All about seborrheic eczema on the face. Symptoms and treatment of seborrheic eczema on the face and scalp Seborrheic eczema treatment

L21 Seborrheic dermatitis

Epidemiology of seborrheic eczema

The average incidence of the disease among the population is 3-5%, but in patients with immunodeficiencies it occurs much more often: from 30 to 80%. Typically begins during puberty, but can develop at any age. Most patients become ill before the age of 30; after 50 years, the risk of developing the disease increases again. Men get sick more often. The main complaint of patients is itching, which worsens with sweating. The condition often worsens in winter.

Causes and pathogenesis of seborrheic eczema

The causes and pathogenesis of seborrheic eczema have not been sufficiently studied to date. A significant role in its development is played by genetic factors, overproduction of the sebaceous glands, pathological changes in the function of the sebaceous glands, bacteria found in the mouths of the hair follicles and sebaceous glands, stress, and allergic reactions.

Hyperfunction of the sebaceous glands is an important predisposing factor. In newborns, the sebaceous glands are active due to the endogenous formation of androgens, so seborrheic eczema can develop in children up to 3 months. At a later age, the activity of the sebaceous glands decreases, so the development of seborrheic eczema occurs less frequently. The influence of androgens also explains the more frequent occurrence of the disease in men. Qualitative changes in sebum have not been proven.

The role of the nervous system is evidenced by facts such as the connection between Parkinson's disease and seborrheic eczema. With poliomyelitis or syringomyelia, skin changes often occur only in the area of damage to the trigeminal nerve. Patients also often emphasize that stress aggravates skin manifestations. Manifestations of the disease are more pronounced in winter. Zinc deficiency or acrodermatitis enteropathica increases the risk of developing seborrheic dermatitis. There is a violation of the metabolism of essential fatty acids. Vitamin B deficiency can also cause such dermatosis.

The possible role of the yeast Malassezia (Pityrosporum) in the development of seborrheic dermatitis is currently being widely studied. The connection is confirmed by the fact that when treating seborrheic eczema with antifungal drugs, there is a decrease in the manifestations of the disease and a decrease in the colonization of the skin by Malassezia. The number of yeast cells on the surface of the patient’s skin significantly exceeds normal values (5 * 10 5 cm 2 in healthy people and 9.2 x 10 5 cm -2 in patients with seborrheic eczema). The mycelial phase of fungi in seborrheic eczema occurs in 26% of patients (in healthy people - in 6% of cases). It is also believed that seborrheic eczema is a kind of specific skin reaction to Malassezia. Various immune system disorders in patients with seborrheic eczema as a result of the activity of yeast-like fungi have been studied: a relationship between antibody titers to Malassezia and the severity of seborrheic eczema of the scalp has been noted.

It is not only Malassezia yeast that plays an etiological role. For example, in some infants suffering from seborrheic eczema, numerous colonies of Candida albicans are sown from the feces and from the surface of the skin, and patch tests and the lymphocyte transformation reaction confirm the presence of sensitization. Cross-antigens between C. albicans and Malassezia are also known.

It is likely, however, that different groups of patients have their own specific pathogenesis of this disease, since, for example, in patients with severe immunodeficiency, Malassezia cells are seeded much less frequently than in patients without immunopathology. Seborrheic eczema is also one of the most important markers of HIV-infected patients.

Symptoms of seborrheic eczema

Symptoms of seborrheic eczema are characterized by a tendency to chronicity, frequent relapses, and are difficult to treat. Cosmetic imperfections can lead to psychological problems in patients and cause disturbances in social adaptation. The main complaint of patients is itching, which worsens with sweating.

Pediatric seborrheic eczema

Infantile seborrheic eczema most often occurs in the first six months of a child's life and usually goes away completely within a few months. Obese children are more likely to get sick. The lesion occurs on the skin of the scalp, but the skin of the face in the area of the eyebrows and nasolabial folds can be affected; when the process spreads, the flexion areas of the limbs and large folds of the body can be involved. On the scalp, layers of fatty yellowish scales - gneiss - are formed, surrounded by cracks. Disseminated foci of infection, localized in large folds, resemble those in psoriasis, but tend to heal quickly.

Rashes occur in places characterized by a high content of sebaceous glands - the face, scalp, chest, interscapular area, large folds. Symptoms are most often represented by the presence of inflammatory, reddened and slightly infiltrated foci with irregular outlines, with yellowish scales and crusts on a hyperemic background. The lesion has the appearance of either confluent large foci, reminiscent of a geographical map, or round multiple foci with clear boundaries, reminiscent of pityriasis versicolor. With strong subjective sensations - itching, burning - excoriations, cracks appear, and a secondary infection occurs. The ducts of the sebaceous glands appear dilated.

On the face, lesions are most often located around the nose, in the nasolabial folds, and the skin of the eyebrows. Some patients experience worsening of their condition after exposure to the sun or after ultraviolet radiation. On the body, infiltration is usually weakly expressed due to the rejection of scales due to sweating. Large folds may be affected - axillary, inguinal, the clinical picture resembles candidiasis or intertrigo.

On the scalp, the rashes have clearly demarcated outlines and tend to merge. Sometimes there is a total lesion of the scalp, resembling a shell. The lesions often extend to the back of the head, lateral areas of the neck, and retroauricular area. Often, a fissure that does not heal for a long time forms in the retroauricular area, which is prone to secondary infection. In the center of the sternum or between the shoulder blades, the lesion takes the form of infiltrated hyperemic lesions.

Seborrheic erythroderma is a complication of seborrheic eczema and occurs when intolerance to external treatment or due to contact sensitization.

