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Choudhary C, Kravvas G, Jones HT. What you need to know about common skin problems in older adults. Br J Hosp Med (Lond) 2024; 85:1-8. [PMID: 38708977 DOI: 10.12968/hmed.2023.0399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Skin ageing is a multifaceted process impacted by both intrinsic and extrinsic factors. Drier and less elastic skin with declining sebum levels in older age makes ageing skin more vulnerable to various skin conditions, including infections, inflammatory dermatoses, and cancers. Skin problems are common among older adults due to the effects of ageing, polypharmacy and multimorbidity impacting not only physical health but wellbeing and quality of life. In the UK, older adults in geriatric medicine wards may present with various skin conditions. Hospitalised older individuals may have undiagnosed skin problems unrelated to their admission, making hospitalisation an opportunity to manage unmet needs. Asteatotic eczema, incontinence associated dermatitis, seborrhoeic dermatitis, chronic venous insufficiency, and cellulitis are common disorders clinicians encounter in the geriatric medicine wards. This article outlines the importance of performing comprehensive skin assessments to help diagnose and commence management for these common conditions.
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Affiliation(s)
- Cherry Choudhary
- Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, London, UK
| | - Georgios Kravvas
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Howell T Jones
- Department of Healthcare Services for Elderly People, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
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Truglio M, Sivori F, Cavallo I, Abril E, Licursi V, Fabrizio G, Cardinali G, Pignatti M, Toma L, Valensise F, Cristaudo A, Pimpinelli F, Di Domenico EG. Modulating the skin mycobiome-bacteriome and treating seborrheic dermatitis with a probiotic-enriched oily suspension. Sci Rep 2024; 14:2722. [PMID: 38302693 PMCID: PMC10834955 DOI: 10.1038/s41598-024-53016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024] Open
Abstract
Seborrheic dermatitis (SD) affects 2-5% of the global population, with imbalances in the skin microbiome implicated in its development. This study assessed the impact of an oily suspension containing Lactobacillus crispatus P17631 and Lacticaseibacillus paracasei I1688 (termed EUTOPLAC) on SD symptoms and the skin mycobiome-bacteriome modulation. 25 SD patients were treated with EUTOPLAC for a week. Symptom severity and skin mycobiome-bacteriome changes were measured at the start of the treatment (T0), after seven days (T8), and three weeks post-treatment (T28). Results indicated symptom improvement post-EUTOPLAC, with notable reductions in the Malassezia genus. Concurrently, bacterial shifts were observed, including a decrease in Staphylococcus and an increase in Lactobacillus and Lacticaseibacillus. Network analysis highlighted post-EUTOPLAC instability in fungal and bacterial interactions, with increased negative correlations between Malassezia and Lactobacillus and Lacticaseibacillus genera. The study suggests EUTOPLAC's potential as a targeted SD treatment, reducing symptoms and modulating the mycobiome-bacteriome composition.
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Affiliation(s)
- Mauro Truglio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Francesca Sivori
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Ilaria Cavallo
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Elva Abril
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Valerio Licursi
- Institute of Molecular Biology and Pathology, National Research Council of Italy, 00185, Rome, Italy
| | - Giorgia Fabrizio
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
- Department of Biology and Biotechnology C. Darwin, Sapienza University of Rome, 00185, Rome, Italy
| | - Giorgia Cardinali
- Cutaneous Physiopathology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | | | - Luigi Toma
- Medical Directorate, IRCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Floriana Valensise
- Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Antonio Cristaudo
- Clinical Dermatology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy
| | - Fulvia Pimpinelli
- Microbiology and Virology, San Gallicano Dermatological Institute, IRCCS, 00144, Rome, Italy.
| | - Enea Gino Di Domenico
- Department of Biology and Biotechnology C. Darwin, Sapienza University of Rome, 00185, Rome, Italy.
