Seborrheic dermatitis in adolescents and adults
- Denis Sasseville, MD, FRCPC
Denis Sasseville, MD, FRCPC
- Professor of Dermatology and Research Coordinator, Division of Dermatology
- McGill University Health Centre
Seborrheic dermatitis is a chronic, relapsing, and usually mild form of dermatitis that occurs in infants and in adults. The severity may vary from minimal, asymptomatic scaliness of the scalp (dandruff) to more widespread involvement. Affected individuals are usually healthy, although seborrheic dermatitis has been associated with human immunodeficiency virus (HIV) infection, Parkinson disease, a number of other neurologic disorders, and use of neuroleptic medications.
This topic will discuss the pathogenesis, clinical manifestations, and management of seborrheic dermatitis in adolescents and adults. The infantile form of seborrheic dermatitis is discussed separately. (See "Cradle cap and seborrheic dermatitis in infants".)
Seborrheic dermatitis has a biphasic incidence, occurring in infants between the ages of 2 weeks and 12 months, and later, during adolescence and adulthood. The prevalence of clinically significant seborrheic dermatitis is approximately 3 percent, with peak prevalence in the third and fourth decades . The actual prevalence is probably much higher when mild cases are included. Men are affected more frequently than women.
The prevalence of seborrheic dermatitis is increased among individuals with HIV in whom it may be a presenting sign. The prevalence has been estimated to be around 35 percent among patients with early HIV infection, and up to 85 percent among patients with AIDS [2,3].
Patients with parkinsonism frequently present with seborrhea (oily skin) and seborrheic dermatitis, both of which may improve with L-dopa therapy [4,5]. (See "Clinical manifestations of Parkinson disease", section on 'Nonmotor symptoms'.)
- Johnson MLT. Skin Conditions and Related Need for Medical Care among Persons 1–74 Years, United States, 1971–1974. Series 11, Data from the National Health Survey November, No. 212, DHEW Pub No. (PHS) 79–1660. U.S. Department of Health, Education, and Welfare, Public Health Service, National Center for Health, Hyattsville, MD 1978.
- Berger RS, Stoner MF, Hobbs ER, et al. Cutaneous manifestations of early human immunodeficiency virus exposure. J Am Acad Dermatol 1988; 19:298.
- Soeprono FF, Schinella RA, Cockerell CJ, Comite SL. Seborrheic-like dermatitis of acquired immunodeficiency syndrome. A clinicopathologic study. J Am Acad Dermatol 1986; 14:242.
- Burton JL, Cartlidge M, Shuster S. Effect of L-dopa on the seborrhoea of Parkinsonism. Br J Dermatol 1973; 88:475.
- Kohn SR, Pochi PE, Strauss JS, et al. Sebaceous gland secretion in Parkinson's disease during L-dopa treatment. J Invest Dermatol 1973; 60:134.
- Burton JL, Pye RJ. Seborrhoea is not a feature of seborrhoeic dermatitis. Br Med J (Clin Res Ed) 1983; 286:1169.
- McGinley KJ, Leyden JJ, Marples RR, Kligman AM. Quantitative microbiology of the scalp in non-dandruff, dandruff, and seborrheic dermatitis. J Invest Dermatol 1975; 64:401.
- Heng MC, Henderson CL, Barker DC, Haberfelde G. Correlation of Pityosporum ovale density with clinical severity of seborrheic dermatitis as assessed by a simplified technique. J Am Acad Dermatol 1990; 23:82.
- Gupta AK, Kohli Y, Summerbell RC, Faergemann J. Quantitative culture of Malassezia species from different body sites of individuals with or without dermatoses. Med Mycol 2001; 39:243.
- Pechère M, Krischer J, Remondat C, et al. Malassezia spp carriage in patients with seborrheic dermatitis. J Dermatol 1999; 26:558.
- Sandström Falk MH, Tengvall Linder M, Johansson C, et al. The prevalence of Malassezia yeasts in patients with atopic dermatitis, seborrhoeic dermatitis and healthy controls. Acta Derm Venereol 2005; 85:17.
