Archive \ Volume.12 2021 Issue 4

Review on Seborrheic Dermatitis Diagnosis and Treatment in Primary Health Care Center

Abdulelah AbdullahA Al Juman¹, Rama Hassan Tawfiq Halabi², Fahad Mohammad Fatini², Ghadah Ali Almuhana³, Anwar Rabeh Alrashidi⁴, Afnan Sultan Mohammed Alshehri⁵, Zainab Othman A Alasafra⁶*, Zahra Nasser Aljubran⁷, Mansour Fulayyih H Almutairi⁸, Mohammed Ibrahim Alsaeed⁹

¹Department of Family Medicine, Khamis Mushait Primary Health Care Center, Khamis Mushait, KSA. ²Faculty of Medicine, Umm Al Qura University, Makkah, KSA. ³Faculty of Medicine, King Saud University, Riyadh, KSA. ⁴Faculty of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, KSA. ⁵Faculty of Medicine, King Khalid University, Abha, KSA. ⁶Faculty of Medicine, Imam Abdulrahman bin Faisal University, Dammam, KSA. ⁷Faculty of Medicine, Dar Al Uloom University, Riyadh, KSA. ⁸ Faculty of Medicine, Shaqra University, Shaqra, KSA. ⁹Faculty of Medicine, Shaqra University, Shaqra, KSA.

Abstract

Seborrheic dermatitis is a common scaly inflammatory skin condition that is induced by Malassezia ovale yeast. Seborrheic dermatitis tends to appear in areas that are loaded with sebaceous glands. Recent studies have shown that dermatitis remains a great burden throughout all the decades of life in comparison to acne valugaris, whose greatest burden is in younger adults a halfway between the late first 10 years and the early third decades of life. This review will discuss the most recent systemic approaches on seborrheic dermatitis, several studies were discussed to increase the understanding of the etiology and clinical evaluation in detecting seborrheic dermatitis relying on important and particular cardinal symptoms to reach the diagnosis. This review aims to evaluate and analyze seborrheic dermatitis clinically for family medicine physicians. This review was performed by the preferred electronic MEDLINE search engine of the PubMed database. This review discussed only published English and English translated documents, articles, systemic reviews related to the subject, and no rejected or papers were included. The etiology of seborrheic dermatitis depends on several factors including dietary pattern and immunity. Using prescribed medications can prevent future relapse of the skin condition.

Keywords: Seborrheic dermatitis, Management, Epidemiology, Evaluation

INTRODUCTION

The human skin serves as a complex ecosystem where it is colonized by various microorganisms including viral, bacterial, archaea, and fungi organisms, relatively known as the skin microbiome [1, 2]. A skin microbiome that comprises 18 species with various strains known as Malassezia has a pathogenic role over skin health and initiates several cutaneous disorders such as seborrheic dermatitis, atopic dermatitis, and psoriasis. Malassezia genus is lipid dependent group of (Club-shaped) basidiomycetous yeasts and has essential factors of the skin microbiome [3, 4]. Seborrheic dermatitis is a common scaly inflammatory skin condition that is induced by Malassezia ovale yeast. The inflammatory skin diseases usually manifest as salmon-pink scaly and itchy lesions. The presenting papulosquamous morphology widely spreads on rich sebaceous glands areas, particularly on the scalp, face, body folds, and trunk. In addition, the pathogenic etiologies in seborrheic dermatitis may be due to immunological or external causes [5-7]. This review is to promote a systemic approach to seborrheic dermatitis, several studies were discussed to increase the understanding of the etiology and clinical evaluation in detecting seborrheic dermatitis relying on important and particular cardinal symptoms to reach the diagnosis. These approaches will assist Family medicine physicians to develop new clinical skills that will aid their evaluation for skin disorders in the primary health care facility. This review will focus and actively participate in the mainstay of therapy for patients that are affected by seborrheic dermatitis.

MATERIALS AND METHODS

This review was performed by preferred electronic MEDLINE search engine of PubMed database, using the term "seborrheic dermatitis” including words used in Mesh ((‘Dermatitis’[Mesh])), ((“Seborrheic”[Mesh])), ((“Epidemiology”[Mesh])), ((“Evaluation”[Mesh])), ((“Management”[Mesh])). This review discussed only published English and English translated documents, articles, systemic reviews related to the subject, and no rejected or papers were included.