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Choi YG, Kim SY, Kim JS, Choi YJ, Kim WS. Efficacy and Safety of Precision Cryotherapy to Treat Seborrheic Dermatitis of the Scalp. Dermatol Surg 2024; 50:47-51. [PMID: 37788291 DOI: 10.1097/dss.0000000000003960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
BACKGROUND Recently, a new cryotherapy device that precisely controls skin temperature was developed. Precision cryotherapy (PC) can be a safe and alternative treatment modality for immune-related skin diseases that are difficult to treat by conventional cryotherapy because of serious adverse events. OBJECTIVE To evaluate the efficacy and safety of PC in scalp seborrheic dermatitis (SD). METHODS A single-arm, prospective trial was designed. Twenty-four patients with SD underwent 3 PC interventions 2 weeks apart. At the baseline, Week 6, and Week 8, overall improvements in Physician Global Assessment (PGA) and clinical severity scores were assessed. At each visit, the erythema index (EI) and transepidermal water loss were evaluated. The patients scored 9 subjective symptoms using a visual analog scale (VAS). RESULTS The itch VAS score decreased by 50.4% at Week 8. Blinded investigators reported improvement of PGA scores from 2.86 ± 0.62 to 1.66 ± 0.61 and clinical severity scores from 4.55 ± 1.30 to 2.45 ± 1.37. The average EI decreased by 19.6% at Week 8 ( p < .05). CONCLUSION This study not only demonstrated the efficacy and safety of PC in scalp SD but it also revealed insights for PC being a promising treatment modality in immune-related skin diseases.
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Affiliation(s)
- Yeon Gu Choi
- All authors are affiliated with the Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Fakhraie S, Erickson T, Chovatiya R. Evaluation of a patient education platform for seborrheic dermatitis. Arch Dermatol Res 2023; 315:2927-2930. [PMID: 37500910 DOI: 10.1007/s00403-023-02681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023]
Abstract
Seborrheic dermatitis (SD) is a common, burdensome inflammatory skin disorder. Little is known about the identity and quality of videos patients consume on social media to better understand and manage SD. We evaluated three social media platforms-YouTube, TikTok, and Instagram-for content, quality, and popularity. Search terms "seborrheic dermatitis," "dandruff," "cradle cap," and "flaky scalp" identified videos on each platform. The first 50 videos for each keyword were analyzed. After screening, 147 YouTube, 132 Instagram, and 164 TikTok videos were included. Videos were characterized by upload source (healthcare provider/organization [HCP]/non-HCP), quality (accurate/misleading/non-informative), content (educational/personal xperience/entertainment/advertisement), and number of likes/views. Data were analyzed by chi square (categorical) or Kruskal-Wallis (continuous) tests. YouTube contained a higher proportion of videos vs. TikTok and Instagram that were made by HCPs (42.2/19.7/17.7%, respectively) and contained more accurate (52.4/28.0/32.9%), and educational (66.7/38.6/34.4%) content (p < 0.0001 for all). Non-HCPs were responsible for creating the majority of videos across platforms along with most inaccurate/non-informative (65.9/86.8/78.6%) and non-educational (56.5/75.5/71.1%) content (p < 0.0001 for all). Despite lower quality of content and information, TikTok videos had the highest mean views (2,418,872) and likes (184,395) (p < 0.0001 for all). HCP vs. non-HCP-made videos were viewed more frequently only on YouTube. Though views and likes were common for all inaccurate and entertainment/advertisement content, they were most characteristic of TikTok and Instagram (p < 0.0001). These results show a high volume of SD video consumption across all platforms, especially those with lower quality and less informative content, and significant content difference across platforms. Additional studies are needed to better characterize online SD educational content and optimize HCP-led video creation and patient video consumption.
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Affiliation(s)
- Sheiva Fakhraie
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Taylor Erickson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Raj Chovatiya
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA.
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Desai S, McCormick E, Friedman A. An Up-to-Date Approach to the Management of Seborrheic Dermatitis. J Drugs Dermatol 2022; 21:1373-1374. [PMID: 36468970 DOI: 10.36849/jdd.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Seborrheic dermatitis (SD) is a chronic, relapsing, inflammatory dermatosis with ambiguous pathophysiology of overcolonization of Malassezia combined with predisposing factors including sebocyte activity, impaired immunity with diminished T-cell responses and activation of complements, disruption of epidermal barrier integrity and skin microbiota, and environmental influences.
