Seborrhoeic eczema is another common type of constitutional eczema that affects the greasy zones of the body. The term 'seborrhoea' literally means 'flowing with sebum' (skin grease). This condition occurs briefly in infancy when the baby's grease glands are temporarily activated by its mother's hormones. Seborrhoeic eczema does not affect children, but it can start after puberty when the skin's grease glands become active. The most commonly affected areas are the scalp, eyebrows, the edges of the eyelids, inner cheeks and sides of the nose areas next to the oily 'T-zone' of the face. The skin folds around the ears and ear canals can be affected. The upper back and chest are also common sites as well as the larger skin folds around the axillae (armpits), under the breast, and the skin around the genitals.
Affected areas appear pink-red and dry, with fine peeling or flaking on the surface. Seborrhoeic eczema is not always itchy, except on the scalp or when the rash is widespread. Dandruff is actually mild seborrhoeic eczema. It appears as tiny white skin flakes with a dry looking scalp. In more severe cases, there may be thicker scaling and redness which can resemble another scaly skin complaint called 'psoriasis'.
What causes seborrhoeic eczema?
The cause of seborrhoeic eczema is unknown, but it appears to be due to an overgrowth of a yeast called 'pityrosporum'. This particular yeast thrives on greasy skin and, along with a variety of other bacteria, makes up part of the skin's normal microbial flora. However, if the yeast grows excessively and this delicate microbial balance is upset, an inflammatory eczema reaction can be triggered. Yeast overgrowth may be encouraged by changes in the climate, sweating, stress and fatigue. Although the skin looks dry, the problem is not due to a lack of oil. On the contrary, seborrhoeic eczema does not affect areas of the body where there is very little sebum production such as the lower legs. People who have seborrhoeic dermatitis are usually quite fit and well no evidence of any underlying health problems. However, widespread and severe seborrhoeic dermatitis can occur in people with Human Immunodefidency Virus (HIV) infection. If there is any reason to suspect this diagnosis, an HIV test can be carried out in full confidence through a department of genito-urinary medicine.
What is the prognosis?
Seborrhoeic dermatitis usually runs a chronic course over many years. It may dear completely for periods of time or persist in a mild form with occasional flares. Seborrhoeic dermatitis can start at any point in adult life but is most common between the ages of 18 and 40, and affects more men than women. It may appear for the first time in the elderly. There is no cure, but regular treatment can keep this condition under control.
What sorts of treatment are available?
Because the overgrowth of pityrosporum yeast is thought to be a key factor in seborrhoeic dermatitis, most work by treatments reducing the levels of this yeast. The scalp can act as a reservoir of yeast, so regular use of an anti-yeast shampoo is recommended. Several suitable 'anti-dandruff shampoos can be bought without prescription. They can also be useful as body washes on hairy backs and chests, but should not be left on the skin as they will cause irritation. Anti-yeast creams can also be used and these are sometimes combined with a mild topical steroid. These dual-action preparations reduce the yeast levels and help to settle the inflammatory process at the same time.
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