Seborrheic dermatitis - Anogenital in
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Synopsis
Infantile seborrheic dermatitis usually manifests in the second week of life and lasts 4-6 months. In infants, it characteristically presents on the face, diaper area, and folds of the neck and axillae.
Seborrheic dermatitis has a bimodal distribution, with peaks in infancy and adolescence / early adulthood. Although seborrheic dermatitis has been associated with HIV infection and neurologic disease, it typically presents in healthy individuals.
The yeast Malassezia has long been regarded as the central predisposing factor to disease development. Malassezia is a normal component of skin flora, but in individuals with seborrheic dermatitis, the yeast invades the stratum corneum, resulting in free fatty acid formation and the activation of the inflammatory cascade. Changes in the skin microbiome have also been implicated in pathogenesis. Additional factors related to the environment such as low temperatures and humidity have been identified as potential triggers.
Codes
ICD10CM:L21.9 – Seborrheic dermatitis, unspecified
SNOMEDCT:
50563003 – Seborrheic dermatitis
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Differential Diagnosis & Pitfalls
The most difficult diagnoses to separate from infantile seborrheic dermatitis are atopic dermatitis and irritant contact dermatitis. Atopic dermatitis more often involves the scalp, cheeks, and extensor surfaces and is associated with a family history of other atopic conditions (asthma, allergic rhinitis). It is usually accompanied by moderate-to-severe pruritus that interferes with sleep and feeding, whereas infantile seborrheic dermatitis is asymptomatic. Irritant contact dermatitis (diaper dermatitis) caused by the irritant effects of urine and feces typically spares the deep body folds for lack of contact with the skin.Psoriasis is extremely uncommon in neonates and infants. However, familial and genetically determined forms of psoriasis and other psoriasiform dermatitis do characteristically present with infantile psoriasis involving a similar distribution. The scaling is thicker in nonoccluded areas and plaques are better defined.
When localized in the diaper area, dermatoses to consider besides irritant contact dermatitis:
- Candidiasis
- Psoriasis – consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis
- Allergic contact dermatitis
- Tinea cruris - rare in infancy
- Intertrigo
- Langerhans cell histiocytosis
- Scabies
- Kawasaki disease
- Sexual abuse
- Acrodermatitis enteropathica
- Lichen sclerosus
- Perianal streptococcal infection
- Congenital syphilis
- Psoriasis – consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis
- Atopic dermatitis
- Candidal intertrigo
- Intertrigo
- Tinea cruris
- Intertrigo
- Lichen simplex chronicus
- Erythrasma
- Impetigo
- Darier disease
- Langerhans cell histiocytosis
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/08/2023
Last Updated:04/06/2023
Last Updated:04/06/2023
Patient Information for Seborrheic dermatitis - Anogenital in
Overview
Seborrheic dermatitis, also known as seborrhea, is a common noncontagious condition of skin areas containing oil glands (the face, scalp, and upper trunk). In seborrheic dermatitis, extra skin cells are produced (leading to flaking), and sometimes inflammation develops. This inflammation leads to pink or red colors in lighter skin colors or pinkish, purplish, dark brown, grayish, or whitish areas in darker skin colors, as well as itching. It varies in severity from mild dandruff of the scalp to scaly patches on the skin. A type of yeast normally found on the skin called Pityrosporum ovale lives in these oil-rich areas and plays a role in this condition. Seborrheic dermatitis seems to worsen with stress, dry weather, and infrequent shampooing. Although there is no cure for seborrheic dermatitis, you can usually control it with medicated shampoos and topical steroids (if inflammation is prominent).Who’s At Risk
Children are more likely to have seborrhea in the first year of life and during the teenage years (adolescence).Signs & Symptoms
The scalp is itchy and sheds white, oily skin flakes. One or more of the following areas may be involved:- Scalp or hairline
- Forehead
- Eyebrows or eyelids
- Creases of the nose and ears
- Ear canals
- Breastbone
- Midback
- Groin or armpits
Seborrheic dermatitis may be:
- Mild – only some flaking and skin color change (as outlined above) in a few small areas.
- Moderate – several areas affected with bothersome skin color change and itch.
- Severe – large areas of skin color change and severe itch that do not improve with self-care measures.
Self-Care Guidelines
Most cases of seborrheic dermatitis are easy to control with nonprescription home treatments. These include:- Frequent shampooing or a longer lather time with shampoo. If a regular daily shampoo fails, consider an over-the-counter dandruff shampoo. There are several types on the market, and one may work better for an individual than another.
- Shampoos containing ketoconazole (Nizoral), selenium sulfide (Selsun Blue), 2% pyrithione zinc (Head & Shoulders), salicylic acid (Neutrogena T/Sal), or tar-based (Neutrogena T/Gel) compounds may be helpful. Consider occasionally rotating shampoos because the ability of how well a product works (its efficacy) can change with time.
- If the scalp is covered with widespread, dense scale, the scale may first be removed by applying warm mineral oil or olive oil to the scalp and washing several hours later with a detergent, such as a dishwashing liquid or a tar shampoo.
- Some over-the-counter creams will help if the medicated shampoo is not working well enough. These can be added to the shampoo until there is improvement and then can be discontinued; these creams can be used again temporarily as needed and include:
- Creams that reduce the Pityrosporum yeast (clotrimazole [Lotrimin], miconazole [Monistat]).
- Hydrocortisone cream (eg, Cortaid), which may work well at first but may be less helpful if used for a long time.
- Managing eyelid inflammation (called blepharitis) by gentle cleaning of the skin around the eyelashes (eyelid margins) with a cotton swab and baby shampoo (eg, Johnson's Baby Shampoo).
When to Seek Medical Care
See your child's dermatologist or other medical professional if the condition does not improve with self-care measures.Treatments
- Corticosteroid creams, lotions, or solutions
- Sulfur or sulfacetamide products, such as a wash, cream, or lotion, applied on the skin (topically)
- Prescription-strength ketoconazole shampoo or cream
- Tacrolimus (Protopic) ointment or pimecrolimus (Elidel) cream
Seborrheic dermatitis - Anogenital in
See also in: Overview,Hair and Scalp