Seborrhoeic eczema: Description
Seborrhoeic eczema (seborrhoeic dermatitis) is a yellow, scaly, red skin rash (eczema) in the area of the sebaceous glands (seborrhoeic glands). These glands produce sebum – a mixture of fats and proteins that protects the skin from drying out. The sebaceous glands are mainly located in the front (chest) and rear (back) sweat ducts, on the face and on the hairy head. These are therefore the preferred sites for the development of seborrhoeic eczema. The scalp is also the area most frequently affected by the skin disease in infants – hence its second name “head gneiss”.
Seborrhoeic eczema should not be confused with seborrhoeic keratosis, which is also known as senile wart.
Seborrhoeic eczema: frequency
Three to five percent of people develop seborrhoeic eczema every year. However, if mild cases that do not require treatment are taken into account, this figure would probably be significantly higher. Men between the ages of thirty and sixty are most frequently and severely affected by the skin disease. Seborrhoeic eczema is particularly common in connection with HIV infection (especially in the AIDS stage) and Parkinson’s disease.
Seborrhoeic eczema: symptoms
Seborrhoeic eczema is characterized by usually clearly defined redness of the skin with yellowish scales on it. However, the skin symptoms vary greatly depending on the severity of the disease: some patients only experience increased scaling of the skin, while others suffer from massive inflammation of the skin. The infestation can also be localized or spread to several areas of the skin. The scales often feel greasy.
Seborrheic eczema occurs most frequently on the head. The face and the front and back sweat ducts are also typical localizations. Inflammation of the eyelids (blepharitis) can also occur.
As a rule, seborrhoeic eczema does not cause pain and only rarely itching. However, the damaged areas of skin can become infected with bacteria and fungi. Scratch marks caused by severe itching then further damage the skin.
In rare cases, seborrhoeic eczema can lead to hair loss. Although such hair loss is usually associated with eczema, it is not caused by it.
Seborrhoeic eczema: different forms
A distinction is made between different forms of seborrhoeic eczema:
In contrast, focal seborrhoeic eczema is characterized by fully pronounced symptoms: The “foci” are clearly reddish inflamed, irregular and yellowish scaling. This form of the disease is often chronic and recurrent (with relapses).
Some experts classify a so-called intertriginous localization as a subtype of seborrhoeic eczema. Intertriginous is the term used to describe areas of the body where opposite skin surfaces touch or can touch directly. These are, for example, the armpits, the area under the female breast, navel, groin and anus. In these cases, there is a high risk of infection. However, seborrhoeic eczema in these areas can also be confused with a pure fungal infection (usually Candida).
Disseminated seborrhoeic eczema is particularly serious and runs a subacute to acute course (“subacute” = less acute/severe). It occurs either without a recognizable cause or after irritation of existing foci, for example due to an intolerable treatment. The foci are often symmetrically distributed, extensive, confluent, scaly and may also be characterized by larger weeping and crusty skin defects (erosions). In severe cases, the entire body is reddened (erythroderma).
Seborrheic eczema in babies
In babies, seborrheic eczema usually develops on the head. This so-called “head gneiss” is characterized by thick, yellow-greasy scales. In many cases, the disease begins on the crown of the head, near the eyebrows, on the cheek or nose. From there, seborrheic eczema can spread to the entire scalp and face. The scaling can be very severe. The baby’s hair appears greasy and stringy.
As with adult patients, seborrhoeic eczema is usually not bothersome for the affected infant, unlike so-called atopic eczema. The “head gneiss baby” seems content. It usually eats and sleeps normally.
Sometimes seborrheic eczema spreads to the diaper area, the groin, the belly button, the armpits or, more rarely, the chest. An infestation in different places is also possible. The spread of pathogens, especially fungi, leads to reddening of the skin and altered scaling around the edges. Disseminated forms of seborrhoeic eczema are rare.
Seborrhoeic eczema: causes and risk factors
In any case, those affected suffer from impaired skin renewal. New skin cells migrate to the surface, where they later die off and are shed to make room for new skin cells. This process is not visible on healthy skin because the skin cells are very small. However, due to the impaired skin renewal in seborrhoeic eczema, the typical large scales form.