Diagnosis of seborrheic eczema

Diagnosis of seborrheic eczema is not difficult and is based on the typical clinical picture of the disease. The main difficulty is differential diagnosis with vulgar psoriasis, especially when the scalp is affected. With psoriasis, the rashes are located along the hair growth, are more infiltrated, and the peeling is drier. Seborrheic eczema responds more quickly to treatment than psoriatic lesions. When large folds are affected, it is necessary to remember about candidiasis or intertrigo. In case of seborrheic erythroderma, Sézary syndrome must be excluded.

Treatment of seborrheic eczema

Treatment of seborrheic eczema can be either local or systemic, and depends on the severity of the disease. Due to the tendency to relapse, treatment is long-term and aimed at correcting seborrhea. Anti-inflammatory and antimycotic therapy is carried out.

For mild forms of seborrheic eczema with localized rashes on smooth skin, an ointment, cream or solution of an antifungal drug is used, which is applied 1-2 times a day for 2-4 weeks. Degreasing of facial skin is carried out with alcohol solutions with the addition of salicylic acid (2-3%) or resorcinol (2%). During the day, use powder containing sulfur. For the face, products containing erythromycin (Zinerit lotion) or ketoconazole (Nizoral cream) are recommended. At night, a drying treatment for seborrheic eczema is indicated: zinc lotion with clioquinol (5%) and/or ichthyol (2-5%), as well as sulfur (2-5%). It is good to treat wet lesions with a 1% aqueous solution of brilliant green.

Topical corticosteroids are one of the most effective treatments for seborrheic eczema. Corticosteroids have a powerful anti-inflammatory effect, but their long-term use is limited by side effects - the occurrence of skin atrophy, telangiectasia, acne, and perioral dermatitis. In children, corticosteroids should be prescribed with extreme caution, given the increased absorption of the skin. Low potency corticosteroid creams - prednisone and hydrocortisone - are prescribed for the face.

For washing the hair, antiseborrheic agents with keratolytic and antimicrobial additives are used: selenium sulfide (Vichy Dercos shampoo with selenium sulfide), salicylic acid, tar (“T-gel”, “Friderm-Tar”), zinc (“Friderm-Zinc”). Ketoconazole (Nizoral shampoo), active against lipophilic yeast-like fungi, is indicated (2 times a week). Antiseborrheic hair tinctures contain sulfur, salicylic acid, resorcinol or non-feminized estrogens. For a short-term effect, alcohol solutions of glucocorticoids, sometimes with the addition of tar, are indicated. For severe inflammation in the lesions, halogenated glucocorticoids are prescribed. Creams, lotions or gels are recommended as bases.

In severe cases of the disease, characterized by the presence of foci with severe inflammation and dense layering of scales, keratolytics, such as salicylic acid or coal tar preparations, are used to remove the latter. After exfoliation, topical antifungal and corticosteroid medications are used. Additionally, antihistamines and calcium supplements may be recommended, and in case of a bacterial infection, antibiotics are prescribed.

If external therapy is ineffective, the use of systemic antimycotic drugs orally for one week is indicated: ketoconazole (200 mg/day), terbinafine (250 mg/day), fluconazole (100 mg/day), itraconazole (200 mg/day). The effects of ketoconazole and itraconazole have been most fully studied. Fluconazole and terbinafine are less effective against Malassezia, but are also used in the treatment of seborrheic eczema.

In especially severe cases, sebosuppressive drugs are prescribed, such as isotretinoin, which reduces the activity and size of the sebaceous glands by up to 90% and also has an anti-inflammatory effect. It has been shown that daily administration of the drug in a daily dose of 0.1 to 0.3 mg/kg body weight leads to an improvement in severe seborrhea after 4 weeks of treatment.

The complex treatment of seborrheic eczema includes antihistamines, multivitamins, sedatives, drugs to normalize the functions of the gastrointestinal tract, and in the case of a secondary infection - antibacterial agents and eubiotics.

Seborrheic eczema is an uncommon disease in dermatology, which is one of the forms of eczema. It is diagnosed in both women and men and often occurs against the background of seborrhea or is a complication of seborrheic dermatitis.

The most susceptible areas of the skin are those rich in sebaceous glands. Most often the scalp is affected, but sometimes seborrheic eczema is localized in other areas.

The exact cause of the development of seborrheic eczema on the head and other areas of the skin is still unknown. However, it is believed that skin manifestations can be provoked by:

disruption of the sebaceous glands;
constant stress;
genetic predisposition.

Other factors may also contribute to the development of seborrheic eczema:

weak immunity due to various infections;
diseases that cause hormonal changes;
vegetative-vascular dystonia;
HIV infection;
excessive secretion production by the sebaceous glands;
gastrointestinal diseases;
liver disease such as hepatitis or cirrhosis;
frequent colds;
allergy;
failure to comply with hygiene rules.

It is worth noting that, despite the lack of an exact cause for the development of the disease and the presence of only supposed factors contributing to the development of eczema, modern medicine is inclined to the infectious-allergic nature of the origin of seborrheic eczema.

According to studies, in most cases the yeast fungi Pityrosporum ovale were found in patients. In more rare cases, Candida and staphylococci have been found.

Despite the fact that microorganisms are present on the skin of almost every person, only under certain conditions is their growth and activity observed, which causes various kinds of manifestations on the skin and unpleasant symptoms, which we will discuss below.

Symptoms of the disease

The onset of seborrheic eczema is characterized by the appearance of small pink-yellow nodules on the head. They will enlarge and merge with each other, resulting in disk-shaped plaques. Their size is 1-2 cm and the plaques themselves are covered with scales, under which the skin is slightly moist.

The formations on the affected areas of the skin have clear boundaries and uneven edges, the lesion is separated by a red rim. At the initial stage, the rash will be dry, then a “greasy” appearance appears.

