Seborrhoeic eczema

• Plenck 1776.
• Unna 1887.

Seborrhoeic dermatitis, Unna's disease.

Common, chronic eczema, which occurs in both infants and adults.

• Lifetime prevalence almost 100%
• Prevalence: approx. 3-5% of the population
• Infants: Manifestation between 2 weeks and 12 months
• Adults: Frequent occurrence between the ages of 30-60 years
• 85% of all HIV-positive patients suffer from seborrhoeic dermatitis

• Association:
  • Morbus Parkinson
  • Psoriasis (seborrhiasis)
  • HIV infection

• Seborrhoeic eczema of the infant (type I)
• Seborrhoeic eczema of the adult (type II)

Possible triggers or co-factors:

• Increased sebaceous gland production
  • In infants, there is ↑ sebaceous gland production due to short-term, high androgen formation.
• Yeast colonisation
  • Malassezia furfur.
  • Pityrosporum ovale.
  • Candida albicans (also frequently in the stool of infants).
• Immune suppression
  • HIV infection.
• Unclear:
  • Role of the nervous system.
  • Essential fatty acid metabolism disorder
• On the face, seborrhoeic eczema may be UV provoked.

• Possible trigger factors
  • Alcohol abuse.
  • High-fat or heavily spiced foods.

• Localisation
  • Capillitium, face (especially nasolabial fold, glabella, eyebrows), retroauricular, sternal, axillary and inguinal.
  • In infants, the intertrigines and capillitium are particularly affected.

• Pruriginous erythema and erythematous plaques with oily, light pityriasiform scaling. Perifollicular arrangement is seen at the capillitium. Retroauricularly, there is a tendency to fissuring.
• In principle, a secondary bacterial infection is possible.
• In some cases, erythroderma can be caused by disseminated seborrhoeic eczema. This is then referred to as "seborrhoeic erythroderma". In older patients, seborrhoeic dermatitis is one of the most common causes of erythroderma.
• Erythema paranasale: Seborrhoeic eczema is found only paranasally.
• Seborrhoeic eczematid: mildest form of expression.
• Hyperhidrosis oleosa: simultaneous occurrence of hyperhidrosis and seborrhoea.
• Pityriasiform seborrhoid: Pityriasis rosea-like seb. Eczema, but without plaque mère and collerette scaling.

• The diagnosis is made clinically.
• In cases of persistent seborrhoeic eczema, HIV serology should be performed.

Seborrhoeic areas. Always look retroauricularly, and gently push the ala nasi to the side to look for the typical flakes in the exposed fold.

Nonspecific. Orthohyperkeratosis, acanthosis, parakeratosis, loss of basket weave structure, spongiosis, serum in str. corneum, crusts, perivascular lymphohistiocytic infiltrates, oedema in papillary dermis, focal epidermotropy.

• Chronic course in adults.
• Stress frequently exacerbates the skin lesions.
• In infants, spontaneous remission occurs within a few months.

No ointments that are too greasy!

Scalp:

• Ciclopirox-Olamine shampoo daily for 14 days, then 2x per week, each time leave foam on for 5min.
• Alternatives: Ketoconazole shampoos, use on body and face
• Ketoconazole creams or solutions
• Efalith®-Creme Widmer 2x tgl. up to 4 weeks.

Dermocorticoids

Mometasone fuorate cream / solution, betamethasone and triclosan cream daily for 7 days, then reduced frequency of use, try to replace with calcineurin inhibitors

Calcineurin inhibitors

• Tacrolimus ointment 0.1% 2x daily for 2 weeks has recently been shown to be better than Ketoconazole cream; alternative is pimecrolimus cream 1% 2x daily for 2 weeks
• UV therapy: Mixed results, sometimes it can worsen. 

Systems therapy

• Itraconazole p.o. 100 mg 2x tgl. for 1 week.
• Isotretinoin p.o. 10 mg 1x tgl. may lead to reduction of seborrhoea.
• If acutely necessary: Prednisolone (Spiricort®) p.o. 25-100 mg 1x tgl.

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