Scalp gneiss
In infants with seborrhoeic eczema of the head, residues of maternal hormones (androgens) play a role: they stimulate the baby’s sebum production and thus support the development of “scalp gneiss”. However, these residues of maternal hormones are already broken down in the baby’s body in the first few months of life, whereupon sebum production returns to normal.
Connection with other diseases
Seborrheic eczema occurs more frequently with certain diseases. These include various neurological diseases, in particular Parkinson’s disease, as well as HIV infections:
Parkinson’s patients often suffer from increased sebum production, which favors the development of seborrheic eczema.
Seborrhoeic eczema is also associated with androgenic effluvium – a form of hair loss caused by a genetic hypersensitivity of the hair roots to male sex hormones (androgens).
Seborrhoeic eczema: influencing factors
A number of medications can cause a skin rash similar to seborrhoeic eczema. These include, for example, erlotinib, sorafenib and interleukin-2 (all cancer drugs). Treatment with so-called neuroleptics, which are used for various psychiatric illnesses, can also promote the development of seborrhoeic eczema.
Stress and cold seem to worsen seborrhoeic eczema. In summer, on the other hand, the skin condition usually improves (under UV radiation). However, the effect of UV light is controversial. Seborrhoeic eczema can also develop as a result of UV-A therapy – a form of light therapy – in psoriasis patients.
Seborrhoeic eczema: examinations and diagnosis
The specialist for seborrheic eczema is the dermatologist or – in the case of infants – the pediatrician. First of all, the doctor will take the patient’s medical history (anamnesis). Possible questions include:
- How long have the skin symptoms been present?
- Are the rashes itchy?
- Have there been similar skin rashes in the past?
This is followed by a physical examination: the doctor carefully examines the relevant areas of skin. Firstly, the localization and secondly, the appearance of the skin symptoms are decisive criteria for the diagnosis of seborrhoeic eczema.
In rare cases of doubt, the doctor may take a skin sample (biopsy) and have it examined by a pathologist. There are no specific signs of seborrhoeic eczema. Typically, however, a thickening of the prickle cell layer of the skin (acanthosis) due to increased formation of new skin cells, impaired keratinization of the skin (parakeratosis), the migration of immune cells and water retention (spongiosis) can be seen under the microscope. In addition, there are more immune cells in the diseased skin than in healthy skin.
The microscopic picture of the skin sample can resemble psoriasis (psoriasiform) or pink lichen (pityrasiform), especially in chronic cases. In the case of an existing HIV infection, the microscopic picture of the skin symptoms may be different.
Seborrhoeic eczema: differentiation from other diseases
Seborrhoeic eczema must be differentiated from diseases with similar symptoms (differential diagnoses). These include, for example
- Atopic dermatitis (neurodermatitis)
- contact eczema
- Psoriasis, also known as psoriasis capitis (psoriasis on the scalp)
- Pink lichen (Pityriasis rosea)
- Other fungal skin infections (such as head fungus = tinea capitis)
- Impetigo contagiosa (infectious, bacterial skin disease in children)
- Rosacea (rosacea)
Other diseases that can cause skin symptoms similar to seborrheic eczema are lupus erythematosus, lues (syphilis) and head lice infestation.
In infants, the pediatrician must differentiate seborrheic eczema from “cradle cap” (atopic eczema). In this disease, the scalp is clearly reddened, weeping and crusty. The affected children also appear to experience severe itching. Cradle cap usually occurs later than seborrheic eczema in infants.
If the rash is particularly pronounced in the diaper area, it may be diaper thrush – a fungal infection with the yeast Candida.
Seborrhoeic eczema: treatment
Seborrhoeic eczema often needs to be treated due to its usually chronic course – externally and, if necessary, also internally (taking medication).
Treatment is based on skin care and stress reduction. The most important therapeutic agents are antifungals (antimycotics) and corticosteroids (“cortisone”). In the beard area, shaving can be helpful.
Patience is required to treat seborrhoeic eczema. However, if the rash persists despite adequate treatment, the diagnosis of seborrhoeic eczema should be reviewed.
Seborrhoeic eczema: external therapy
External treatment is usually long-term and is primarily directed against sebum production, inflammation and infections. The various applications can usually be combined with each other.
The basic principle of treatment should be good skin care. Use alkali-free detergents. They should promote the degreasing of the skin and prevent infections.