Review

Epidemiology

In 2013, dermatoepidemiology was investigated to measure the worldwide burden of the disability-adjusted life years rate (DALY) and mortality of skin disorders in younger and older age categories. The study globally estimated 15 skin conditions including seborrheic dermatitis for the years 1980 to 2013 in 188 countries. The results have shown that dermatitis remains a great burden throughout all the decades of life in comparison to acne valugaris, whose greatest burden is in younger adults a halfway between the late first 10 years and the early third decades of life. All skin conditions are known to contribute about 1.7% of the worldwide burden of diseases. The size of these skin conditions was discriminated in percentages as dermatitis took the lead by 0.38% of the total DALYs including (seborrheic dermatitis, atopic dermatitis, and contact dermatitis) [8].

Seborrheic dermatitis typically affects healthy individuals as well as it is identified in viral immunodeficiency virus infections and also is associated with neurological diseases as in Cerebrovascular, Stroke, Alzheimer dementia, and Parkinson diseases [7, 9]. In general populations, seborrheic dermatitis reaches 1% to 3% and reaches up to 34 & to 83% in immunocompromised patients. Seborrheic dermatitis in males is present in aggressive forms, unlike females. The condition usually increases during stress and favors cold and dry temperatures [7, 10].

Etiology

Seborrheic dermatitis has a specific dietary pattern. High processed food and meat consumption that is included in the western diet has shown significant association markers of inflammation [11, 12]. Although in some data seborrheic dermatitis females have shown to have higher adherence to the western diet, males have not shown any association with western diet patterns. Sex differences between males and females’ fat distribution, demonstrates different immune response in autoimmune and inflammatory diseases and underline the relations between nutrition and sex as an important source of interaction [12-14].

Other medications that may induce seborrheic dermatitis include cofactors that are linked to T-cell count depression such as inflammatory dermatoses in HIV-AIDS, particularly in cases where CD4 T cell count is less than 400 cell/mm³ [6]. Seborrheic dermatitis also occurs more frequently with certain psychotropic medications especially on long-term usage; these include buspirone, haloperidol decanoate, chlorpromazine, and lithium [15].

Clinical Evaluation

Presentation and Manifestation of Seborrheic Dermatitis

Seborrheic dermatitis tends to appear in areas that are loaded with sebaceous glands (Table 1). The areas of spread in seborrheic dermatitis are considered because they share many clinical features that provide valid directions for future laboratory assessment and treatments. One of the main features is that seborrheic dermatitis lesions are presented in a symmetrical pattern and it is neither fatal nor contagious, however, it is associated with painful and physical discomfort issues [16].

Adults’ seborrheic dermatitis is generally more common than infantile seborrheic dermatitis and is mostly presented as scaly pityriasiforms and ill-identified erythematous patches [17]. As for children, tinea capitis is often confused with seborrheic dermatitis. To confirm the diagnosis of seborrheic dermatitis clinicians need to identify the differential diagnosis related to seborrheic dermatitis (Table 2) [5, 7].

Management

Seborrheic dermatitis does not need routine investigation to confirm the diagnosis. The approach of treatment will vary according to age, skin condition, site and distribution of the lesions, and other systemic factors associated with the flare of seborrheic rash. Seborrheic dermatitis medication is usually over-the-counter preparations including topical fungal, keratolytic, antipruritic, shampoos, and corticosteroids to decrease symptoms (Table 3) [7].

Steroids are beneficial on scalp seborrheic dermatitis and reduce the severity of inflammation [7, 18]. Using this medication as prescribed can prevent any relapse of the skin condition. Often patients with delayed response to any of the therapy’s regimens should be referred to a dermatologist for further assessments and follow-up [7].

CONCLUSION

Seborrheic dermatitis is a common scaly inflammatory skin condition that is induced by Malassezia ovale yeast. The inflammatory skin diseases usually manifest as salmon-pink scaly and itchy lesions. The etiology of seborrheic dermatitis depends on several factors including dietary pattern and immunity. The areas of spread in seborrheic dermatitis are considered because they share many clinical features that provide valid directions for future laboratory assessment and treatments. Moreover, Seborrheic dermatitis does not need routine investigation to confirm the diagnosis. The adopted medications for seborrheic dermatitis reduce the severity of inflammation. Using the list of medications available in this review can prevent any relapse of the skin condition.

ACKNOWLEDGMENTS: None

CONFLICT OF INTEREST: None

FINANCIAL SUPPORT: None

ETHICS STATEMENT: None