Seborrheic Dermatitis: An Overview

Seborrheic Dermatitis: An Overview
ROBERT A. SCHWARTZ, M.D., M.P.H., CHRISTOPHER A. JANUSZ, M.D., and CAMILA K. JANNIGER, M.D.University of Medicine and Dentistry at New Jersey-New Jersey Medical School, Newark, New Jersey

Seborrheic dermatitis affects the scalp, central face, and anterior chest. In adolescents and adults, it often presents as scalp scaling (dandruff). Seborrheic dermatitis also may cause mild to marked erythema of the nasolabial fold, often with scaling. Stress can cause flare-ups. The scales are greasy, not dry, as commonly thought. An uncommon generalized form in infants may be linked to immunodeficiencies. Topical therapy primarily consists of antifungal agents and low-potency steroids. New topical calcineurin inhibitors (immunomodulators) sometimes are administered. (Am Fam Physician 2006;74:125-30. Copyright © 2006 American Academy of Family Physicians.)

Seborrheic dermatitis can affect patients from infancy to old age. The condition most commonly occurs in infants within the first three months of life and in adults at 30 to 60 years of age. In adolescents and adults, it usually presents as scalp scaling (dandruff) or as mild to marked erythema of the nasolabial fold during times of stress or sleep deprivation. The latter type tends to affect men more often than women and often is precipitated by emotional stress. An uncommon generalized form in infants may be linked to immunodeficiencies.

Infants with generalized seborrheic dermatitis, diarrhea, and failure to thrive should be evaluated for immunodeficiencies.

Seborrheic dermatitis and pityriasis capitis (cradle cap) are common in early childhood. According to one survey of 1,116 children, the overall age- and sex-adjusted prevalence of seborrheic dermatitis was 10 percent in boys and 9.5 percent in girls. The highest prevalence occurred in the first three months of life, decreasing rapidly by one year of age, and slowly decreasing over the next four years. Most patients (72 percent) had minimal to mild seborrheic dermatitis. Pityriasis capitis occurred in 42 percent of the children examined (86 percent had a minimal to mild case). Prevalence estimates for older persons are consistently higher than estimates for the general population.