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Seborrheic eczema
Medical expert of the article
Last reviewed: 04.07.2025
Epidemiology of seborrheic eczema
The average incidence of the disease in the population is 3-5%, but it is much more common in patients with immunodeficiencies: from 30 to 80%. As a rule, it begins during puberty, but can develop at any age. Most patients become ill before the age of 30, after 50 the risk of developing the disease increases again. Men get sick more often. The main complaint of patients is itching, which intensifies with sweating. The condition often worsens in winter.
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Causes and pathogenesis of seborrheic eczema
The causes and pathogenesis of seborrheic eczema have not been sufficiently studied to date. Genetic factors, hyperproduction of sebaceous glands, pathological changes in the function of sebaceous glands, bacteria found in the mouths of hair follicles and sebaceous glands, stress, and allergic reactions play a significant role in its development.
Hyperfunction of the sebaceous glands is an important predisposing factor. In newborns, the sebaceous glands are active due to endogenous formation of androgens, so seborrheic eczema can develop in children up to 3 months. At a later age, the activity of the sebaceous glands decreases, so the development of seborrheic eczema occurs less often. The influence of androgens also explains the more frequent occurrence of the disease in men. Qualitative changes in sebum have not been proven.
The role of the nervous system is evidenced by such facts as the connection between Parkinson's disease and seborrheic eczema. In poliomyelitis or syringomyelia, skin changes often occur only in the area of the trigeminal nerve lesion. Patients also often emphasize that stress aggravates skin manifestations. Manifestations of the disease are more pronounced in winter. With a lack of zinc or enteropathic acrodermatitis, the risk of developing seborrheic dermatitis is increased. There is a violation of the metabolism of essential fatty acids. Vitamin B deficiency can also cause such dermatosis.
Currently, the possible role of Malassezia (Pityrosporum) yeast in the development of seborrheic dermatitis is being widely studied. The connection is confirmed by the fact that when treating seborrheic eczema with antifungal drugs, there is a decrease in the manifestations of the disease and a decrease in the colonization of the skin by Malassezia. The number of yeast cells on the surface of the patient's skin significantly exceeds normal values (5 * 10 5 cm 2 in healthy people and 9.2 x 10 5 cm -2 in patients with seborrheic eczema). The mycelial phase of fungi in seborrheic eczema occurs in 26% of patients (in healthy people - in 6% of cases). It is also assumed that seborrheic eczema is a specific skin reaction to Malassezia. Various immune system disorders in patients with seborrheic eczema as a result of the activity of yeast-like fungi have been studied: a relationship has been noted between titers of antibodies to Malassezia and the severity of seborrheic eczema of the scalp.
It is not only the yeast Malassezia that plays an etiologic role. For example, in some infants suffering from seborrheic eczema, numerous colonies of Candida albicans are isolated from the stool and skin surface, and patch tests and the lymphocyte transformation reaction confirm the presence of sensitization. Cross antigens of C. albicans and Malassezia are also known.
It is likely, however, that different groups of patients have their own specific pathogenesis of this disease, since, for example, in patients with severe immunodeficiency, Malassezia cells are seeded significantly less frequently than in patients without immunopathology. Seborrheic eczema is also one of the most important markers of HIV-infected patients.
Symptoms of Seborrheic Eczema
Symptoms of seborrheic eczema are characterized by a tendency to chronicity, frequent relapses, and are difficult to treat. Cosmetic defects can lead to psychological problems in patients and cause social adaptation disorders. The main complaint of patients is itching, which intensifies with sweating.
Infantile seborrheic eczema
Infantile seborrheic eczema most often occurs in the first six months of a child's life and usually completely disappears within a few months. Children prone to obesity are more often affected. The lesion occurs on the scalp, but the facial skin in the eyebrow and nasolabial fold area may be affected, and as the process spreads, the flexor areas of the limbs and large folds of the body may be involved. Layers of greasy, cracked yellowish scales - gneiss - form on the scalp. Disseminated foci of infection, localized in large folds, resemble those in psoriasis, but tend to heal quickly.
The rash occurs in areas characterized by an increased content of sebaceous glands - the face, scalp, chest, interscapular region, large folds. Symptoms are most often represented by the presence of inflammatory reddened and slightly infiltrated foci with irregular outlines, with yellowish scales and crusts on a hyperemic background. The lesion looks like either large confluent foci resembling a geographical map, or round with clear boundaries of multiple foci resembling pityriasis versicolor. With strong subjective sensations - itching, burning - excoriations, cracks appear, a secondary infection joins. The ducts of the sebaceous glands look dilated.
