Seborrheic psoriasis: scalp, face, difference from seborrheic dermatitis

Most patients with vulgar psoriasis have characteristic rashes not only on the skin of the elbows and knees, but also all over the body, including the head. And skin lesions on the head are often defined as seborrheic psoriasis.

Perhaps, at one time, the decisive role in the use of this term was played by the identical localization of scalp psoriasis and another common skin pathology - seborrheic dermatitis. Then what is the difference between psoriasis and seborrheic dermatitis? And is seborrheic psoriasis of the scalp really just a diagnosis formulation reflecting the impossibility of distinguishing two similar diseases from each other?

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Causes seborrheic psoriasis

If we adhere to this interpretation, then the causes of seborrheic psoriasis are the same as those of psoriasis itself, that is, the disease develops in the presence of appropriate endocrine, immune or neurologically mediated factors. However, as the journal Clinical Dermatology writes, seborrheic psoriasis is simply a combination of seborrheic dermatitis and psoriasis, in which both diseases develop simultaneously and ordinary psoriasis on the head looks a little different, and foreign specialists call it differently - sebopsoriasis or seborrheic-like psoriasis.

Indeed, the coexistence of psoriasis with seborrheic dermatitis is not uncommon, moreover, both diseases even have some symptomatic similarity, quite often causing problems with their differentiation when making a diagnosis. But, still, how does psoriasis differ from seborrheic dermatitis?

First of all, each disease has its own causes, while the pathogenesis of psoriasis is not associated with any infectious agents. Read in detail about why psoriasis can develop, what are the risk factors for its occurrence, as well as the pathogenetic features of this disease in a special material entirely devoted to this issue - Causes of Psoriasis

But seborrheic dermatitis is associated with an abnormal increase in the production of a protective lipid secretion by the sebaceous glands of the skin - sebum, which can have an allergic, hormonal or genetically determined etiology (with oily skin).

However, mycologists believe that the main culprits in the development of seborrheic dermatitis are the unicellular lipid-dependent yeasts of the genus Malassezia SPP (M. sympodialis, M. globosa, M. slooffiae) that live on the skin of every person (i.e., belong to the obligate microflora of the skin). They produce lipase, an enzyme that breaks down sebum, as a result of which its composition changes: triglycerides are converted into free fatty acids, the proportion of wax esters increases, and the alkalinity of the skin increases. Skin receptors (TLR, LRP-1, A2MR, etc.) react to this, causing activation of chemotaxis of prostaglandins, interleukins, histamine, and other inflammatory mediators and a local immune response in the form of edema, hyperemia, itching, etc.

In addition, when psoriasis is combined with seborrheic dermatitis - against the background of excessive production of sebum and its accelerated oxidation - the proliferation of keratinocytes in common psoriasis is aggravated, as well as in such dermatoses as seborrheic forms of atopic dermatitis and psoriasis.

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Symptoms seborrheic psoriasis

In fact, the symptoms of seborrheic psoriasis are a combination of the symptoms of common scalp psoriasis and seborrheic dermatitis.

If the first signs of vulgar psoriasis are visually manifested by clearly demarcated hyperemic papules, which quickly increase in size and become thickened plaques covered with dry silvery-white scales, then the morphological elements of the skin rash in seborrheic psoriasis have some differences.

Seborrheic psoriasis of the scalp manifests itself with the same primary elements of the rash with erythema and flaking, but the spots are covered with yellowish scales that are greasy to the touch. The separated scales resemble greasy dandruff. The usual subjective symptom is itching of the scalp, leading to excoriation, and a burning sensation in the affected areas.

Typically, the individual elements of the rash merge and the rash diffuses over the entire head, forming yellow-gray crusts; the skin beyond the hairline on the forehead, behind the ears and on the back of the neck is affected. There is a tendency for the rash to be localized on the face (usually in the nasolabial folds), and then seborrheic psoriasis of the face can be diagnosed. It is also possible for affected areas of skin to appear on the upper chest or in the shoulder blade area.

