Diagnostic feature :

Seborrhoeic dermatitis is characterized by red, lesions covered with greasy looking scales on the scalp, face and upper trunk,  areas rich in sebaceous glands. Scalp Dandruff is usually the earliest manifestation. There may be hair loss which is reversible when the inflammation is controlled. On the face, the eyebrows,  nasolabial fold and eyelids are often involved. Ears are a common site of involvement.  

Seborrhea in infants may appear  as early as three weeks  in the diaper area, the face and scalp (cradle cap), and occasionally on the trunk. The "rash" is red and scaling with tiny vesicles.

Adult management.

Ketoconazole shampoo is effective, reducing  dandruff. Shampoos that contain salicylic acid, selenium sulphide, zinc pyrithione are alternatives. Steroid lotion applied twice daily provides symptomatic relief but may relapse.

Lesions on face, chest can be treated by weak topical steroid and antiseborrhoeic shampoo. 2% Ketoconazole cream once a day is highly effective in difficult cases.

Scaling of blepharitis may be suppressed by frequent washing. Prolonged use of steroid lotion on the eyelids causes glaucoma and should be avoided. 2% ketoconazole cream once a day should be tried in resistant cases.

Infants

Cradle cap should be oiled regularly with warm olive oil and washed off few hours later with 5% cetrimide shampoo. Erythema and scaling on the body can be treated with weak topical corticosteroid cream topical antibiotic if infection is present. Shampoo that contains salicylic acid or selenium sulphide should be avoided in neonates for the risk of systemic absorption.

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