- Faergemann J, Bergbrant IM, Dohsé M, et al. Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry. Br J Dermatol 2001; 144:549.
- Riciputo RM, Oliveri S, Micali G, Sapuppo A. Phospholipase activity in Malassezia furfur pathogenic strains. Mycoses 1996; 39:233.
- Parry ME, Sharpe GR. Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast. Br J Dermatol 1998; 139:254.
- Mathes BM, Douglass MC. Seborrheic dermatitis in patients with acquired immunodeficiency syndrome. J Am Acad Dermatol 1985; 13:947.
- Naldi L, Rebora A. Clinical practice. Seborrheic dermatitis. N Engl J Med 2009; 360:387.
- Muñoz-Pérez MA, Rodriguez-Pichardo A, Camacho F, Colmenero MA. Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse. Br J Dermatol 1998; 139:33.
- Osei-Sekyere B, Karstaedt AS. Immune reconstitution inflammatory syndrome involving the skin. Clin Exp Dermatol 2010; 35:477.
- Tegner E. Seborrhoeic dermatitis of the face induced by PUVA treatment. Acta Derm Venereol 1983; 63:335.
- Reygagne P, Poncet M, Sidou F, Soto P. Clobetasol propionate shampoo 0.05% in the treatment of seborrheic dermatitis of the scalp: results of a pilot study. Cutis 2007; 79:397.
- Shuster S, Meynadier J, Kerl H, Nolting S. Treatment and prophylaxis of seborrheic dermatitis of the scalp with antipityrosporal 1% ciclopirox shampoo. Arch Dermatol 2005; 141:47.
- Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial. Br J Dermatol 1995; 132:441.
- Danby FW, Maddin WS, Margesson LJ, Rosenthal D. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol 1993; 29:1008.
- Lebwohl M, Plott T. Safety and efficacy of ciclopirox 1% shampoo for the treatment of seborrheic dermatitis of the scalp in the US population: results of a double-blind, vehicle-controlled trial. Int J Dermatol 2004; 43 Suppl 1:17.
- Ramirez RG, Dorton D. Double-blind placebo-controlled multicentrestudy of fluocinolone acetonide shampoo (FS shampoo) in scalp seborrheic dermatitis. J Dermatol Treat 1993; 3:135.
- Piérard-Franchimont C, Goffin V, Decroix J, Piérard GE. A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis. Skin Pharmacol Appl Skin Physiol 2002; 15:434.
- Kastarinen H, Oksanen T, Okokon EO, et al. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Cochrane Database Syst Rev 2014; :CD009446.
- Zienicke H, Korting HC, Braun-Falco O, et al. Comparative efficacy and safety of bifonazole 1% cream and the corresponding base preparation in the treatment of seborrhoeic dermatitis. Mycoses 1993; 36:325.
- Warshaw EM, Wohlhuter RJ, Liu A, et al. Results of a randomized, double-blind, vehicle-controlled efficacy trial of pimecrolimus cream 1% for the treatment of moderate to severe facial seborrheic dermatitis. J Am Acad Dermatol 2007; 57:257.
- Firooz A, Solhpour A, Gorouhi F, et al. Pimecrolimus cream, 1%, vs hydrocortisone acetate cream, 1%, in the treatment of facial seborrheic dermatitis: a randomized, investigator-blind, clinical trial. Arch Dermatol 2006; 142:1066.
- Koc E, Arca E, Kose O, Akar A. An open, randomized, prospective, comparative study of topical pimecrolimus 1% cream and topical ketoconazole 2% cream in the treatment of seborrheic dermatitis. J Dermatolog Treat 2009; 20:4.
- Papp KA, Papp A, Dahmer B, Clark CS. Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults. J Am Acad Dermatol 2012; 67:e11.