The rash is often located on the scalp, but can also occur on the forehead, above the eyebrows, in the nasolabial folds, behind the ears, and less commonly on the chest and around the mouth. In most cases, seborrheic eczema first appears on the scalp, then it spreads to the hairline and forehead.

In patients, you can notice a clear red border in this place, which is also called the “seborrheic crown.” From the back of the side, eczema is already spreading to the area behind the ears and neck. In advanced cases, the formations merge, which also has its own name - “seborrheic helmet”.

In addition to the rash, other symptoms of the disease are possible:

itching in the affected areas, usually minor;
weeping wounds where the scales have separated;
cracks in the skin and swelling underneath;
lethargic state;
in rare cases, a slight increase in temperature is observed.

In some patients, eczema is accompanied by damage to the eyelids - redness, the presence of scales and small cracks. Often the condition is combined with conjunctivitis, resulting in discharge from the eyes.

In rare cases, complications due to secondary infection of the formations are possible. As a result, there is a risk of developing folliculitis, ostiofolliculitis, hidradenitis, streptoderma, etc.

How to diagnose

To diagnose eczema, you need to see a dermatologist. In most cases, it is enough for the doctor to conduct an external examination of the affected skin. In some cases, various additional studies are recommended:

dermatoscopy;
fluorescent diagnostics;
scraping the skin for the presence of fungus;
bacterial culture – indicated for secondary infection.

The above studies will help make the correct diagnosis and recognize the disease among similar ones in dermatology.

Since seborrheic eczema can develop against the background of diseases of the internal organs, it is recommended to consult other specialists: an allergist, gastroenterologist, endocrinologist, neurologist and others.

In this regard, in addition to basic studies, doctors carry out additional studies: gastroscopy, ultrasound, immunological blood test, rhinoscopy and others. If the patient has eyelid damage, a consultation with an ophthalmologist will be required.

In a situation with seborrheic eczema on the body or face, it is important to differentiate the disease from true and occupational eczema. In the first case, a large number of weeping areas are noted, in the second, the disease “goes away” if the irritating factor associated with the patient’s professional activity is excluded.

Treatment: what drugs are used

Seborrhea treatment is almost always carried out at home. Depending on the specific case, several types of drugs and ointments are used in the fight against eczema:

anti-allergic – act on histamine, reducing swelling, some drugs have a sedative effect, which also has a good effect on the patient’s condition, but it should be remembered that you should not drive or do work that requires increased concentration;
sedatives - help cope with psycho-emotional stress and normalize sleep, especially if stress has caused rashes, for example Novopassit or Adaptol are suitable for this;
antifungal – affect the cellular structure of the fungus: Clotrimazole, Nystanin;
antibiotics - usually prescribed only for secondary infection in cases of bacterial infection;
vitamins – vitamins B1 and B6 will be especially useful; they will help quickly restore damaged skin on the head or other areas.

sulfur mash;
greenery;
solution with alcohol;
white mercury ointment;
salicylic ointment;
powder with resin or sulfur.

To relieve the inflammatory process, corticosteroid drugs are used, for example: Hydrocortisone, Diproslan or Prednisolone.

Various physiotherapeutic procedures also have excellent effects:

laser exposure;
cryomassage;
magnetic therapy;
cryotherapy;
Darsonvalization.

If you use the above procedures in combination with basic drug treatment, you will be able to increase their effect and get rid of unpleasant symptoms faster.

For seborrheic eczema on the head, it is recommended to use special medicated shampoos: Nizoral, Friederm, Sebiprox, Sulsena. When choosing a shampoo, you should pay attention to its purpose or consult with your doctor so that you can choose the most suitable product.

Folk remedies for eczema

In addition to the main treatment, you can use folk remedies in parallel. You should carefully select recipes for home therapy so as not to cause harm or aggravate the situation. In this case, several recipes have worked well:

A mixture of protein and lemon. You need to take the white of one egg and beat it into a thick foam. Next, gradually add the juice of one lemon, 0.5 cups of ethyl alcohol and a teaspoon of glycerin, remembering to stir the mixture regularly. After mixing the ingredients, apply the resulting lotion to the affected skin several times a day.
Oak bark. Take 20 grams of oak bark and cook it in a water bath. Once the solution has cooled, use it as a compress.
Nettle with garlic. Nettle and garlic gruel is considered an excellent remedy in the fight against eczema. They need to be finely crushed and applied to areas of the skin with rashes, then washed off with chamomile decoction.
An infusion of dandelion and burdock roots is another effective remedy for getting rid of flaking. One tablespoon of plants is diluted with a glass of water and left to infuse for 12 hours. Then the product should be boiled for 10 minutes and taken three times a day, half a glass.

Prevention of exacerbations

To avoid having to select a suitable treatment method for eczema, it is better to prevent the disease altogether. As a preventative measure, experts recommend adhering to several rules:

Lead a healthy lifestyle: give up bad habits, normalize your daily routine, include moderate exercise, eat right, excluding sweet, starchy, spicy foods, as well as smoked meats, sauces, etc.
Monitor your weight and avoid obesity, as it directly affects the functioning of the entire body.
Observe personal hygiene rules; scalp problems often arise if you do not wash your hair on time.
Pay careful attention to the selection of cosmetics. Gentle shampoos, conditioners and shower gels are safer for people. Aggressive components in the composition increase the risk of a negative skin reaction to the products.
Take responsibility for your health and treat chronic diseases, especially for problems with the gastrointestinal tract.

At the first signs of seborrheic eczema, you need to contact a specialist as soon as possible, which will allow you to quickly begin treatment and get rid of skin rashes.