Stages

In the clinical picture of the development of seborrheic psoriasis, the same stages are distinguished as in the usual: progressive, stationary and regressive. For more details, see - Stages of psoriasis

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Complications and consequences

The consequences and complications of this disease are associated with scratching and infection, as well as extensive exfoliation of large areas of the epidermis and the risk of developing erythroderma.

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Diagnostics seborrheic psoriasis

As already noted, the diagnosis of seborrheic psoriasis causes certain difficulties, especially in those cases when the manifestation of psoriasis begins not with plaques on the elbows, but with the appearance of papulosquamous rashes on the head.

To diagnose seborrheic psoriasis, instrumental diagnostics are performed - dermatoscopy, as well as laboratory testing of scales and a tissue sample of plaques or spots.

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Differential diagnosis

Differential diagnostics are necessary to avoid confusing seborrheic psoriasis with diseases such as atopic and seborrheic dermatitis, keratosis, lichen, etc.

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Treatment seborrheic psoriasis

To ensure that the treatment of seborrheic psoriasis is as effective as possible, you need to use medications recommended by a dermatologist.

Typically, they start with using an antifungal medicated shampoo containing ketoconazole (Nizoral, Dermazole, etc.) or zinc pyrithione - daily for 10-14 days.

The following ointments are suitable for softening and removing crusts: salicylic, tar, with urea. Thus, Keratolan ointment (with urea, betaine and lactic acid) copes well with squamous rashes, which can be used up to three times a day.

Ointments and creams containing vitamin D3 or its derivatives reduce the intensity of hyperkeratosis. For example, Calcitriol ointment (Forcal) is applied to the affected areas twice a day for one to three months.

Also read – Psoriasis Creams

Dermatotropic drugs with strong corticosteroids are contraindicated for fungal infections, but for seborrheic psoriasis, lighter GSCs are prescribed. Most often, doctors recommend ointments and gels with fluocinolone acetonide (Sinaflan, Flucinar, Flunolone) or shampoo with clobetasol. It should be borne in mind that drugs based on corticosteroids cannot be used for a long time, as this is fraught with side effects that manifest as atrophy of the epidermis, extensive hyperemia, inflammation of the hair follicles, etc.

To reduce the level of stress that leads to an exacerbation of hyperkeratotic skin pathologies, mild sedatives may be prescribed; aloe juice, eleutherococcus or aralia tincture are taken as general tonics; vitamins (retinol, tocopherol, riboflavin, pyridoxine, nicotinic and orotic acid) are required.

Physiotherapeutic treatment includes: UV irradiation; oxygen, hydrogen sulphide and sea baths; sulphite mud applications.

Folk remedies

Among the methods offered by folk treatment of seborrheic psoriasis, it is worth noting:

• rubbing mineral oils into the skin on damaged areas with the addition of essential oils of tea tree, thuja, sophora, chamomile, carrot seeds;
• lubrication of rashes with a mixture of fish oil or cottonseed oil with aloe juice (in a 2:1 ratio);
• lubrication of the skin with a propolis solution (10 g per 100 ml of water) or a suspension of turmeric (teaspoon) dissolved in apple cider vinegar (150-180 ml);
• applying a paste of crushed fresh rowan berries to the scalp.

Herbal treatment is widely practiced, and herbalists recommend using celandine, oregano, wild pansy, succession, calendula, licorice root and elecampane for baths and hair washing.

Read also - Psoriasis Treatment at Home

Prevention

It is still unknown how to prevent seborrheic psoriasis, but you can read about the prevention methods that are being used to prevent psoriasis here – Prevention of Psoriasis.

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Forecast

The prognosis for a complete cure for this disease is, unfortunately, disappointing: this disease is chronic, although with persistent treatment it is possible to achieve fairly long periods of remission.

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