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Dréno B, Gallo RL, Berardesca E, Griffiths CEM. Advocacy for a shared physician/patient approach for the management of acne, rosacea, seborrheic dermatitis and photodamage. Eur J Dermatol 2022; 32:138-139. [PMID: 35653084 PMCID: PMC9170546 DOI: 10.1684/ejd.2022.4236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Brigitte Dréno
- INSERM, CNRS, Immunology and New Concepts in Immuno Therapy, INCIT, UMR 1302/EMR6001, Nantes Université, F-44000 Nantes, France
| | - Richard L. Gallo
- Department of Dermatology, University of California San Diego, La Jolla, CA USA
| | - Enzo Berardesca
- Phillip Frost Department of Dermatology, University of Miami, Miami, USA
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Hassan S, Szeto MD, Sivesind TE, Memon R, Muneem A, Victoire A, Magin PJ, van Driel ML, Nashawaty M, Dellavalle RP. From the Cochrane Library: Interventions for infantile seborrheic dermatitis (including cradle cap). J Am Acad Dermatol 2021; 86:e87-e88. [PMID: 34571061 DOI: 10.1016/j.jaad.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/30/2021] [Accepted: 09/14/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Shahzeb Hassan
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rohail Memon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abraar Muneem
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Anousha Victoire
- University of Newcastle, Discipline of General Practice, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Parker J Magin
- University of Newcastle, Discipline of General Practice, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, St Lucia, Queensland, Australia
| | | | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
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8
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Abstract
BACKGROUND Infantile seborrhoeic dermatitis (ISD) is a chronic, inflammatory, scaling skin condition, which causes redness and a greasy scaling rash in infants and young children. It can last from weeks to months, but rarely years. When it occurs on the scalp, it is referred to as 'cradle cap'. While benign and self-limiting, irrelevant of its location on the body, it can distress parents. The effectiveness of commonly promoted treatments is unclear. OBJECTIVES To assess the effects of interventions for infantile seborrhoeic dermatitis in children from birth to 24 months of age. SEARCH METHODS We searched the following databases up to 22 May 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched trials registers and checked reference lists of included studies for further references to randomised controlled trials (RCTs). We searched for unpublished RCTs and grey literature via web search engines, and wrote to authors and pharmaceutical companies. SELECTION CRITERIA We included RCTs of interventions for ISD in children from birth up to 24 months who were clinically diagnosed by a healthcare practitioner with ISD or cradle cap. We allowed comparison of any treatment to no treatment or placebo, and the comparison of two or more treatments or a combination of treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Change in severity score from baseline to end of study' and 'Percentage of infants treated who develop adverse effects or intolerance to treatment'. The secondary outcome was 'Improvement in quality of life (QoL) as reported by parents'. MAIN RESULTS We included six RCTs (one with a cross-over design) randomising 310 children and reporting outcomes for 297 children. Most participants were aged under seven months with only two participants aged over one year (seven and 12 years old); where specified, 60% were boys. In two studies, condition severity was mild to moderate; one study included two participants with severe ISD; the other studies did not describe baseline severity or described it as body surface area affected.The study setting was not always clear but likely a paediatric outpatient clinic in the following countries: Thailand, Israel, USA, France, and Australia.Two studies compared oral biotin (a B group vitamin) against placebo, two studies compared proprietary products against placebo cream or a control shampoo, and two studies compared topical corticosteroids against other products. The studies were generally short-term, between 10 and 42 days' duration; only one study followed the participants until resolution of the rash or eight months of age.We assessed the risk of bias as unclear for most aspects due to lack of reporting, but two of the studies were at high risk of performance and detection bias due to the appearance of the intervention, the trial design (open-label), or use of overlabelled tubes. Two trials had a high risk of