- Ballanger F, Tenaud I, Volteau C, et al. Anti-inflammatory effects of lithium gluconate on keratinocytes: a possible explanation for efficiency in seborrhoeic dermatitis. Arch Dermatol Res 2008; 300:215.
- Dreno B, Moyse D. Lithium gluconate in the treatment of seborrhoeic dermatitis: a multicenter, randomised, double-blind study versus placebo. Eur J Dermatol 2002; 12:549.
- A double-blind, placebo-controlled, multicenter trial of lithium succinate ointment in the treatment of seborrheic dermatitis. Efalith Multicenter Trial Group. J Am Acad Dermatol 1992; 26:452.
- Dreno B, Chosidow O, Revuz J, et al. Lithium gluconate 8% vs ketoconazole 2% in the treatment of seborrhoeic dermatitis: a multicentre, randomized study. Br J Dermatol 2003; 148:1230.
- Gupta AK, Richardson M, Paquet M. Systematic review of oral treatments for seborrheic dermatitis. J Eur Acad Dermatol Venereol 2014; 28:16.
- Vena GA, Micali G, Santoianni P, et al. Oral terbinafine in the treatment of multi-site seborrhoic dermatitis: a multicenter, double-blind placebo-controlled study. Int J Immunopathol Pharmacol 2005; 18:745.
- Kose O, Erbil H, Gur AR. Oral itraconazole for the treatment of seborrhoeic dermatitis: an open, noncomparative trial. J Eur Acad Dermatol Venereol 2005; 19:172.
- Scaparro E, Quadri G, Virno G, et al. Evaluation of the efficacy and tolerability of oral terbinafine (Daskil) in patients with seborrhoeic dermatitis. A multicentre, randomized, investigator-blinded, placebo-controlled trial. Br J Dermatol 2001; 144:854.
- Shemer A, Kaplan B, Nathansohn N, et al. Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study. Isr Med Assoc J 2008; 10:417.
- Ghodsi SZ, Abbas Z, Abedeni R. Efficacy of Oral Itraconazole in the Treatment and Relapse Prevention of Moderate to Severe Seborrheic Dermatitis: A Randomized, Placebo-Controlled Trial. Am J Clin Dermatol 2015; 16:431.
- Cömert A, Bekiroglu N, Gürbüz O, Ergun T. Efficacy of oral fluconazole in the treatment of seborrheic dermatitis: a placebo-controlled study. Am J Clin Dermatol 2007; 8:235.
- Piérard-Franchimont C, Piérard GE, Vroome V, et al. Comparative anti-dandruff efficacy between a tar and a non-tar shampoo. Dermatology 2000; 200:181.
- Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol 2009; 10:103.
- Pari T, Pulimood S, Jacob M, et al. Randomised double blind controlled trial of 2% ketoconazole cream versus 0.05% clobetasol 17-butyrate cream in seborrhoeic dermatitis. J Eur Acad Dermatol Venereol 1998; 10:89.
- Gupta AK, Bluhm R. Seborrheic dermatitis. J Eur Acad Dermatol Venereol 2004; 18:13.
- Osborne GE, Taylor C, Fuller LC. The management of HIV-related skin disease. Part II: neoplasms and inflammatory disorders. Int J STD AIDS 2003; 14:235.
- Ford GP, Farr PM, Ive FA, Shuster S. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol 1984; 111:603.
- CLINICAL MANIFESTATIONS
- In patients with HIV
- CLINICAL COURSE
- DIFFERENTIAL DIAGNOSIS
- Therapeutic options
- - Topical antifungal agents
- - Topical corticosteroids
- - Topical calcineurin inhibitors
- - Other topical agents
- - Systemic treatments
- Approach to management
- - Seborrheic dermatitis of the scalp
- - Seborrheic dermatitis of the face
- - Seborrheic blepharitis
- - Seborrheic dermatitis of the trunk and intertriginous areas
- - Seborrheic dermatitis in HIV patients
- - Severe or refractory seborrheic dermatitis
- PREVENTION OF RELAPSE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS