Seborrhoeic dermatitis – treatment in Wrocław and Nysa

Seborrhoeic dermatitis is among the most common chronic inflammatory skin diseases. It affects about 3–5% of adults, and its mildest form, ordinary dandruff, occurs in a considerably larger proportion of the population. The lesions cover the areas rich in sebaceous glands: the scalp, the face, the retroauricular area and the upper trunk.

The course of the disease is chronic and relapsing, with periods of flares and remission. In most patients the symptoms intensify in the autumn and winter months and in periods of increased psychological tension. The aim of treatment is not the permanent removal of the disease but the control of a flare and keeping the skin free of symptoms for as long as possible.

We hold dermatological consultations in Wrocław at ul. Barlickiego 31/1U and in Nysa. We see patients privately, without a referral. Telephone booking: 573 290 488.

The clinical picture

The lesions take the form of erythema covered with yellowish, greasy scales. The borders of the lesions are often indistinct and the severity varies over time. The distribution of the lesions is characteristic and is one of the most important diagnostic clues.

• The scalp – scaling of varying severity, from fine and dry, resembling dandruff, to thick, greasy scales on an erythematous base. Most patients report itching, which intensifies with sweating and after hairdressing procedures.
• The face – the nasolabial folds, the eyebrows and the glabella, the smooth part of the forehead and the hairline. In men the lesions additionally cover the moustache and beard area.
• The retroauricular area and the external auditory canal – scaling and fissures at the base of the auricle, sometimes complicated by a secondary bacterial infection.
• The chest and the interscapular area – erythematous and scaling lesions in a follicular distribution, in some patients taking a ring-shaped form.
• The skin folds – the armpits, the groin and the umbilical area, where the disease takes an intertriginous form: erythema with maceration of the epidermis, without clear scaling.

Clinical forms

Ordinary dandruff

The mildest form of the disease, limited to the scalp. It presents as fine scaling without perceptible erythema and usually without itching. The appearance of redness, itching and greasy, yellowish scales indicates a transition to fully symptomatic seborrhoeic dermatitis.

The adult form

The most common variant, usually beginning after puberty, with a peak incidence between the ages of 30 and 60. Men are affected more often, which is connected with the influence of androgens on the activity of the sebaceous glands.

Cradle cap in infants

In children in the first months of life the disease takes the form of yellowish, greasy crusts on the scalp. The course is mild and self-limiting; the lesions most often resolve between the 8th and the 12th month of life. Management consists in applying an oily preparation and gently removing the layers, without using preparations intended for adults.

The generalised form

Extensive involvement of the skin, in extreme cases with the development of erythroderma, occurs rarely. A sudden, severe course in an adult calls for wider diagnosis towards immune disorders.

Causes and aggravating factors

The development of the disease is due to an abnormal inflammatory response of the skin to the presence of lipophilic yeasts of the genus Malassezia, above all the species Malassezia restricta and Malassezia globosa. These microorganisms are part of the normal skin flora of every person. The disease is therefore not an infection transmitted by another person but a reaction to the metabolic products of the yeasts, mainly the free fatty acids arising from the breakdown of sebum.

Factors that increase the risk of the lesions appearing and intensifying:

• seborrhoea and increased androgen activity,
• low temperature and low air humidity during the heating season,
• chronic stress and lack of sleep,
• the consumption of alcohol,
• diseases of the nervous system, in particular Parkinson’s disease, the state after a stroke and facial nerve palsy,
• immune disorders, including HIV infection and immunosuppressive treatment,
• certain medicines, among others lithium preparations and neuroleptics,
• Down syndrome.

Differential diagnosis

Seborrhoeic dermatitis is sometimes confused with several other conditions. The distinction matters in practice, because management differs in each of them and treatment matched to the wrong diagnosis may aggravate the lesions.

Disease	Distinguishing features
Psoriasis	Silvery scales, sharply demarcated lesions, typical location on the elbows and knees, nail changes, a positive family history.
Atopic dermatitis	Intense itching comes to the fore, the lesions cover the flexures, a history of atopic diseases.
Pityriasis versicolor	Hypopigmented or hyperpigmented patches on the trunk, bran-like scaling, no inflammatory erythema.
Tinea of the glabrous skin and of the scalp	Ring-shaped lesions with an active border, broken hairs within the scalp. The mycological examination is decisive.
Rosacea	Erythema with telangiectasias, papules and pustules, no scales, aggravation after vasomotor factors.
Discoid lupus erythematosus	Lesions with scarring atrophy and keratotic plugs, photosensitivity.
Pityriasis rubra pilaris	Follicular papules with a keratotic plug, characteristic islands of unaffected skin.

Diagnostic procedure

In most cases we make the diagnosis on the basis of the history and the clinical examination, taking into account the distribution and the character of the lesions. During the visit we assess the scalp, the face, the retroauricular areas and the upper trunk, because the involvement of several areas at once is an important diagnostic clue.

• Trichoscopy – assessment of the scalp under magnification. It makes it possible to distinguish seborrhoeic from psoriatic scaling and to assess the condition of the hair follicles.
• Mycological examination – performed when a fungal infection is suspected, especially in children and with unilateral, sharply demarcated lesions.
• Skin biopsy – reserved for cases with an atypical course or resistant to correctly conducted treatment.
• Extended diagnosis – considered with a sudden, extensive onset in an adult and with a lack of response to treatment persisting for more than six weeks.

Treatment of seborrhoeic dermatitis

We conduct the treatment in two stages. The first stage is control of the flare, the second is maintenance therapy, whose task is to lengthen the symptom-free periods. Omitting the second stage is the most frequent cause of a rapid relapse of the lesions.

Topical treatment of a flare

• Antifungal preparations – ketoconazole and ciclopirox olamine in the form of shampoos, creams and foams. During a flare they are usually used twice a week, with a contact time with the surface of the skin of 3–5 minutes.
• Topical glucocorticosteroids of low and medium potency – used briefly, in order to remove erythema and itching quickly. On the skin of the face we do not use them for longer than 7 days, because of the risk of skin atrophy, telangiectasias and perioral dermatitis.
• Calcineurin inhibitors – tacrolimus and pimecrolimus. They do not cause skin atrophy, so they are suitable for longer use on the face and in the retroauricular areas.
• Keratolytic preparations – salicylic acid and urea, used to remove thick layers of scale before the treatment proper.
• Selenium sulphide and zinc pyrithione – ingredients of shampoos with an anti-seborrhoeic action that limit the growth of the yeasts.

Systemic treatment

Orally administered antifungal medicines are considered only in extensive forms or in forms resistant to topical treatment. In selected cases of severe seborrhoea, isotretinoin in small doses is used. In every case this requires assessment of the indications, the contraindications and the interactions with other medicines taken, so the decision is made individually during the visit.

Maintenance treatment

Once the lesions have resolved we recommend using an antifungal preparation once or twice a week for a further 3–6 months. This significantly reduces the frequency of relapses. In patients with a clear seasonality of the symptoms we introduce maintenance treatment before the period of the expected flare.

Skin care

• washing the hair every 2–3 days, in water at a temperature close to body temperature,
• giving up preparations containing alcohol and intensive mechanical scrubs,
• using emollients of a light consistency, free of oils of plant origin that serve as a medium for the yeasts,
• limiting styling with high temperature during a flare.

The course of treatment – what you may expect

• 7–14 days – resolution of the itching and a clear reduction of the erythema and the scaling.
• 4–6 weeks – a follow-up visit, assessment of the response to treatment and establishing the maintenance schedule.
• 3–6 months – the period of maintenance treatment, conducted at an individually established frequency.
• More than 6 weeks without improvement – verification of the diagnosis and consideration of extended diagnosis.

Contraindications and limitations of treatment

The chronic use of topical glucocorticosteroids on the skin of the face is contraindicated. In pregnant and breastfeeding women the choice of preparations is limited and requires individual arrangement. UVB phototherapy at a wavelength of 311 nm is sometimes used in resistant forms; this treatment is carried out in centres equipped with an irradiation cabin.

We do not recommend the long-term use of over-the-counter steroid preparations on one’s own, nor the mechanical removal of the layers of scale, because this aggravates the inflammatory reaction and favours secondary infections.

When to see a dermatologist

• the lesions persist despite the use of over-the-counter preparations for 4 weeks,
• the scaling is accompanied by intense itching, oozing or painful fissures of the skin,
• the lesions cover the face, the eyelids or the retroauricular area,
• you observe increased hair loss coexisting with lesions on the scalp,
• the disease has appeared suddenly in an adult and takes an extensive course.

Prices

• Medical visit – dermatological examination: 280–350 PLN
• Consultation with a specialist online, with the possibility of issuing a prescription: 220 PLN
• Examination of the skin for a fungal infection – collection of material and mycological examination: from 100 PLN

The full list is available on the page HappyDERM price list.

Frequently asked questions

Is seborrhoeic dermatitis contagious?

No. Yeasts of the genus Malassezia occur on the skin of every person, and the disease results from an individual inflammatory reaction to the products of their metabolism, not from an infection transmitted by another person. There is no need to isolate everyday objects or towels.

Can seborrhoeic dermatitis be cured permanently?

The disease is chronic and relapsing, so we do not promise a permanent cure. Correctly conducted treatment does, however, make it possible to control a flare within 1–2 weeks, and maintenance therapy significantly lengthens the symptom-free periods.

How does seborrhoeic dermatitis differ from dandruff?

Ordinary dandruff is mild scaling of the epidermis without an inflammatory reaction. If redness of the skin, itching and greasy, yellowish scales appear, we are dealing with seborrhoeic dermatitis, which requires different management.

Does diet affect the course of the disease?

There is no diet that cures seborrhoeic dermatitis. In some patients limiting alcohol, regulating the sleep rhythm and reducing psychological tension is associated with a lower frequency of flares.

Can the hair be dyed in seborrhoeic dermatitis of the scalp?

During a flare we advise against hairdressing procedures using oxidising preparations, because they increase the irritation. Once the erythema and the scaling have resolved, dyeing is permissible, after an interval of at least 7 days from the end of the topical treatment.

Does seborrhoeic dermatitis cause hair loss?

The disease itself does not lead to permanent loss of hair. Chronic inflammation and scratching may, however, increase hair loss of a transient character, which resolves once the skin lesions are controlled. Persistent hair loss requires separate diagnosis.

Are over-the-counter shampoos enough?

In a mild form limited to slight scaling, pharmacy preparations are sometimes sufficient. With lesions accompanied by erythema, itching or involvement of the face, treatment established by a doctor is necessary, because the choice of preparation depends on the severity and the location of the lesions.

How to prepare for the visit?

Please do not use medicinal preparations for 2–3 days before the visit, so that the clinical picture is not obscured, and prepare a list of the medicines taken. It is also helpful to bring the packaging of the preparations used so far.

How long does the visit take and is a referral needed?

The visit usually takes 20–30 minutes. We see patients privately; a referral is not required. An appointment can be arranged by telephone or e-mail.

The doctors who see patients

Consultations in inflammatory skin diseases are provided in Wrocław by dr n. med. Małgorzata Micał-Strąk and lek. Ireneusz Pijanowski. The appointment with the chosen doctor is arranged during booking.

Booking a visit

An appointment for a dermatological consultation can be booked by telephone on 573 290 488. The Wrocław clinic is located at ul. Barlickiego 31/1U. We also hold consultations in Nysa.