attrition bias.All the results given below were based on very low-quality evidence. Treatment duration ranged from one week to three weeks.For the two trials comparing biotin versus placebo (n = 35), one did not report a measure of change in severity (only change in duration of rash) while the other did not report raw data (only 'no statistically significant difference'), measured at three weeks. Neither trial reported on adverse events.Two trials compared proprietary products against placebo (n = 160). One trial assessed change in severity via percentage success (96% of participants in non-steroidal cream Promiseb versus 92% in placebo), and reported no adverse events (both assessed at day 14). The other trial assessed change in severity via reduction in lesional score (surface area covered), finding better results for lactamide MEA gel (a moisturising agent) plus shampoo (81.4%) compared with shampoo only (70.2%; P = 0.0092). No adverse events were described, but signs of discomfort were similar in both groups (both assessed at day 21).In the comparison of topical steroids versus another product, change in severity was measured through evaluation of cure and body surface (n = 102).In one trial comparing hydrocortisone 1% lotion with licochalcone 0.025% lotion, there was no significant difference in participants cured (95.8% with hydrocortisone compared to 97.1% with licochalcone). One person in the licochalcone group developed more erythema, but there were no other adverse events (both outcomes assessed at day 14). In the trial comparing flumethasone pivalate 0.02% ointment versus eosin 2% aqueous solution, a reduction in body surface area affected was seen in both groups at day 10 (9% with corticosteroid versus 7% with aqueous solution), with all infants showing less than 10% involvement. There were no adverse events (both outcomes assessed at day 10).No studies measured QoL.We found no trials testing commonly used treatments such as mineral oils, salicylic acid, or antifungals. AUTHORS' CONCLUSIONS Our review identified only a limited number of studies investigating the effects of interventions for ISD in infants and young children. Unlike the reviews investigating the effects of treatments in adults, our results showed that there is uncertainty regarding the effectiveness and safety of studied treatments due to the very low-certainty evidence for all comparisons and outcomes.We assessed most bias domains as at unclear risk, but there was a high risk of bias for (mainly) performance, attrition, and detection bias. Evidence was limited further by imprecision (small studies, low number of events), indirectness (mainly with the outcomes assessed), and poor trial reporting. In most studies, the prognosis for the condition was favourable regardless of intervention but interpretation is limited by the very low-certainty evidence.Further research is needed with large, well-conducted, and well-reported intervention trials, particularly of interventions commonly recommended or used, such as emollients or shampoos and brushing, antifungals, or steroids. All studies should report standardised and validated relevant outcome measures, including adverse events, severity, and QoL, and they should be conducted in primary care settings where the majority of ISD is managed. Future trials should compare against placebo, no treatment, or standard care.
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Affiliation(s)
- Anousha Victoire
- The University of NewcastleDiscipline of General Practice, School of Medicine and Public HealthCallaghanNewcastleAustralia2308
| | - Parker Magin
- The University of NewcastleDiscipline of General Practice, School of Medicine and Public HealthCallaghanNewcastleAustralia2308
| | - Jessica Coughlan
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusNottinghamUKNG7 2NR
| | - Mieke L van Driel
- The University of QueenslandPrimary Care Clinical Unit, Faculty of MedicineBrisbaneQueenslandAustralia4029
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Taylor SC, Barbosa V, Burgess C, Heath C, McMichael AJ, Ogunleye T, Callender V. Hair and scalp disorders in adult and pediatric patients with skin of color. Cutis 2017; 100:31-35. [PMID: 28873105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As increasing numbers of patients of African descent seek treatment for hair and scalp-related diseases, it is imperative that all dermatologists be adequately trained to address the concerns of this patient population. We present must-know information to effectively approach the concerns of patients with seborrheic dermatitis, acquired trichorrhexis nodosa, acne keloidalis nuchae, pseudofolliculitis barbae, alopecia, and common pediatric hair and scalp disorders.
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Affiliation(s)
- Susan C Taylor
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | | | - Cheryl Burgess
- Center for Dermatology and Dermatologic Surgery, Washington, DC, USA
| | - Candrice Heath
- Premier Dermatology and Cosmetic Surgery, Newark, Delaware, USA
| | - Amy J McMichael
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Temitayo Ogunleye
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA
| | - Valerie Callender
- Callender Dermatology and Cosmetic Center, Glenn Dale, Maryland, USA
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10
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Suchánková D. [Diseases affecting the scalp]. Cas Lek Cesk 2017; 156:137-140. [PMID: 28722457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The skin of the scalp differs from the skin on the other areas of the body because of a higher density of hair follicles and higher sebum production. These, together with the presence of hair, provide a suitable environment for superficial infections, infestations and inflammatory diseases. The good condition of the scalp has a significant impact on the patient's mental well-being and social interaction. The visibility of this part of the skin and the presence of hair itself restrict the range of possible therapeutic agents that can be used due to the complicated application and poor cosmetic outcome. That is the reason why different galenic forms are usually chosen for the scalp compared to the other sites of the skin. The article provides an overview of the most common scalp disorders, the diagnostic approach and recommendations for the treatment.
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11
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Naldi L, Diphoorn J. Seborrhoeic dermatitis of the scalp. BMJ Clin Evid 2015; 2015:1713. [PMID: 26016669 PMCID: PMC4445675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Seborrhoeic dermatitis affects a variable proportion of the general population, ranging from 3% to 10%. Malassezia yeast species (previously referred to as Pityrosporum) are thought to be the responsible organisms, and cause inflammation by still poorly defined mechanisms. Seborrhoeic dermatitis tends to relapse after treatment. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for seborrhoeic dermatitis of the scalp in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 14 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: bifonazole, ciclopirox, ketoconazole, pyrithione zinc, selenium sulfide, tar shampoo, terbinafine, and topical corticosteroids (betamethasone valerate, clobetasol propionate, clobetasone butyrate, hydrocortisone, mometasone furoate).
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Abstract
Siddha medicine is one of the oldest (5000 years old) well-documented Indian traditional medicines, compared with Ayurveda, Unani, and traditional Chinese medicine, by way of keen observation and experimentation. It mentions 108 diseases that occur in childhood, which are further classified and described into various subtypes based on the clinical features and different stages of a particular disease. The authors translate the elegant and detailed description of one neonatal disorder, infantile seborrheic dermatitis (cradle cap), called kabaala kuttam (KK), described in 17 stanzas of four lines for each stanza from Tamil language script into English. There are five different types of cradle cap, including white type, dark black type, red type, weeping type, and toxic type. Four polyherbal formulations are described for external and oral administration, in which there is mention of 39 herbals and pure sulfur as ingredients. The safety and efficacy of these herbal products varies and has not been fully explored in infants, but may represent options for clinical development.
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Affiliation(s)
| | - Arul Amuthan
- Melaka Manipal Medical College, Manipal University, India, 576104.
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13
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Silverberg NB. Scalp hyperkeratosis in children with skin of color: diagnostic and therapeutic considerations. Cutis 2015; 95:199-207. [PMID: 25942029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Scalp hyperkeratosis is common in childhood and adolescence. Diagnosis is affected by age, race, and history of infectious exposure, and associated symptoms including atopic features, alopecia, inflammatory nodules, presence and type of cutaneous lesions outside of the scalp, and nuchal lymphadenopathy. Tinea capitis is common in children with skin of color, especially black and Hispanic children. In adolescents, seborrheic dermatitis predominates as the cause of scalp hyperkeratosis, but tinea is still of concern. This article aims to help the practitioner comfortably diagnose and treat scalp hyperkeratosis in children with skin of color.
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Affiliation(s)
- Nanette B Silverberg
- Department of Dermatology, 1090 Amsterdam Ave, Ste 11D, New York, NY 10025, USA.
