seborrheic dermatitis
Introduction
Introduction to seborrheic dermatitis Seborrhoeic dermatitis (seborrhoeicdermatitis) refers to hypersecretion of sebaceous glands, which is characterized by scalp fatty, greasy and shiny, and more desquamation. It is more likely to occur in the developed parts of sebum, and it is a chronic inflammation that occurs on the basis of seborrhea. The damage is bright red or yellow-red patches with greasy scales or suede on the surface, often accompanied by varying degrees of itching. It is more common in adults and can also be found in newborns. basic knowledge The proportion of illness: 0.3% Susceptible people: more common in adults Mode of infection: non-infectious Complications: Acne, Rosacea
Cause
Causes of seborrheic dermatitis
Improper treatment and medication (15%):
A lot of treatment and improper medication are now another cause of seborrheic dermatitis. Without knowing your condition, not using drugs under the guidance of a doctor or using some drugs that are not symptomatic will often make them counterproductive.
Mental factors and bacterial infections (20%):
Mentally stressed, overworked, bacterial infection. On the basis of excessive seborrhea, seborrheic dermatitis can be secondary to fungi (P. ovale) and bacteria (Acne propioni) infection, and it can also cause acne symptoms; it can also be secondary to allergic reactions to fungi and bacteria. The self-immune response may also be followed by the occurrence of eczema-like lesions and disseminated seborrheic dermatitis.
Dietary factors (15%):
Too rich in glycerin, sugar, excessive fat, drinking, overeating spicy and greasy food, endocrine dysfunction, digestive dysfunction.
Acne (15%):
Seborrheic dermatitis can be caused by adolescent acne vulgaris or adult acne (toxic acne) that is not cured in time or improperly treated.
Abuse of skin care products (10%):
Improper care and abuse of skin care products have damaged the water and oil balance function of the skin itself, and the skin water and oil metabolism is disordered. The pH of healthy skin surfaces is about 5.2-5.5, which is not conducive to bacterial growth. Because chemical substances (cosmetics, skin care products, hot dyes), increased sebum secretion, and changes in chemical composition, the inhibition of bacterial effects is reduced, so that normal bacteria such as staphylococcus, malaria pityria present on the surface of the skin And streptococcus, etc., multiply, invade the skin and cause disease.
Endocrine disorders (10%):
Associated with gonad secretion disorders, caused by hyperandrogen secretion. In addition, such as women's menstrual syndrome. Some think it is possible to be related to immune, genetic, hormonal, neurological and environmental factors.
Other factors (15%):
Metabolic disorders, genetic factors, vitamin B deficiency, and physical and chemical stimuli, often scratching or using alkaline detergents can aggravate the onset of seborrheic dermatitis.
Prevention
Seborrheic dermatitis prevention
Wash your hair frequently and keep your skin clean to reduce microbial parasitis. If you have more skin oil, you should wash your face with warm water, sulfur soap 2-3 times a day, with little or no cosmetics, and eat less animal fat, carbohydrates and Irritating food, avoiding smoke, alcohol, eating more fresh vegetables and rich in vitamin B foods.
Complication
Seborrheic dermatitis complications Complications, acne, rosacea
The disease has a long course of disease, which is light and heavy, and can be followed by seborrheic alopecia, hemorrhoids and rosacea.
Symptom
Seborrheic dermatitis symptoms Common symptoms Itching pustular erythema scaly Chest itching scaly Nasal labial sulcus Red sputum Split nose Both sides of the skin corticosteroids rely on dry lipids squeezing baby scalp with yellow crusting
Common in polystea, hairy, sweaty parts, starting from the scalp, when the symptoms are aggravated, can develop to the face, behind the ears, armpits, chest and back, umbilical fossa and pubic bone.
According to different skin lesions, it can be divided into dry and wet.
Dryness is mostly erythema desquamation damage, wetness is mostly papules, blisters, sputum can produce erosion, exudation, and formed into yellow suede, often itching, unbearable, slow, recurrent, occur in sebum overflow The area is often confined to the scalp. In severe cases, it can be developed to the face, nasolabial folds, eyebrows, eyelids, central thoracodors, umbilical fossa and groin or ankle. The lesions are initially small follicular papules that gradually merge into different sizes. Yellow-red patches, covered with greasy scaly scars, severe cases of mild exudative eczema-like dermatitis, limited to a certain part or generalized, and even developed into erythroderma, due to differences in location and damage, Clinical manifestations also differ.
1. The scalp begins with small patches of white or oily scaly patches, which later expand into large patches with clear boundaries. The base is slightly red, mildly itchy, and the heavy ones are oily scaly circular patches. It may be accompanied by exudation and thick sputum or red papules centered on hair follicles. In severe cases, the entire scalp is covered with a greasy odor and thick hair, accompanied by hair loss.
2. Face, ear, behind the ear and neck often spread from the head, yellow-red or greasy white scales and suede, diffuse erythema around the eyebrow and around it, desquamation, eyebrows scarce due to scratching, eyelid involvement It is blepharitis, severe cases can be erosive ulcers, scars left behind, scars after the ear, flushing and cleft palate, can be unilateral or bilateral, more common in girls and young women, seborrheic otitis externa is more common in the elderly patient.
