Seborrhoeic Dermatitis

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Yeasts play an important role in the development of seborrhoeic dermatitis but the exact mechanism is not known. Control of the yeasts improves symptoms.

Aetiology

Although the causes of seborrhoeic eczema are not fully understood, the yeast Malassezia ovale (M. ovale), formerly known as Pityrosporum ovale, is known to play a role
It is unclear as to how M. ovale induces inflammation and scaling, although there is a hypothesis that the yeast hydrolyzes sebum to release a mixture of saturated and unsaturated fatty acids. The fatty acids are taken up by the yeast but the unsaturated fatty acids remain and breach the skin's barrier function causing the inflammatory reaction
Seborrhoeic eczema is more common and can be much more severe in patients with HIV and in Parkinson's disease

Referral Criteria:

Referral should only be considered if patient is responding inadequately to treatment

Formulary, Chapter 13. Skin: Treatment of seborrhoeic dermatitis

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History

It is most commonly seen in patients aged 18 to 40 but can occur at any age
It is more common in males
Itch is not a predominant feature
Symptoms fluctuate and the condition may last for years

Clinical findings

Distribution, it affects areas rich in sebaceous glands:

Scalp and behind the ears. More extensive involvement of the ears with otitis externa may occur
Face - medial eyebrows (can be associated with chronic blepharitis), glabella and nasolabial folds. Areas under spectacles or hearing aids may also be involved
Upper trunk - presternal and interscapular regions
Flexures - axillae, groins, umbilicus, anogenital and submammary regions

Morphology:

Red, sharply marginated macules / patches covered with greasy-looking yellowish scales

Differential Diagnoses

Psoriasis

Formulary, Chapter 13. Skin: Treatment of seborrheic dermatitis

Referral should only be considered if patient is responding inadequately to treatment.

Evidence

North and East Devon formulary - Skin

The Primary Care Dermatology Society

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: 30 January 2017

Referral