On the face, lesions are most often located around the nose, in the nasolabial folds, and the skin of the eyebrows. Some patients experience a worsening of their condition after exposure to the sun or after UFO exposure. On the body, infiltration is usually weakly expressed due to the rejection of scales due to sweating. Large folds can be affected - axillary, inguinal, the clinical picture resembles candidiasis or intertrigo.
On the scalp, the rash has clearly defined outlines and a tendency to merge. Sometimes, there is total damage to the scalp, resembling a shell. The lesions often spread to the back of the head, lateral areas of the neck, and the retroauricular area. Often, a long-term non-healing crack forms in the retroauricular area, which is prone to secondary infection. In the center of the sternum or between the shoulder blades, the lesion takes the form of infiltrated hyperemic lesions.
Seborrheic erythroderma is a complication of seborrheic eczema and occurs due to intolerance to external treatment or as a result of contact sensitization.
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Diagnosis of seborrheic eczema
Diagnosis of seborrheic eczema is not difficult and is based on the typical clinical picture of the disease. The main difficulty is differential diagnosis with vulgar psoriasis, especially when the scalp is affected. With psoriasis, the rash is located along the hair growth, is more infiltrated, and the peeling is drier. Seborrheic eczema responds to therapy faster than psoriatic lesions. When large folds are affected, candidiasis or intertrigo should be remembered. With seborrheic erythroderma, Sezary syndrome should be excluded.
Treatment of seborrheic eczema
Treatment of seborrheic eczema can be both local and systemic, and depends on the severity of the disease. Due to the tendency to relapse, treatment is long-term and aimed at correcting seborrhea. Anti-inflammatory and antimycotic therapy is carried out.
For mild forms of seborrheic eczema with rashes localized on smooth skin, an ointment, cream or solution of an antifungal drug is used, which are applied 1-2 times a day for 2-4 weeks. Degrease the skin of the face with alcohol solutions with the addition of salicylic acid (2-3%) or resorcinol (2%). During the day, use a powder containing sulfur. For the face, products with erythromycin (Zinerit lotion) or ketoconazole (Nizoral cream) are recommended. At night, drying treatment of seborrheic eczema is indicated: zinc lotion with clioquinol (5%) and/or ichthyol (2-5%), as well as sulfur (2-5%). Weeping lesions are well treated with a 1% aqueous solution of brilliant green.
Local corticosteroids are one of the most effective methods of treating seborrheic eczema. Corticosteroids have a powerful anti-inflammatory effect, but their long-term use is limited by side effects - the occurrence of skin atrophy, telangiectasia, acne, perioral dermatitis. In children, corticosteroids should be prescribed with extreme caution, given the increased absorption of the skin. Low-activity corticosteroid creams are prescribed for the face - prednisolone and hydrocortisone.
Antiseborrheic agents with keratolytic and antimicrobial additives are used for washing hair: selenium sulfide (Vichy Dercos shampoo with selenium sulfide), salicylic acid, tar (T-gel, Friedrm-Tar), zinc (Friderm-Zinc). Ketoconazole (Nizoral shampoo), active against lipophilic yeast-like fungi (2 times a week), is indicated. Antiseborrheic hair tinctures contain sulfur, salicylic acid, resorcinol or non-feminized estrogens. Alcohol solutions of glucocorticoids, sometimes with the addition of tar, are indicated for a short-term effect. In case of a strong inflammatory process in the foci, halogenated glucocorticoids are prescribed. Creams, lotions or gels are recommended as bases.
In severe cases of the disease, characterized by the presence of foci with pronounced inflammation and dense layering of scales, keratolytics such as salicylic acid or coal tar preparations are used to remove the latter. After exfoliation, local antifungal and corticosteroid preparations are used. Additionally, antihistamines, calcium preparations may be recommended, and in the case of a bacterial infection, antibiotics are prescribed.
If external therapy is ineffective, systemic antifungal drugs taken orally for one week are indicated: ketoconazole (200 mg/day), terbinafine (250 mg/day), fluconazole (100 mg/day), itraconazole (200 mg/day). The action of ketoconazole and itraconazole has been studied most thoroughly. Fluconazole and terbinafine are less effective against Malassezia, but are also used in the treatment of seborrheic eczema.
In particularly severe cases, sebosuppressive drugs such as isotretinoin are prescribed, which reduces the activity and size of the sebaceous glands by up to 90% and also has an anti-inflammatory effect. Daily administration of the drug at a daily dose of 0.1 to 0.3 mg/kg of body weight has been shown to improve severe seborrhea after 4 weeks of treatment.
Complex treatment of seborrheic eczema includes antihistamines, multivitamins, sedatives, drugs to normalize the functions of the gastrointestinal tract, and in the case of a secondary infection - antibacterial agents and eubiotics.