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14
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Pagliarello C, Fabrizi G, Cortelazzi C, Boccaletti V, Feliciani C, Di Nuzzo S. Psoriasis and seborrheic dermatitis in infancy and childhood. GIORN ITAL DERMAT V 2014; 149:683-691. [PMID: 25315289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Psoriasis is a common inflammatory dermatosis that may be seen in infants, children, and adolescents. The clinical presentation and course may be quite variable, and while patients with mild disease are often easily managed, those with recalcitrant or more severe disease often present a therapeutic dilemma given the number of therapies available and the relative lack of data on the efficacy and safety of use of these therapies in children. Diagnosis in children can be more difficult, but family history may be helpful. Moreover, sometimes clinical pattern of pediatric psoriasis is very different from its adult counterpart or it could manifests in association with atopic dermatitis, and for these reason it is possibly misdiagnosed and under recognized. We therefore focus on diagnostic patterns and effective treatments of this challenging disease.
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Affiliation(s)
- C Pagliarello
- Section of Dermatology, Department of Surgical Sciences, Parma Medical School, Parma, Italy -
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15
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Ooi ET, Tidman MJ. Improving the management of seborrhoeic dermatitis. Practitioner 2014; 258:23-3. [PMID: 24689165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Seborrhoeic dermatitis usually starts at puberty with a peak incidence at 40 years of age and is more common in males. Patients develop symmetrical, well demarcated, dull or yellowish red patches and plaques with overlying adherent, yellowish greasy scales. Seborrhoeic dermatitis has a distinctive distribution in areas rich in sebaceous glands - the scalp, eyebrows, glabella, nasolabial and nasofacial folds, cheeks, peri-auricular skin, pre-sternal and interscapular areas. It may occur in flexures, especially the axillae, groin, anogenital skin, infra-mammary skin and the umbilicus. Some patients may develop blepharitis with erythematous eyelids and destruction of eyelash follicles. Patients with HIV infection, neurological diseases, including parkinsonism and cranial nerve palsies, have a higher incidence of seborrhoeic dermatitis. Patients presenting with sudden onset severe seborrhoeic dermatitis should be screened for risk factors for HIV. Patients should be referred in the following situations: diagnostic uncertainty - consider other differential diagnoses; failure to respond to first-line treatment after four weeks - consider secondary changes e.g. bacterial infection, flexural intertrigo, lichenification, otitis externa; and severe/widespread disease. Patients with seborrhoeic dermatitis have a good prognosis, particularly infantile seborrhoeic dermatitis, which usually remits within a few weeks or months and does not recur.
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Bukvić Mokos Z, Kralj M, Basta-Juzbašić A, Lakoš Jukić I. Seborrheic dermatitis: an update. Acta Dermatovenerol Croat 2012; 20:98-104. [PMID: 22726283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Seborrheic dermatitis is a chronic relapsing inflammatory skin disorder clinically characterized by scaling and poorly defined erythematous patches. The prevalence of adult seborrheic dermatitis is estimated at 5%. Although the exact cause of seborrheic dermatitis has yet to be understood, Malassezia yeasts, hormones (androgens), sebum levels and immune response are known to play important roles in its development. Additional factors including drugs, winter temperatures and stress may exacerbate seborrheic dermatitis. A variety of treatment modalities are available, including antifungal agents, topical low-potency steroids and calcineurin inhibitors (immunomodulators). This review summarizes current knowledge on the etiopathogenesis and therapy of adult seborrheic dermatitis.
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Affiliation(s)
- Zrinka Bukvić Mokos
- University Hospital Center Zagreb, Department of Dermatology and Venereology, School of Medicine University of Zagreb, Šalata 4, HR-10000 Zagreb, Croatia.
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Menzinger S, Laffitte E. [Seborrhoeic dermatitis: clinical manifestations and management]. Rev Med Suisse 2011; 7:752-758. [PMID: 21568097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Seborrhoeic dermatitis is a frequent chronic inflammatory dermatosis characterized by erythematous patches surmounted by fatty and yellowish scales, affecting particularly the scalp, the naso-labial folds and the eyebrows. Its etio-pathogeny is still not clear, but Malassezia type yeast appear to play a very important role in its development. Several conditions can be associated with high prevalency of seborrhoeic dermatitis (HIV, Parkinson's disease, Down's Syndrome). No curative treatment is available yet, but nevertheless the symptomatology can be controlled, mainly with topical treatments, and particularly antifungals. This article will develop first clinical and pathological aspects of the disease, then propose therapeutic recommendations based on evidences from the literature.
