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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.

Products to Help (Anti-fungal, Anti-inflammatories)

RESOLVE BALM
Contains 2% miconozole nitrate to provide effective treatment of tender, inflamed or itchy skin infections. It also contains bufexamac to reduce inflammation, and is cortisone free. Use for thrush of the vulval area, male groin area or under the breast, fungal infected eczema/dermatitis, pityriasis versicolor and pityrosporum folliculitis with pityrosporum organisms. It rapidly soothes inflamed skin. Apply to the affected and surrounding skin twice daily for two weeks after symptoms disappear to avoid recurrence.

RESOLVE PLUS 0.5
Contains miconazole nitrate and 0.5% hydrocortisone for the treatment of inflamed fungal skin infections not responding to other anti-fungal treatments. Resolve Plus 0.5% works by treating the inflammation of the fungal infection and reducing the irritation caused by moisture and inflammation at the site of infection. Studies have shown cure rates of up to 90% when using miconazole and hydrocortisone together*.

RESOLVE PLUS 1.0
Contains miconazole nitrate and 1.0% hydrocortisone for the treatment of inflamed fungal skin infections not responding to other anti-fungal treatments. Resolve Plus 1.0% works by treating the inflammation of the fungal infection and reducing the irritation caused by moisture and inflammation at the site of infection. Studies have shown cure rates of up to 90% when using miconazole and hydrocortisone together*.

HAIRSCIENCE ANTI-DANDRUFF SHAMPOO
HairScience Anti-Dandruff Shampoo is a broad spectrum anti-microbial, antipruritic treatment for scalp disorders such as dandruff - mild seborrhoeic dermatitis. It is an effective anti-dandruff shampoo yet gentle enough for regular use. It contains a blend of gentle surfactants that work synergistically to provide effective cleansing without irritation. HairScience Anti-Dandruff Shampoo is effective against Pityrosporum ovale widely thought to be the causative agent in dandruff and seborrhoeic dermatitis. Use twice daily for effective dandruff treatment.

Products to Help (Topical Anti-inflammatories - Hydrocortisone)

DERMAID™ 0.5% CREAM*
DermAid™ 0.5% Cream is a topical corticosteroid with anti-inflammatory and vaso-constrictive properties that’s suitable for the majority of skin types. It contains dissolved hydrocortisone in an occlusive base which provides increased skin penetration and enhanced effectiveness for treatment of red, itchy skin. DermAid™also contains a moisturising element which helps prevent dry skin, and it’s lanolin and paraben-free to help avoid secondary allergic reactions. DermAid™ 0.5 Cream contains 0.5% hydrocortisone.

DERMAID™ 1.0% CREAM*
DermAid™ 1.0% Cream is a topical corticosteroid with anti-inflammatory and vaso-constrictive properties that’s suitable for the majority of skin types. It contains dissolved hydrocortisone in an occlusive base which provides increased skin penetration and enhanced effectiveness for treatment of red, itchy skin. DermAid™ also contains a moisturising element which helps prevent dry skin, and it’s lanolin and paraben-free to help avoid secondary allergic reactions. DermAid™1.0% Cream contains 1.0% hydrocortisone.

DERMAID SOFT™ 0.5% CREAM*
DermAid Soft™ 0.5% Cream has been formulated especially for people with sensitive skin. The essential difference with DermAid Soft™ is that the hydrocortisone is dispersed throughout it so that it gently penetrates the irritated skin. DermAid Soft™ is smooth and non-greasy. It’s easy to apply which also helps prevent further trauma, especially if skin is already tender and inflamed. The emollients in DermAid Soft™ moisturise and soften dry, inflamed skin, helping to restore its hydration and suppleness, as well as reducing skin roughness and encouraging the healing process. DermAid Soft™ 0.5% Cream contains 0.5% hydrocortisone.

DERMAID SOFT™ 1.0% CREAM*
DermAid Soft™ 1.0% Cream has been formulated especially for people with sensitive skin. The essential difference with DermAid Soft™ is that the hydrocortisone is dispersed throughout it so that it gently penetrates the irritated skin. DermAid Soft™ is smooth and non-greasy. It’s easy to apply which also helps prevent further trauma, especially if skin is already tender and inflamed. The emollients in DermAid Soft™ moisturise and soften dry, inflamed skin, helping to restore its hydration and suppleness, as well as reducing skin roughness and encouraging the healing process. DermAid Soft™ 1.0% Cream contains 1.0% hydrocortisone.

*DermAid Cream 1.0%, DermAid Soft Cream 1.0% and EgoCort 1.0%

Contraindications:
Known sensitivity to any of the ingredients. Chickenpox, herpes, other viral infections and other skin infections, otherwise concurrent antimicrobial therapy is required. Acne.

Dosage:
(DermAid Cream 1.0%) Apply a small amount to affected skin 1-2 times daily as required.
(DermAid Soft Cream 1.0%) Apply a small amount to affected skin 2-4 times daily as required
(EgoCort 1.0%) Apply a thin layer 1-2 times daily to the affected skin.

Products to Help (Anti-fungal)

Resolve Tinea
Resolve Tinea contains miconazole nitrate to provide effective treatment for fungal infections. Anti-fungal Cream also contains 10% dimethicone to help prootect the skin from chafing. Apply 2-3 times to affected skin.

* Faergemann J (1986) Seborrhoeic dermatitis and Pityrosporum

Orbiculare: treatment of seborrhoeic dermatitis of the scalp with miconazole – hydrocortisone (Daktacort), miconazole and hydrocortisone. British Journal of Dermatology 114:695-700

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