If the disease is neglected, wet wounds may appear, and there is also a risk of rapid spread of rashes. Some patients experience damage to almost the entire scalp, extending to the neck and forehead.

For treatment, medications that have anti-inflammatory, antifungal, antihistamine and sedative effects are usually used. The patient is also recommended to take vitamins.

Some people prefer to be treated at home with the help of improvised means, but you should not use home therapy as the main one. It is also important to remember a healthy lifestyle, proper nutrition and avoidance of stressful situations.

Seborrheic eczema is a chronic type of dermatosis that manifests itself as rashes in the form of small nodules. Over time, such nodules form plaques, covered with dense and greasy scales. If such scales and crusts are removed, a moist surface will be revealed. The rashes are usually localized behind the ears, in the head and face, on skin folds, in the umbilical area, as well as on the skin of the torso and on the flexor surface of the limbs.

Diagnostics includes dermatoscopy, scraping for pathogenic fungi, consultation with various specialists, examination of the gastrointestinal tract, and study of hormonal status. Treatment is usually through topical antimicrobials, vitamins, and physical therapy.

Seborrheic eczema is considered a clinical form of eczema, which includes true, occupational, microbial eczema. The disease occurs in both sexes and at any age. Very often, seborrheic eczema will form against the background of seborrhea or as seborrheic dermatitis. In HIV carriers, seborrheic eczema can become a manifestation of AIDS. A feature of eczema is its spread throughout the entire skin.

Causes of seborrheic eczema

In modern dermatology they talk about the infectious-allergic theory of the development of seborrheic eczema. In clinical studies, 50% of cases of seborrheic eczema have the presence of Pityrosporum ovale in the lesion itself. Less commonly, Candida (or staphylococcus) fungi are usually detected.

Factors that are considered precursors to the development of seborrheic eczema are an increased level of secretion production (sebaceous glands), gastrointestinal diseases (ulcers, gastritis), liver dysfunction (cirrhosis, hepatitis), hormonal disorders (obesity, diabetes, estrogen imbalance, for example), VSD. Very often, seborrheic eczema occurs against the background of reduced immunity, which is caused by acute respiratory viral infections, chronic infections (sinusitis, sinusitis), and serious illnesses.

Symptoms of seborrheic eczema

The first stage of development of seborrheic eczema begins with the formation of pink-yellow nodules on the skin. Such nodules are small in size. Gradually, such nodules may enlarge or merge, which will subsequently lead to the appearance of infiltrated disc-shaped plaques. Such plaques reach a diameter of 1-2 cm and are covered with multiple dense scales, which are also greasy.

When you try to remove the scales, the opening surface becomes wet. The lesions have jagged edges and clear boundaries. At the very beginning, they may be dry or, on the contrary, have a “greasy” appearance. The accompanying itching is not pronounced and rarely bothers patients. The resolution of the elements begins from the very center of the lesion and subsequently leads to the process of transformation of plaques into arcs or rings. If you carry out the correct therapy, then subsequently not a single trace will remain on the skin.

As a rule, seborrheic eczema rashes are located in the head area (in the area of hair growth, eyebrows, nasolabial fold, near the mouth, behind the ears). If foci of seborrheic eczema are localized on the scalp, growing along the periphery, they tend to move to the hairline, affecting the forehead. The lesion is usually well defined by an infiltrated border of a reddish color, resembling a psoriatic disc. This symptom is called “seborrheic crown”. From the back of the head, from its scalp, a rash of seborrheic eczema penetrates the neck and into the folds behind the ears. When the rashes merge, they form an extensive lesion in the form of a helmet - an “eczematous helmet.”

During the course of seborrheic eczema, skin damage with the formation of blepharitis is often observed. Typically, blepharitis is markedly swollen and red in color, as well as the presence of scales and cracks near the outer edge of the eye. Damage to the eyelids is most often combined with conjunctivitis and occurs in parallel with discharge from the eyes, which is why they stick together in the morning.

Seborrheic eczema of smooth skin is concentrated in the chest area, as well as in the periumbilical or interscapular areas. It is possible that seborrheic eczema is located in the armpits and on the flexor surface of the limbs. Due to the uneven edges, the lesion on the surface of smooth skin may resemble a map. Typically, such lesions rise slightly above the general level and tend to grow peripherally.

It is possible that seborrheic eczema is complicated by infection of the rash elements with the further appearance of folliculitis, ostiofolliculitis and hidradenitis.

Diagnosis of seborrheic eczema

Seborrheic eczema is usually diagnosed by a dermatologist. Usually, to make a diagnosis, it is enough to conduct an external examination of the dermal lesion itself. Dermatoscopy is also performed, skin and hair scrapings are taken for the presence of pathogenic fungi. Fluorescent diagnostics cannot be ruled out. Secondary infection will serve as a signal to carry out bacterial culture of secretions from the outbreak.

Histological examination during seborrheic eczema can reveal hyperkeratosis, as well as a mild degree of acanthosis and intracellular edema. The elongation of epidermal processes is also determined through this study. The latter is also observed with neurodermatitis. A distinctive feature is the presence of accumulated lipids located in the upper layers of the epidermis. The presence of coccal flora, symptoms of perifolliculitis - all this can also be diagnosed.

In order to identify other underlying diseases and symptoms of chronic diseases, people suffering from seborrheic eczema are prescribed a consultation with other specialists - an endocrinologist, gynecologist, neurologist, gastroenterologist. For the same purpose, other studies are carried out: ultrasound of the peritoneum, gastroscopy, hormonal studies, ultrasound of the pelvis, pharyngoscopy and rhinoscopy. Patients whose eyelids are affected need to consult an ophthalmologist.