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Treadwell PA. Papulosquamous disorders: atopic dermatitis, psoriasis, seborrheic dermatitis, and nickel contact dermatitis. Adolesc Med State Art Rev 2011; 22:157-168. [PMID: 21815450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article has addressed some of the recent discoveries in pathogenesis and treatment options of 4 papulosquamous disorders: atopic dermatitis, psoriasis, seborrheic dermatitis, and nickel contact dermatitis.
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Williams C. Olive oil for cradle cap? Community Pract 2010; 83:14; author reply 14. [PMID: 21121479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Puzenat E, Riou-Gotta MO, Messikh R, Humbert P. [Facial dermatosis: acne, rosacea, seborrhoeic dermatitis]. Rev Prat 2010; 60:849-855. [PMID: 20623910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Eve Puzenat
- Service de dermatologie, CHU Saint-Jacques, 25030 Besançon Cedex, France.
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Stefanaki I, Katsambas A. Therapeutic update on seborrheic dermatitis. Skin Therapy Lett 2010; 15:1-4. [PMID: 20505895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Seborrheic dermatitis is a recurrent, usually mild, skin disorder with typical clinical manifestations. As it most frequently involves exposed areas, such as the face and scalp, patients seek advice from a dermatologist in order to control their disease. This article will review the available treatments for this common dermatologic problem.
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Affiliation(s)
- I Stefanaki
- Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece
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Do I need a prescription medication to treat seborrheic dermatitis? Mayo Clin Womens Healthsource 2009; 13:8. [PMID: 19727041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Chatzikokkinou P, Sotiropoulos K, Katoulis A, Luzzati R, Trevisan G. Seborrheic dermatitis - an early and common skin manifestation in HIV patients. Acta Dermatovenerol Croat 2008; 16:226-230. [PMID: 19111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Seborrheic dermatitis is a common dermatosis occurring on the scalp, face and chest. In the general population, the prevalence of seborrheic dermatitis varies between 3% and 5%, while in HIV positive patients there is an increased prevalence of seborrheic dermatitis ranging between 30% and 83%. Seborrheic dermatitis occurs early in the course of HIV disease and may be an initial clinical marker of HIV infection.
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Abstract
Seborrheic dermatitis (SD) has no diagnostic criteria and its etiology remains unknown. SD is distributed in the areas rich in sebaceous glands. Initially, MALASSEZIA FURFUR was thought to be the causing agent. Currently, SD is thought as not being proportional to the mean yeast count, but rather as an abnormal host immune response to the yeasts on the skin. There are a variety of topical and systemic antifungal agents available as a remedy. Corticosteroids and ultraviolet B are also used as treatment.
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Affiliation(s)
- J Rashid
- Department of Psychiatry, Mount Sinai Services, Elmhurst Hospital Center, Elmhurst, New York, USA.
