As the pace of modern society becomes faster and faster, people find that dandruff on the scalp increases very easily and itching of the scalp is noticeable, interfering with people’s daily life – it is seborrheic dermatitis.
Seborrheic dermatitis is a chronic inflammatory skin disease that occurs at the site of high seborrhea. The cause is not well understood. Some researchers now believe that the disease is caused by an increase in the growth of Malassezia furfur on top of seborrhea and a dysbiosis of the normal flora of the skin surface (other factors may be involved, including genes, environment, hormones, and the immune system). Seborrheic dermatitis is a bright red or yellowish-red patch with greasy scales or scabs, often with varying degrees of itching, and is common in adults, but also in newborns. In children, overconsumption of vitamin A may cause seborrheic dermatitis. Deficiency of vitamin B6 and vitamin B2 (also known as riboflavin) may also be a cause.
There are two preferred ages for seborrheic dermatitis, one from 2 weeks of age to 1 year of age and one from adolescence to adulthood. Only 1 to 3% of patients are symptomatic, and it occurs mostly in the 30s and 40s. There are more males than females.
Clinical manifestations.
1, typical lesions are yellow-red spots, patches or macules, covered with greasy scales, and in severe cases there may be exudate; or dry erythematous spots with gray-white bran-like scales.
2. The rash is usually found on the scalp, eyebrows, eyelids, nose and sides, behind the ears, neck, forehead and upper back interscapular area, axillae, groin, umbilicus and other areas rich in sebaceous gland distribution.
3.Self-perceived symptoms are different degrees of itching.
4.Infant seborrheic dermatitis often occurs in the first month after birth, the lesions are mostly on the scalp, forehead, between the eyebrows and cheeks, as exudative erythematous patches, with thick yellow greasy crust.
General treatment.
Principle: Restrict sugar and fatty diet, avoid irritating food, avoid scratching, regular life and living.
Local topical treatment: mainly to remove fat, sterilization, anti-inflammation and anti-itch.
(a) compound sulfur lotion (Ku’s lotion), 1 time per night for external use, 5% sulfur ointment for external use; selenium sulfide shampoo (Hilsen) or sulfur soft soap, 1-2 times per week to wash the hair.
(ii) antifungal preparations: such as 2% ketoconazole lotion or 1% bifenbendazole shampoo shampoo and bath.
(iii) vitamin B6 cream, vitamin E cream (some patients will be red and itchy skin when used topically), etc., can be used in rotation, 1-3 times a day.
(iv) glucocorticoid preparations In the case of heavy inflammation and itching of the rash, it can be added as appropriate, such as 1% hydrocortisone cream or 0.1% hydrocortisone butyrate ointment, tretinoin cream, 0.05% dexamethasone ointment, etc., choose one, short-term use, 1-2 times daily for external use. Note that long-term application is not recommended for facial and thin skin lesions to avoid local side effects of hormones, such as acne, capillary dilation, skin atrophy and pigmentation changes.
(E) Chinese medicine: topical application of compound cypress lotion, etc.
Systemic oral treatment.
(i) Vitamin B complex, 2 tablets, taken orally 3 times daily; Vitamin B6, 10-20 mg, taken orally 3 times daily. Take 20 to 30 mg of zinc daily.
(ii) Antihistamines 1-2 kinds can be chosen orally for the purpose of itching.
(iii) Glucocorticoids Mainly applied for a short period of time when inflammation is obvious or the rash is widespread and cannot be controlled by other treatments, prednisone may be given, 20-40mg/d, divided into 2-3 oral doses.
(iv) Antibiotics In severe seborrheic dermatitis or with obvious exudation, choose minocycline 50-100mg orally twice daily or erythromycin or antifungal agents such as itraconazole capsules 0.1-0.2g orally twice daily. The course of treatment is 1-2 weeks.
(E) Chinese medicine: you can take oral anti-silver granules, etc.
According to the recommendation of the American Academy of Family Physicians, there is one form of treatment that is proven to work, especially when steroid or other shampoo treatments do not have any effect while the patient has been suffering from rapid hair loss – the use of low doses of retinoic acid (isotretinoin), about 10 to 30 mg per day. The exact mechanism by which it is effective is not known, but it is estimated that it works by reducing oil production. Excessive oil production is thought to be an important factor in seborrheic dermatitis. If patients are treated as described above, they need to be properly evaluated for liver function every month. For female patients, special caution is needed during specific periods, as this may lead to fetal defects (women of childbearing age need contraception for 2 years if they are taking retinoids). For chronic seborrheic dermatitis, this low-dose treatment can be taken year-round. Nevertheless, patients need to stop taking the medication every 6 months for 1 to 2 months in order to observe if the patient is still experiencing similar symptoms.
Warm tip: Patients with seborrheic dermatitis should not wash their hair daily. Too many shampoos and too high water temperatures instead stimulate excessive compensatory sebum secretion in the scalp, aggravating the condition.