Differential diagnosis of seborrheic eczema should be made with psoriasis, occupational true eczema, microscopy and trichophytosis. Localization of rashes on the head, as well as the absence of a history of harmful influences that are associated with the patient’s professional activities, will exclude the professional nature of the disease.

As is known, with seborrheic eczema, the clinical symptoms manifest themselves more monomorphically: there are no vesicular rashes, as well as the oozing associated with them. The presence of not very dense plaques and small massiveness of scales, as well as elements on the flexor surface of the arms and legs, helps to distinguish this type of eczema from psoriasis, for example.

If we talk about microscopy and trichophytosis of the scalp, then it will be characterized by changes in the hair in the form of peeling and the release of fungal mycelium during hair examination.

Treatment of seborrheic eczema

Patients who have an increased degree of sebum secretion should limit the consumption of fatty and sweet foods, and also temporarily stop visiting baths, staying in hot places and humid hot climates. With this disease, you should very carefully select products intended for hair and skin care. Such products must fully match the patient’s hair type and oily skin.

Local treatment of seborrheic eczema

If we talk about local treatment of seborrheic eczema, it is carried out using antimicrobial agents, which include sulfur-resorcinol and white mercury ointment, salicylic ointment and sulfur talk. Riboflavin and vitamins B1 and B6 are prescribed orally. One of the following physiotherapeutic methods can have a beneficial effect in treatment: darsonvalization, laser treatment, magnetic therapy, cryotherapy, cryomassage. If a secondary infection joins the main disease, then the use of antibacterial ointments and other antibiotics will be required.

It is important to know that the treatment of seborrheic eczema is carried out together with the therapy of the underlying disease, as well as with the sanitation of infectious foci.

A pathological process on the surface of the skin in the area where the sebaceous glands are concentrated, characterized by the appearance of scab-like plaques and weeping areas. The rash is accompanied by periodic itching. Eczema, manifested in this form, can occur at any age in both men and women equally.

Causes

The causes of the disease are still completely unknown.

Potentially dangerous factors that could trigger the problem include:

heredity;
stress;
allergic diseases;
lack of vitamins;
a history of diseases of the stomach, liver, intestines;
hormonal imbalances;
diabetes;
the presence of focal organic lesions;
weak immune response.

According to the results of laboratory tests, the infectious agents Pityrosporum ovale, traces of the presence of Candida fungi and staphylococci are often found in the lesions of patients.

Symptoms

As a rule, the onset of seborrheic eczema is characterized by the formation of pink-yellowish nodules, which eventually merge with each other, forming disc-shaped asymmetric plaques with a circumference of 1-2 cm. Pathological foci are covered with a dense layer of difficult-to-remove yellow and whitish scales. When the crust is removed, an irritated, weeping surface is revealed underneath.

Main characteristic features:

growths with clear edges and uneven boundaries;
itching, feeling of discomfort;
the dry crust gradually turns into a greasy crust.

The disease most often affects the dermis of the head, its scalp, forehead, eyebrows, skin behind the ears, around the mouth and nose. In case of damage to the scalp, the disease, progressing, can spread to the neck, forehead, forming a single continuous layer of scales - an eczematous helmet. In such a situation, along the edge of the patient’s hair, you can see a red border with pronounced boundaries. The “seborrheic crown,” as dermatologists call it, resembles a psoriatic disc. It is important not to confuse these two diseases.

The lesion may also spread to the eyelid area, causing redness and swelling of the skin. In such patients, in addition to scales, cracks appear at the outer edge of the eye. Often such localization provokes the occurrence of conjunctivitis. Discharge appears. During the night they dry out, and it is difficult for the patient to open his eyes.

Seborrheic eczema on smooth areas of the skin occurs on the flexor surfaces, in the chest area, in the armpits, at the navel and between the shoulder blades. The formations always rise above the level of healthy areas. Spots with a modified surface and asymmetrical boundaries resemble a geographical map. Over time they grow even more.

Due to its characteristics, the seborrheic subtype of eczema is characterized by complications such as folliculitis and hidradenitis. They occur due to re-infection of the affected area.

Photo of seborrheic eczema: what it looks like

With seborrheic dermatitis of the scalp, the scaly layer reaches the edge of the hair area and spreads to the forehead, neck, and surface behind the ears. Individual lesions merge with each other, taking on the appearance of a continuous whitish crust with an uneven structure.

Diagnostics

As a rule, a dermatologist can make an appropriate diagnosis for a patient based on only one visual examination.

For more detailed diagnostics:

a scraping is taken to determine the presence of pathogenic fungi;
Dermatoscopy is performed;
luminescent and histological studies.

Scraping is a collection of material for subsequent research. The scales are analyzed under a microscope and the nature of the skin lesion is determined - fungal or dermatomycosis. The doctor uses a small scalpel to separate the required number of scales and place them on a glass slide. If microscopy reveals the presence of spores and mycelium, dermatomycosis is diagnosed. The fungus is determined by additional inoculation of the material on cultural media.

Dermatoscopy is performed using a dermatoscope. The device allows you to greatly increase the view of the surface and make a more accurate assessment of focal pathologies.

Luminescence studies carried out using an ultraviolet lamp. The skin is illuminated. Its healthy areas give off a light blue glow. Areas affected by the fungus are green, inflamed areas are white. This technique, in addition to its diagnostic properties, allows the doctor to carry out targeted sampling of material from the affected areas.

Histology reveals intracellular edema, minor acanthosis, hyperkeratosis, and altered shape of the outgrowths. In the seborrheic form of the disease, the results of histological studies are characterized by the presence of coccal flora, accumulation of lipids, and symptoms of perifolliculitis.

