Seborrheic dermatitis

Seborrheic dermatitis.
Dermatitis of the sebaceous areas. This is chronic and difficult to define exactly but has a distinctive morphology(red sharply marginated papulosquamous lesions covered with greasy scales) and typical distribution in areas with rich supply of sebaceous glands especially the scalp, face and upper trunk.
Dandruff which is a visible desquamation from the sclap surface, appears to be the precursor or mild form of seborrheic dermatitis. This may gradually progress into a red, irritated skin with marked increases in the scaling of the scalp and thus become a true seborrheic dermatitis.
The yeast Malassezia ovale which is normally present on the skin, is increased in the scales of seborreic dermatitis and is thus supposed to be the cause of it.
The condition is more commonly seen in males than in females it can occur in all ages even in infants below2 months of age. it is also seen in patients suffering from HIV infection. possibly due to the enhanced growth of yeasts secondary to immunosuppression.
It is also seen to occur secondarily in patients suffering from parkisonism. Generally shows features of both psoriasis and chronic dermatitis. most of the cells of the stratum corneum are parakeratotic.(distinguishes it from psoriasis). There is an increase in production of keratinocytes with marked epidermal proliferation and desquamation.
Malassezia ovale yeast with marked follicular involvement of the akin is more characteristic of seborrheric dermatitis in an immuno suppressed(AIDS) individual.
They commonly originate in hairy skin and involve the sclap,face, upper trunk and the flexures. In rare cases it can be generalized occuring all over the body. The lesions tend tobe dull or yellowish red in color and covered with greasy scales pruritus is minimal and chroicity of the lesions or recurrence is very common .
Dandruff is usually the earliest manifestation of seborrheic dermatitis on the sclap. Gradually there is perifollicular redness and scaling evident which spreads to form sharply marginated patches which eitgher remain discrete or tend to coalesee together. There can be loss2of hair occurring with this condition. There is redness and sticky scale and crust  formation behind the ears, which can spread to involve surrounding areas,can also be infection of the external ear canal along with this
The medial half of the eyebrows, eyelids glabella and nasolabial folds are especially affected.
Seborrheic dermatitis seen in males are petal shaped lesions on the front of the chest and in the interscapular region.
The intial lesions appeares as a small reddish brown follicular papule covered by greasy scale, these then spread and tend to coalesce to form a particular circular pattern.
The most commonly involved flexures are the axillae, groins and breast fold in few cases the anogenital and umbilical region. there is usually increased perspiration in these parts more prone to secondry infection if left untreated. In chronic cases the skin becomes thickned and erythmatous..
Diagnosis is easy but in some cases diagnosis can be difficult partly because of the lack of well defined diagnostic criteria.
Psoriasis is most often confused with seborrheic dermatitis especially in cases where there the lesions are present only on the scalp. The differentiating feature is that the psoriatic lesions are usually thicker and bright pink in color with a silvery scale. also psoriatic changes of the nails should be looked for and a family history of psoriasis should be checked for .
Lichen simplex can appear similar to seborrheic dermatitis but there be thickened plaques are often much more irritable than seen in seborrheic dermatitis.
Pityriasis rosea must be distinguished from the pityriasiform type of seborrheic dermatitis in which the lesions are more widely distributed and in which there is no herald patch.
Ringworm infection pityriasis versicolor and candidiasis should be ruled out in cases of lesions occurring only at the flexures by performing a microscope examination of the scrapings from the advancing margin.
Contact dermatitis needs to be ruled out with the help of a patch test.
Biopsy may be required to rule out pemphigus.
Some Homoeopathic remedies.
Ars alb. Graphites Ant crd Calc carb Barytra c Petroleum Sepia Lyc Thuja Crot t Sil Nit a Bell Apis Rhu tox Cantharis
Formic acid therapy internally or perferably hypidermically in medium potency.