3. The beard is seen in middle-aged males. The hair follicles are slightly red and swollen. There are small light brown crusted sputum, often called sores, stubborn and difficult to treat. Some manifest as hair follicle pustules with greasy scales and bright red around the base. Cause hair follicle damage and scar formation, but also scalp and pubic bone at the same time.
4. Torso Common in men over the age of 20, occurs in the chest and shoulder blades, starting with a small reddish-brown follicular papules, covered with greasy scales, gradually formed through the center, the center can be cured to form fine scaly scales, An annular patch with dark red papules and large greasy scales on the edges, and another pityria-like seborrheic dermatitis with round or oval yellow or dark red patches with only fine marginal scales. The boundary is obvious and the center is healed, forming a ring-shaped damage.
5. Wrinkles Common in the ankle, groin, under the breast and umbilical fossa, more common in 30 to 50 years old, especially obese middle-aged people, the skin lesions are clearly defined erythema, with greasy scales, such as sowing Scattered frictional erythema-like fissures, swelling, due to local hyperhidrosis, easy secondary infection, or improper treatment can cause skin lesions to develop, genital involvement in time, can form round erythema and scales and skin exfoliation, showing subacute Eczema-like or chronic lichen-like erythema, such as psoriasis, is characterized by no typical seborrheic dermatitis.
6. Limbs The extremities of the extremities are more common than the flexor side, showing yellow-red or red-red plaques. Due to scratching, it can form erosion and resemble eczema.
7. Infant seborrheic dermatitis 2 to 10 weeks after birth, the baby, scalp, forehead, ear, eyebrows, nasal buccal groove and wrinkles appear round erythema, the boundary is clear, the scaly is covered, the erythema can be expanded and merged Sticking to greasy jaundice, there is erosion and exudation, inflammation is more obvious, symmetry occurs, itching, general children can be cured within 3 weeks to 2 months, if sustained unhealed, often with atopic dermatitis in infants, also Can be secondary to bacterial infection or Candida infection, infants without adult hair follicle damage and seborrhea.
Examine
Examination of seborrheic dermatitis
1, special examination of skin diseases: skin lesions mainly appear in the scalp, eyebrows, nasolabial folds, cheeks, behind the ears, upper chest, interscapular region, umbilical cord, vulva and groin. The initial manifestation is an inflammatory papule around the hair follicle, which can then manifest as a clear, slightly yellowish dark red patch with a greasy scale or suede. Self-consciously mild itching. The lesions that occur in the trunk are often ring-shaped. Skin lesions start from the scalp and gradually spread down. In severe cases, the whole body can be spread and develop into erythroderma.
2, pathological examination.
Diagnosis
Diagnosis and differentiation of seborrheic dermatitis
diagnosis
Seborrheic dermatitis is clinically variable, some progress slowly, recurrent, some can be limited to the head, some are distributed in other parts or the whole body, due to itching, scratching can cause erythroderma, folliculitis, bloated Lymph node inflammation, etc., also caused by contact dermatitis or eczema-like changes caused by improper treatment.
Greasy scaly yellow-red patches appear in the sebum spill area, the boundary is clear, consciously itching, chronic, and the diagnosis is easier.
TCM pathogenesis and syndrome differentiation: Chinese medicine believes that the disease is congenital endowment or over-eating paste, thick and damp, moist and hot, and windy evil, stagnation on the skin, steaming on hot and humid (oily fat spill), or eating irregularly, It leads to less blood loss, blood deficiency and dryness, and skin dystrophy (dry seborrheic).
Differential diagnosis
1, the head and face psoriasis damage scattered into a sheet, the boundary is clear, the scales are very thick, the touch is uneven, the hair does not fall off, the short hair gathers into a bundle, and the heavy damage can be connected into a large piece, extending to the front hairline Invasion of the forehead a few centimeters, scraping off the scales has a film phenomenon (ie, the scales are scraped off, under which is a red shiny film) and bleeding phenomenon (ie, light scratching film can appear scattered in small bleeding points), film phenomenon and bleeding phenomenon It is an important feature of psoriasis damage.
2, rose pity tendon occurs in the neck, trunk, proximal limbs, oval-shaped rash, the center is slightly yellow, the edge is slightly elevated, pale red, with white squama-like scales, a single damage from the beginning, said It is a mother spot; the mother spot is gradually larger, the diameter can reach 2 to 5 cm or more, and sometimes 2 to 3 mother spots can appear at the same time. After 1 to 2 months, small erythema appears successively, which occurs in the trunk and the rash is long. The axis is consistent with the skin pattern, generally 4 to 6 weeks can be self-resolved, no recurrence.
3, the body damage damage edge is narrow and narrow, the boundary is clear, there is a ring damage that the central healing is extended to the surrounding, itching is obvious, patients often have a history of hand and foot hyperthyroidism.
4, erythema pemphigus is mainly distributed in the face, neck, chest and back in the middle, began to have symmetrical erythema on the face, overlying scaly and crusted, blisters on the back of the neck and chest and back erythema, formed after rupture Skin, Nissl's sign positive, (ie, applying pressure on the blister top, you can see the blister infiltration into the surrounding epidermis; pulling the residual wall of the blister wall, causing further exfoliation of the surrounding epidermis; more importantly, the skin with normal appearance is also Rub it off.)
5, slag-like dermatitis does not involve the scalp area, eyebrows and nasolabial folds are not good hair parts, and there are many long-term external application of hormone preparations.
