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Seborrhoeic Dermatitis

Seborrhoeic Dermatitis is a common dermatitis with a characteristic distribution. It appears in areas where sebaceous glands are numerous such as the face, extending downwards to the neck and behind the ears, the scalp, central chest and between the shoulder blades. The flexures may also be affected, particularly the axillae, the submammary regions and the ano-genital region.

The sebaceous glands are active at birth, but when stimulation by maternal hormones ceases they become inactive for 9 – 12 years. Seborrhoeic Dermatitis during infancy is normally confined to the first months of life. Most commonly, Seborrhoeic Dermatitis occurs between the ages of 18 – 40. Occasionally cases are seen in old age. At all ages Seborrhoeic Dermatitis is more common in males than in females.

Seborrhoeic Dermatitis may appear as the following variations:
(a) a scaly, reddened eruption on the scalp, forehead, eyebrows, base of the nose, on the chest or pubic region, or

(b) a moist, fissured eruption which may appear in flexural areas.

On the scalp Seborrhoeic Dermatitis usually begins as red spots covered with greasy, yellowish scales, which frequently spread and increase in size. The patient complains of itchiness, discomfort and sometimes loss of hair. It may spread downwards to involve the ears and neck, or forward to involve the forehead. Eyelids may also be affected. The flexural type of Seborrhoeic Dermatitis may appear as moist, red, scaly persistent areas under the breasts, between the buttocks, in the armpit, the groin or umbilicus. Behind the ears, scales may accumulate and fissuring occur. Without treatment, the eruption extends.

Treatment
A review of the literature by Shuster (1984) Br J Dermatol, 111:235, concluded that Pityrosporum, a yeast organism, is the causative agent in seborrhoeic dermatitis. This view is gaining increasing support in the medical community.

The way in which Pityrosporum induces inflammation and desquamation is not clear although it is known that Pityrosporum can activate complement and this may play some role. Treatment of seborrhoeic dermatitis should be aimed at decreasing yeast numbers as well as inflammation. As this is a chronic, recurring condition, treatment must be effective and safe for long term use.

Advice for the Patient

1. As with all skin conditions that involve pruritus, it is important to advise the patient not to scratch. Scratching can introduce secondary infection to the area leading to a more complicated condition to treat.

2. The patient should be advised to avoid using soap as normal alkaline soaps will remove the skin’s natural acid protection against infection.

Products to Help (Anti-pruritics, Soap Alternatives)

PINETARSOL SOLUTION
An anti-itch, anti-inflammatory and cleansing solution with a pH of 6.5, Pinetarsol Solution relieves itching and reduces inflammation. Bathing also helps to keep the skin and fingernails clean to reduce the risk of secondary infection caused by scratching. Add 15 - 30 mL to a warm to tepid bath (5 mL to baby’s bath). Bathe for 5 – 10 minutes, once daily or more often in severe cases.

PINETARSOL BATH OIL
Pinetarsol Bath Oil is a non-greasy, water dispensable bath oil for the treatment of dry, itching, inflamed skin conditions. Containing pine tar, Pinetarsol Bath Oil reduces the inflammation and relieves pruritus. Pinetarsol Bath Oil also contains emollient oils to hydrate the skin. Due to the cleansing properties of Pinetarsol Bath Oil it may be used as a soap alternative. Add 15-30mL to a warm to tepid bath (5mL
to a baby’s bath or hand basin) and bathe for 10 minutes once daily, more often in severe cases. Pat skin dry.

PINETARSOL BAR, PINETARSOL GEL
Pinetarsol Bar and Pinetarsol Gel are soap alternatives which can be used to cleanse the skin when ordinary soaps are contraindicated. Both Pinetarsol Bar and Pinetarsol Gel contain pine tar to relieve itching and reduce inflammation.

SEBITAR
Sebitar is a scalp cleansing treatment for scalp dermatitis, scalp psoriasis and seborrhoea. Sebitar contains coal tar solution and pine tar to relieve severe itching and reduce inflammation of the scalp. Sebitar also helps control excess flaking of the skin and its anti-fungal properties makes it effective against Pityrosporum. The gentle formulation leaves hair soft, shining and manageable and has a pH of 6 to protect the cuticle of the hair, preventing damage. Sebitar may be used daily if required and is safe for permed or tinted hair. Follow treatment with SebiRinse to condition the hair.