SEBORRHOIC ECZEMA

This is an eczema with classically greasy scales on seborrhoic areas of
the skin; scalp, border of forehead/scalp, behind ears, above and in
between eyebrows, in nasolabial folds, chin, the sternum, the middle of
the upper back in between the shoulder blades, in axilla, groin and
perianal area. Constitutional and stress factors play a role as well as a
yeast, pityrosporum ovale, which is found in sebaceous glands. Patients
often complain of oily skin as a result of their pronounced sebum production.
The eczema comes and goes.
In mild cases only the face, scalp and chest are affected. Sometimes, and
commonly in case of immunosuppression such as in HIV-infected persons
the eczema can become very widespread and easily superinfected. It
occurs in armpits and groin and is conspicuous behind the ears. It may
generalise to cover the entire skin. Usually you will still find the typical
greasy scales in e.g. the nasolabial folds. The entire skin is inflamed, red
to a darker shade than normal.
Management of seborrhoic eczema
- Stop vaseline, use a non-greasy or no moisturiser.
For minor lesions e.g. only on seborrhoic areas in the face and on the scalp:
- An imidazole cream twice daily (suppresses pityrosporon) with or without
hydrocortisone, sulphur 3-5% cream with or without hydrocortisone, or
hydrocortisone cream twice daily. For chronic scaling salicylic acid 2-5% ointment or
sulphur 2-5% ointment. Warn the patient that the eczema will probably recur.
For acute and severe, widespread lesions (usually infected):
- Hydrocortisone cream once or twice daily.
- An imidazole cream twice daily.
- Ketaconazole 200 mg once daily or 200 mg on alternate days orally
1-3 weeks.
- Antibiotics and betadine scrub/potassium permanganate solution
as required.
For chronic recurrent widespread lesions:
- At night: Coal tar 2-6% in zinc paste or coal tar ointment or coal
tar + sulphur 5-10% ointment (not on wet lesions).
- Daytime: Hydrocortisone cream or betamethasone cream once
daily and / or an imidazole cream twice daily.
- Salicylic acid 2% or 5% ointment twice daily for dry scaling lesions.
- Systemic ketaconazole in low doses as above may be added
when severe.
- Antibiotics and antiseptics as required.