In addition to laboratory diagnostics, a dermatologist can refer the patient to a gastroenterologist, neurologist, gynecologist, or endocrinologist to identify seborrheic eczema. Consultation and examination with these specialists are necessary to identify possible concomitant diseases, which may turn out to be the very provocateur that caused seborrhea. The patient must undergo ultrasound diagnostics of the abdominal organs and donate blood for immunological and hormonal tests. If the eyelids are affected, consultation with an ophthalmologist is required.

The final diagnosis must be clearly differentiated from diseases with similar external manifestations, such as psoriasis, microsporia, trichophytosis, true and occupational eczema.

The occupational subtype of the disease is excluded if there is no history of exposure to adverse substances. The true form differs from seborrheic in more pronounced symptoms: the presence of vesicular rashes, oozing, denser focal lesions and large scales. Trichophytosis and microsporia differ from seborrheic eczema in the nature of peeling. It is rather pityriasis-like and non-greasy. The examination reveals fungal mycelium.

Treatment of seborrheic eczema

Therapy for this form of the disease is carried out as prescribed by the doctor. Tablets, ointments, lotions, and shampoos are widely used as dosage forms. A diet is prescribed, antimicrobial treatment is carried out, and vitamins are prescribed. Hormone therapy may be recommended at the discretion of the attending physician. If re-infection is added to the general disease, antibacterial treatment is carried out.

To effectively treat the disease, it is necessary to carry out therapy for both current symptoms and background ailments - potential provocateurs of the disease.

Physiotherapy

Physiotherapy procedures such as:

magnetotherapy,
cryotherapy,
darsonvalization,
laser therapy,
cryomassage.

Magnetotherapy

This is the effect of a pulsed magnetic field on a focal lesion. The procedure has a powerful anti-inflammatory, trophic, hypotensive, analgesic and calming effect. Under the influence of the impulse, the blood vessels are toned. They expand, blood microcirculation is activated, swelling is reduced, and metabolism increases.

Cryotherapy

This is the effect of cooled gases or air on the affected area. The patient is placed in a cryochamber. The procedure improves metabolism, improves the overall condition of the body, thermoregulation, improves the quality of the immune response, and reduces itching.

Darsonvalization

This is alternating electric current treatment. The physiotherapy procedure is carried out using a professional apparatus. Current pulses of low strength under high voltage pass through the gas, producing a local effect. During the procedure, different shaped attachments are used. The person should not be wearing metal objects.

Laser therapy

Laser treatment involves several methods of exposure:

local,
irradiation of venous blood,
mixed therapy.

Laser exposure provides excellent biostimulating support for the body. Swelling is reduced, itching and hyperemia are reduced, promotes rapid healing and restoration of the skin, prolongs the stages of remission, and reduces the frequency and severity of exacerbations.

Cryomassage

Cryomassage differs from cryotherapy in its local form of influence. The affected part of the skin is massaged with liquid nitrogen, sometimes with ice. This procedure not only heals, but also rejuvenates the skin, activates metabolic processes, dilates blood vessels, increasing their tone, normalizes blood flow, eliminates pain, itching, swelling, and has a beneficial effect on skin turgor and the body as a whole.

Ointments and lotions

In the form of ointments, patients are prescribed:

products with salicylic acid,
sulfur-resorcinol cream,
Nizoral,
Zenerite,
white mercury ointment,
lotions and ointments containing zinc and sulfur.

Hormonal drugs are prescribed:

Diprosalik,
Belosalik,
Prednisolone,
Hydrocortisone.

Pills

Drugs in tablet form are usually vitamins, antifungals, antihistamines and antibiotics.

Antimycoticfacilities:

Fluconazole,
Ketoconazole,
Terbinafine,
Itraconazole.

Vitamins:

group "B"
riboflavin,
group "E".

Antibacterial therapy is carried out only in exceptional cases, when secondary infection occurs.

Shampoos

To care for the scalp of the dermis with seborrheic eczema, the following is prescribed:

Keto plus,
Nizoral,
Skin Cap,
shampoos containing birch tar.

Diet

This form of the disease is characterized by the secretion of excess sebum. Therefore, patients are recommended to exclude from their diet:

fatty foods;
spicy food;
roast;
sweet;
strong allergens: honey, nuts, raspberries, mushrooms, caviar, citrus fruits, milk, strawberries;
foods enriched with gluten: pasta, baked goods, cereal porridges;
fast food;
alcohol.

Your daily diet should include:

lean meat;
vegetables and seasonal fruits;
olive oil;
blue/deep sea fish (herring, sprats, mackerel, anchovies, tuna, trout);
vinegar;
oilseeds;
whole grains.

Treatment with traditional recipes at home

For home therapy, liquid tar, tea tree oil and herbal medicine are widely used.

Birch bud baths

Half a glass of dried birch buds is poured with a liter of water and kept on fire for 15 minutes. The resulting broth is cooled, filtered and rinsed with problem areas of the skin. The product can also be added to the bath. You can use the decoction for water procedures every day until complete recovery.

Olive oil mask

Mix two tablespoons of olive oil, moisturizer and golden mustache extract in a container. Pour 1 tsp into the thoroughly mixed mixture. valerian. The mask is applied to the surface of the head or the affected area of the body two hours before water procedures. Then everything is washed off. The product should be used no more than once a week.

Oak bark compresses

To make a tincture, pour 20 g of pharmaceutical oak bark with a liter of hot water. Keep the solution in a water bath for up to 12-15 minutes. Cool and strain the broth. Soak a gauze pad or tampon in the solution. Apply the compress to the affected area for 20-30 minutes once a day.

Garlic cream

One head of garlic and 100 g of nettle are crushed into a homogeneous mass. The resulting paste is spread on the pathologically altered area for 10-15 minutes, 2-3 times a week. The product can be used until stable remission is achieved.

