Seborrhea

(Inflammatory Dandruff; Seborrheic Dermatitis; Seborrheic Eczema)

Seborrhea, a common chronic skin disorder, is characterized by rough, dry, inflamed skin that gives off yellowish scales. There may be itching, and when it develops in skin folds, these areas are often red and sore. The term seborrhea is misleading because the scaling has little or nothing to do with the production of sebum, the waxy substance secreted by the skin's sebaceous glands; instead, the scales are dead cells shed by the epidermis layer. Seborrhea can develop at any age, but occurs most often in young adults.

The areas generally affected are the scalp; the face, especially the eyebrows, eyelids, moustache area, around the nose, and behind the ears; the torso, usually the central chest and upper back; and the skin folds of the armpit and groin and under the breasts.

The cause is unknown, but stress and climate may be factors. For example, many people find that their skin clears up when they are on vacation, especially if the locale is warm and sunny, only to have the problem recur when they return to work or when winter arrives.

In older people, seborrhea is sometimes associated with Parkinson's disease or other neurological disorders. The condition tends to run in families, so there may be an inherited predisposition, but it is not a genetic disease.

Diagnostic Studies and Procedures

Dermatologists can diagnose seborrhea simply by inspecting the skin. In unusual cases, a skin biopsy may be ordered to rule out other conditions.

Medical Treatments

Treatment varies according to the part of the body affected. A physician may recommend a mild, 1 percent hydrocortisone cream, available without a prescription, for facial seborrhea. If this does not help, a prescription of a 2.5 percent strength solution may be tried.

Seborrhea on the trunk is harder to treat, and often recurs. Topical hydrocortisone usually doesn't help, although oral or injected steroids may bring it under control. Stubborn cases may respond to overnight tar preparations.

Mild seborrhea in skin folds generally responds to a topical prescription-strength steroid. For severe cases, 10-minute, twice-daily applications of compresses soaked in aluminum acetate or potassium permanganate may be prescribed, along with steroids and antibiotics. In these areas, seborrhea is often accompanied by secondary bacterial or Candida infections; thus, antibacterial or antifungal medications may be added to the regimen.

Scalp seborrhea is treated with special shampoos containing tar, zinc pyrithione, selenium sulfide, or sulfur and salicylic acid or tar.

Alternative Therapies

Aromatherapy. Practitioners recommend bathing the affected skin with 2 percent essence of geranium in a base of distilled water. This should be done three times a week before bedtime. The scalp, chest, and skin folds may be treated twice a week with 10 percent essence of sage in an olive oil base, which is massaged into the affected areas and washed out in two hours.

Herbal Medicine. Compresses soaked in dandelion, goldenseal, or red clover teas may help seborrhea. Some herbalists also recommend a chaparral tea rinse following a shampoo.

Meditation. Because stress appears to be a precipitating factor, meditation and other relaxation techniques may prevent flare-ups.

Nutrition Therapy. Some naturopathic practitioners believe seborrhea could be due to vitamin A deficiency and recommend a daily supplement, although other medical specialists disagree. Vitamin B complex and zinc supplements may also be recommended.

Self-Treatment

Mild seborrhea can usually be self-treated with nonprescription hydrocortisone creams and antidandruff shampoos. Judicious exposure to sun may also help, but care must be taken not to bum, which can worsen the condition.

Other Causes of Skin Scaling

Ordinary dandruff may resemble scalp seborrhea without the inflammation. Psoriasis may be mistaken for seborrhea, but its scales are thicker and the skin is likely to be redder. Tinea versicolor, a superficial fungal infection, sometimes resembles seborrhea, as do several other fungal infections, especially those affecting the skin folds.