from the center of the lesion, which leads to the transformation of plaques into rings or arcs. With proper treatment of the disease after its completion, no traces remain on the skin.
Usually, rashes of seborrheic eczema are located on the head: in the hair growth zone, on the forehead, in the eyebrow area, in the nasolabial folds, around the mouth and behind the auricles. With the localization of foci of seborrheic eczema on the scalp, they, growing along the periphery, eventually move to the edge of hair growth and to the forehead. Here, the lesion is clearly outlined by an infiltrated border of red color and resembles a psoriatic disk. This symptom is called “seborrheic crown”. From behind, rashes of seborrheic eczema from the scalp spread to the neck and the behind-the-ear folds. Merging, they form a vast lesion in the form of a helmet — the so-called “eczema helmet”.
With seborrheic eczema, the skin of the eyelids is often affected with the development of blepharitis, which is characterized by pronounced swelling and redness of the eyelid, the presence of scales and the formation of cracks at the outer edge of the eye. The lesion of the eyelids is often combined with conjunctivitis and is accompanied by a discharge from the eye, which causes the eyelids to stick together in the morning.
Disease of smooth skin is localized on the chest, in the umbilical and interscapular areas, in the armpits, on the flexor surface of the extremities. Due to their uneven edges, lesions of smooth skin resemble “geographical maps”. They rise slightly above the general level of the skin and are prone to peripheral growth. Seborrheic eczema can be complicated by secondary infection of rash elements with the development of folliculitis, hydradenitis, streptodermia, etc.
Diagnostics
The diagnosis of seborrheic eczema is established by a dermatologist. Often, a visual inspection of the lesions of the skin is enough for this. Dermatoscopy, luminescent diagnostics, skin and hair scraping for pathogenic fungi are also carried out. Secondary infection serves as an indication for carrying out back-sowing of the separated from the lesions.
Histological examination of seborrheic eczema reveals hyperkeratosis, mild acanthosis and intracellular edema, elongation of epidermal outgrowths, which is also observed in neurodermatitis. Distinctive features are the presence of lipid accumulations in the upper layers of the epidermis, the presence of coccal flora, signs of perifolliculitis.
To identify background diseases and foci of chronic infection, patients with seborrheic eczema may be prescribed consultations with other specialists: gastroenterologist, endocrinologist, gynecologist, otolaryngologist, neurologist. For the same purpose, additional examinations are carried out: gastroscopy, ultrasound of the abdominal cavity, hormonal and immunological blood test, pelvic ultrasound, rhinoscopy, pharyngoscopy, etc. Patients with eyelid lesions need to consult an optometrist.
Differential diagnosis of seborrheic eczema should be carried out with true and occupational eczema, psoriasis, trichophytia, microsporia. The location of the rash on the head and the absence in the anamnesis of harmful effects associated with the professional activity of the patient makes it possible to exclude the professional nature of eczema. In comparison with idiopathic eczema with seborrheic eczema, the clinical symptoms are more monomorphic: there are no vesicular rashes and associated wetness. Less dense plaques and less massive scales, as well as the location of elements on the flexor surfaces of the extremities, make it possible to distinguish seborrheic eczema from psoriasis. Microsporia and trichophytia of the scalp are characterized by hair changes in the form of “stumps”, bran-like (not greasy) peeling and the detection of fungal mycelium during hair examination.
Treatment
Patients with increased sebum secretion are recommended to limit the use of fatty, fried, sweet and spicy foods, avoid visiting the bath and staying in humid and hot climates. With seborrheic eczema, it is necessary to carefully select hair and skin care products. They should match the type of hair and the fat content of the skin.
Local treatment of seborrheic eczema is carried out with antimicrobial agents: sulfur-resorcinol and white mercury ointment, sulfur talker, salicylic ointment. Inside, riboflavin, vitamins B1 and B6 are prescribed. Physiotherapy methods have a good effect in the treatment of seborrheic eczema: darsonvalization, magnetotherapy, laser treatment, cryotherapy and cryomassage. The addition of a secondary infection requires the appointment of antibacterial ointments and systemic antibiotic therapy. Treatment of seborrheic eczema should be carried out in conjunction with the therapy of the background disease and the rehabilitation of infectious foci.