Tea tree oil

To treat the affected surface, a solution of tea tree concentrate, which has excellent antiseptic characteristics, is often used. Add 1-2 drops of a concentrated product purchased at a pharmacy into a full glass of cool water. Stir, soak a cotton sponge in the liquid, and wipe the problem area with it. The procedure should be repeated daily. As a preventive measure, a drop of oil can be added to your regular care shampoo or shower gel.

Potatoes with honey

Take 11 potato tubers. Clean. Grate the potatoes using a fine-toothed grater. Mix half a glass of the resulting pulp with one teaspoon of liquid honey. Take a gauze bandage and form it into a compress or bandage. Spread the paste on it in a layer of no more than 1 cm. Apply the bandage to the affected area of skin and secure with another bandage or tourniquet. You should wear the compress for 1.5-2 hours a day every day until complete recovery. The recipe is contraindicated for people with food allergies to honey.

All folk recipes can only be used in conjunction with complex therapy and only after consultation with a doctor!

People suffering from seborrheic eczema are not recommended to:

visit baths, saunas, steam;
relax in places with a humid and hot climate;
contact with chemical allergens;
eat allergenic foods.

In case of illness it is necessary:

carefully select care products: shampoos, gels, soaps;
carry out daily hygiene procedures;
follow a diet;
Wear loose, skin-friendly clothing.

Prevention

Preventive measures include regular personal hygiene. Maintaining a healthy lifestyle, a balanced diet, wearing loose clothing made from natural materials and minimizing contact with aggressive household chemicals.

Complications and consequences

Seborrheic eczema is a complex disease. If it is not treated or done incorrectly, a secondary infection may accompany the disease.

Common types of complications:

folliculitis,
ostiofolliculitis,
streptoderma,
hidradenitis

Is it contagious and how is it transmitted?

Seborrheic eczema is a non-contagious disease. It manifests itself as a result of decreased immunity, stress factors and other problems in the body. It is impossible to get eczema after contact with someone who is sick.

Features in children

The course of seborrheic eczema in children is no different from the symptoms of the disease in adults. Most often, this form of the disease affects infants under 3 months and children who are overweight. As a rule, a small child cannot restrain himself and scratches the itchy areas, which often leads to secondary infection of the affected area with staphylococcal bacteria.

During pregnancy

Seborrheic eczema in women during pregnancy is not uncommon. Especially if a woman is predisposed to the disease, or it has already happened to her before. The disease in the expectant mother proceeds in the same way as in an ordinary woman. But the treatment of the disease is different. She cannot use many of the drugs indicated for therapy in her normal condition. Most often this concerns hormonal drugs and antibiotics, which can harm the fetus. Only her attending physician can select safe therapy for a pregnant woman. As a rule, in this case, dermatologists recommend a strict diet, prescribe ointments, balms, shampoos containing zinc, panthenol, and antiallergic agents.

Video about eczema

Famous TV presenter Elena Malysheva talks about the symptoms and treatment of seborrheic eczema.

Forecast

The prognosis for patients with seborrheic eczema, despite the complexity of the disease, is quite favorable. In many ways, the effectiveness of therapy depends on the patient’s accuracy of compliance with all instructions. By treating all chronic infections, adhering to a diet and a healthy lifestyle, a person can get rid of the disease forever or achieve a fairly long and stable remission.

Seborrheic eczema is a dermatological pathology of a chronic nature, in which small red nodules and plaques appear, covered with shiny crusts, greasy scabs, and scales in the locations of the sebaceous glands.

The affected areas are most often visible in the skin folds on the body, in the scalp, behind the ears, in the groin area, and in the armpits.

Causes of dermatosis

The development of the clinical form of the disease is facilitated by unfavorable exo- and endogenous factors of various etiologies.

Causes of seborrheic eczema:
mycoses;
increased sweating;
avitaminosis;
dysbacteriosis;
non-compliance with personal hygiene;

hormonal imbalance.

On a note. Seborrheic eczema in children develops under the influence of dermatophyte fungi, allergens, helminthic infestations, during the period of hormonal changes in the body, with an incorrectly selected diet, and during artificial feeding.

The severity of the clinical picture depends on the body’s resistance, age, general physiological condition, and the underlying cause.

This form of dermatosis is manifested by the formation of small yellowish-red, pink nodules, which gradually increase in size. As a rule, the formation of weeping zones is not typical for this pathology, although they may appear. As the disease progresses, the nodular rashes merge, which leads to the formation of infiltrated disc-shaped plaques.

Rashes with typical seborrheic eczema are localized in the scalp, on the forehead, near the eyebrows, in the nasolabial folds, T-zone, behind the ears, in the upper part of the sternum, and back.

Merging, local rashes form extensive foci of inflammation of the skin, which in medical practice are called “eczematous helmet”.

Important! The lesions are characterized by the appearance of specific plaques up to 2-3 cm in diameter, which are covered with shiny dry crusts. The affected areas have asymmetrical edges and clear boundaries. The lesion is always separated from the healthy epidermis by a red border. As dermatosis develops, small areas are transformed into peculiar arcs and rings.

The main symptoms of seborrheic eczema:
itching in affected areas;
the presence of infiltrated plaques on the body;
slight increase in temperature;
deterioration of general condition;
deep, painful cracks, under which the skin swells greatly;
ulcers, weeping wounds on the body that form after the scales are separated from the dermis;

decreased performance, lethargy.

Rejection of scales and scabs occurs due to hypertrophy of the sebaceous and sweat glands. This disease causes psychological discomfort, causes a lot of trouble, and requires immediate treatment.