Keratolytics
Seborrhoeic eczema on the head can be treated well with special shampoos, which dissolve the dandruff and help to prevent infections. Selenium, zinc, urea, tar, salicylic acid, chloramphenicol and ethanol are among the effective ingredients in shampoos for seborrhoeic eczema. The shampoo should generally be applied two to three times a week in the evening. A bandage is wrapped around the head overnight and the hair is washed in the morning.
Possible side effects are mainly local reactions such as itching, burning and also changes in the color of the hair or scalp.
Antimycotics
Possible side effects are local irritation and burning. Serious side effects from the topical application of antifungal shampoos or ointments are rare.
Corticosteroids
Seborrhoeic eczema can also be treated with preparations containing cortisone (e.g. as shampoo, lotion or foam) for a short time. It is important to start treatment with cortisone preparations with the lowest possible potency. The use of cortisone has proven to be equivalent to antifungal medication. Cortisone also helps well against any itching. Inflammation of the eyelids (blepharitis) in the context of seborrhoeic eczema is usually treated with cortisone (and antibiotics if necessary).
Calcineurin inhibitors
Treatment of seborrhoeic eczema with so-called calcineurin inhibitors (pimecrolimus, tacrolimus), for example in the form of ointments, is just as effective as antimycotics and corticosteroids. These medications directly inhibit the immune system. However, they should only be used in the short term or as intermittent treatment, as cases of tumors (especially lymphomas and skin tumors) have been described.
Antibiotics
Seborrhoeic eczema is only treated with antibiotics if there is also a clear bacterial infection.
Lithium
Seborrhoeic eczema: internal therapy
The internal use of medication may be indicated in particular if the disseminated variant of the disease is present or if seborrhoeic eczema shows a clear tendency to spread. Even if external treatment is not (sufficiently) effective or more than three skin areas are affected, internal treatment with cortisone or antimycotics can be considered. In addition, seborrhoeic eczema can often be treated internally at an early stage and for longer, especially in patients with an HIV infection.
Antimycotics are usually taken daily for a week. This is usually followed by a follow-up treatment (e.g. two applications per month for three months).
The use of antibiotics is only indicated if the skin also shows a bacterial infection.
As a last resort to inhibit sebum production, the doctor may prescribe isotretinoin – a derivative of vitamin A that is actually used to treat severe acne.
Treatment for infants
If these measures do not help and the seborrhoeic eczema does not recede or even worsens, you should take your child to the pediatrician. If necessary, they can prescribe a local antifungal treatment twice a week for two weeks or a cortisone cream once a day for one week. Short-term treatment with local corticosteroids is considered safe – even in children. If the symptoms do not improve within a week, the diagnosis of seborrhoeic eczema should be reconsidered.
Seborrhoeic eczema: homeopathy & co.
There are a variety of alternative therapies for the treatment of seborrhoeic eczema, for example homeopathy, Bach flowers, Schuessler salts, household remedies and medicinal plants. However, the concept of these alternative treatment methods and their specific effectiveness are controversial in the scientific community and have not been proven beyond doubt by studies.
For example, bathing with wheat bran and oat straw extract is said to promote healing. Slate oils are also said to promote wound healing and have an antimicrobial effect. Menthol and thymol can reduce itching. However, such treatments should be supervised by an experienced therapist.
Seborrhoeic eczema: course of the disease and prognosis
Seborrhoeic eczema in adults is often chronic and recurs after the medication has been discontinued. For this reason, treatment often has to be repeated or continued on an ongoing basis to prevent recurrence.
Seborrhoeic eczema damages the skin barrier that protects against infections. This favors bacterial and fungal infections of the skin. These must be monitored and treated accordingly in order to prevent the germs from progressing or spreading.
In rare cases, contact sensitization develops in the form of an allergic reaction or seborrhoeic eczema turns into psoriasis (psoriasis vulgaris). However, seborrhoeic eczema can usually be well controlled with the help of modern treatment methods.
Infants
In the vast majority of cases, a baby’s ability to thrive is not affected by “scalp gneiss”. The condition is therefore considered harmless. However, the skin condition can recur within weeks or even months and then require renewed treatment. Seborrhoeic eczema usually disappears on its own by the end of the second year of life at the latest.