With an oily type of dermis, the face acquires an unnatural grayish tint, the skin looks unkempt and greasy. Acne appears on the forehead and wings of the nose, which over time begin to become inflamed. In affected areas, the skin resembles an “orange peel.”

Often with seborrheic eczema, damage to the eyelids (redness), conjunctivitis, and serous-catarrhal discharge from the eyes are noted, especially after waking up.

Gray scales and small cracks are visible on the eyelids.

This form of the disease has its own morphology and develops gradually. Since eczematous rashes are localized in the scalp, at the beginning of the development of the disease, itching and pain upon palpation of the affected areas do not appear.

The first affected areas are observed along the hairline. With this form of dermatosis, small red nodules are noticeable, which over time form disc-shaped plaques covered with greasy gray-white scales of a hard consistency.

Seborrheic eczema on the head is characterized by overdried, dry, tight, hyperemic skin, which takes on an unnatural color and greasy appearance. Over time, severe itching occurs in the affected areas.

Important. The condition of the hair noticeably deteriorates. Rashes can cause hair to fall out.

The affected areas do not have clear contours, but are limited from healthy areas of the dermis. Eczematous spots are thickened. After the scales and scabs are separated from the dermis, a moist, slightly weeping area is formed under them.

When the lower hairline is affected, the rash spreads to the neck, behind-the-ear folds, and upper back.

On a note. When dermatosis becomes chronic, local affected areas are outlined by a red infiltrated border, reminiscent of a psoriatic disc.

Treatment of pathology

When diagnosing seborrheic eczema, treatment methods are prescribed by the attending dermatologist, based on research results. It is very important to establish the root cause that led to the development of this form of the disease.. A dermatologist, depending on the degree of damage, may prescribe complex or local treatment.

Treatment for seborrheic eczema includes:

symptomatic therapy;
local use of drugs;
physiotherapy;
antibiotic therapy;
use of alternative medicine.

Remember! With timely and correct treatment, the prognosis for seborrheic eczema is favorable.

For mild forms of seborrheic eczema on the head and face, topical medications are used for treatment. If the cause lies in digestive disorders, vitamin deficiency, or nervous disorders, treatment methods are aimed at eliminating it.

If the cause of dermatosis is digestive disorders, to normalize the intestinal microflora, the doctor will adjust the diet, prescribe a therapeutic diet, probiotics, enzymes ( "Mezim", "Pancreatin"»).

If seborrheic eczema of the skin has developed under the influence of toxic substances, in order to prevent its further development, it is important to eliminate contact with the allergen. "Claritin", "Cetrin", "Loratadine", "Telfast".

For nervous disorders, sedatives will be prescribed: "Novopassit", "Sedasen", "Adaptol".

Advice! To prevent the recurrence of allergic manifestations, you should adhere to a hypoallergenic diet and exclude from your diet foods containing stabilizers, honey, citrus fruits, chocolate, and spices.

To normalize the protective immune forces, the dermatologist will select multivitamin complexes, immunomodulators, and mineral supplements (vitamin group B).

Patients with seborrheic eczema are often prescribed antibiotics with complex effects (“ Doxycycline"), fungicidal, antiviral, anti-inflammatory drugs, sorbents, corticosteroids.

External products will help eliminate symptoms: “Prednisolone”, “Advantan”, “Psoricap”, “Sinaflan”, “Losterin”, “Diprospan”, “Nizoral”, “Skin-Cap”, “Cinovit”, “Sebozol”.

Therapeutic preparations for topical use eliminate inflammatory processes in the structures of the dermis and have a mild antimicrobial and antiseptic effect.

Sulfur, salicylic acid, resorcinol, and medicinal plant extracts contained in ointments and pharmaceutical mash eliminate itching, dry out the skin, and promote healing of affected areas of the dermis.

Important! For better results, medicinal ointments and liniments are recommended to be used in combination with oral medications and only under the supervision of a physician.

For seborrheic eczema of the head, it is recommended to use antiseborrheic shampoos, balms containing antifungal, keratolytic additives: zinc pyrithione, tar, selenium disulfide, ciclopirox, 1-2% ketoconazole.

Shampoos have antimycotic, anti-inflammatory, cytostatic effects.

Good results are noted after physiotherapy. Patients are prescribed:
laser treatment;
cryotherapy sessions;
magnetic therapy;
electrophoresis;

darsonvalization.

Physiotherapeutic techniques together with drug treatment accelerate the healing processes of the dermis, alleviate symptoms, and normalize the functioning of the sweat glands. Patients are prescribed about 10-12 sessions, which can be repeated after a few weeks.

Important. If seborrheic eczema is complicated by secondary infections, antibiotic therapy, hormonal, antifungal creams, ointments will be prescribed, and the affected areas will be sanitized.

Folk remedies for eczema

Alternative medicine in combination with prescribed medications will help get rid of seborrheic rash on the body and scalp in the initial stages of the disease.

Traditional recipes for external and internal treatment are aimed at normalizing processes in the affected dermis and improving skin condition. For seborrheic eczema, it is recommended to wash the face with decoctions based on medicinal plants: chamomile, string, plantain, calendula, nettle leaves, yarrow.

Juice of young aloe, golden mustache, coltsfoot, tea tree oil or infusion of black currant bark will help relieve itching and inflammation. An excellent effect in the treatment of eczema is shown by the use of tar soap; pharmaceutical mash with the addition of sulfur, zinc, medicinal herbs, and essential oils will help.

Tinctures, decoctions of medicinal herbs, essential oils can be added to the bath and used to prepare nourishing masks. For seborrheic eczema of the head, experts recommend rinsing the hair with a decoction based on oak bark, chamomile, and birch buds.