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Raza N, Ejaz A, Ahmed MK. Knowledge, attitude and practice regarding dandruff among soldiers. J Coll Physicians Surg Pak 2007; 17:128-31. [PMID: 17374295 DOI: 03.2007/jcpsp.128131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 02/10/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the knowledge, attitude and practice regarding dandruff among soldiers. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Departments of Dermatology at Combined Military Hospitals, Abbottabad, Malir and Gujranwala from January 2006 to March 2006. PATIENTS AND METHODS Serving male soldiers posted at Abbottabad, Malir and Gujranwala Cantonments were included in the study. Convenience sampling was used to distribute the questionnaire. All soldiers included in the study were asked or assisted by the trained staff to fill the close-ended questionnaire in Urdu, which included information about demographic profile and questions relevant to the objectives of the study. The ethical requirements for the study were fulfilled. SPSS-10 was used for data management. RESULTS A total of 800 serving male soldiers were surveyed. Five hundred and twenty-one soldiers (65.1%) answered yes to dandruff, whereas 279 (34.9%) replied in negative. Dandruff was considered a disease by 433 (83.1%) respondents. Hair fall (n=392, 75.2%) and scalp itching (n=380, 72.9%) were the common symptoms and 330 (63.3%) respondents were embarrassed by dandruff. Bad water (n=93, 17.8%), winter (n=40, 07.6%) and lack of sleep (n=30, 05.7%) were considered the most common causes of dandruff. Majority of the individuals (n=487, 93.4%) used different hair oils and household remedies for the treatment of dandruff. One hundred and fourteen (21.9%) and 50 (09.6%) participants consulted doctors and traditional healers respectively for their dandruff. Advertisements in electronic or print media and wall hoardings etc. influenced 213 (40.9%) respondents to use various anti-dandruff shampoos, hair tonics and oils. CONCLUSION Dandruff is a common problem and there is a need for education programmes and formulation of a policy regarding the positive role of media on health matters.
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Affiliation(s)
- Naeem Raza
- Department of Dermatology, Combined Military Hospital, Abbottabad.
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Arora V, Arora S. Management of infantile seborrheic dermatitis. Am Fam Physician 2007; 75:807. [PMID: 17390592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
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Abstract
BACKGROUND There are few publications on facial seborrhea treatment. A focused therapy is needed. OBJECTIVE Our aim was to evaluate the efficacy of electrothermolysis of the sebaceous glands. METHODS In the preliminary studies, histologic changes in the cheek skin by electrothermolysis were examined by light microscopy. In the clinical studies, 15 adult women subjects with facial seborrhea were treated four times by the same procedure. A 1.50-mm-long needle with a 0.45-mm base insulation was inserted into pores in the forehead and cheeks, and a high-frequency electrical current was applied for 0.25 to 0.50 seconds with an output of 40 W. Each treatment took 60 to 90 minutes. The subjects returned for 6-months follow-up after their fourth treatment. RESULTS Histology 1 and 6 months later showed fewer sebaceous glands and the development of fibrosis. All 12 subjects who completed the 6-month follow-up gave a subjective assessment of continuous reduction of facial seborrhea. On a scale of 0.0 to 3.0, the mean improvement score was 1.67+/-0.75. The mean reduction rate of skin surface lipids was 31.5% by sebumeter (p< .01). CONCLUSIONS Even though this is a pilot, uncontrolled clinical assessment study, electrothermolysis of sebaceous glands may be an effective and safe approach for facial seborrhea treatment.
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Sheffield RC, Crawford P, Wright ST, King VJ. Clinical inquiries. What's the best treatment for cradle cap? J Fam Pract 2007; 56:232-3. [PMID: 17343816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Ryan C Sheffield
- Eglin Air Force Base Family Medicine Residency, Eglin Air Force Base, FL, USA
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Smoker AL. On top of cradle cap. J Fam Health Care 2007; 17:134-6. [PMID: 17824212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Cradle cap is often viewed as the norm in infancy. It is, however, highly amenable to treatment. While cradle cap generally causes no ill-effects to the newborn baby, new parents may experience disappointment in their attempts to resolve the problem and be distressed by others' response to their infant's appearance. Moisturisers have an important role in softening scale, yet baby oil alone is often not sufficient. Greasier emollients may not be cosmetically acceptable and parental choice can be a key factor in the successful treatment of the problem. Parents may benefit from instructions on how to apply topical treatments effectively, and the opportunity to discuss their anxieties. Good skin care (i.e. the use of emollients) will promote general skin health and reduce any dryness associated with co-existing atopic eczema.
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Affiliation(s)
- Annabel L Smoker
- University of Southampton School of Nursing and Midwifery, Southampton
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Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician 2006; 74:125-30. [PMID: 16848386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Seborrheic dermatitis affects the scalp, central face, and anterior chest. In adolescents and adults, it often presents as scalp scaling (dandruff). Seborrheic dermatitis also may cause mild to marked erythema of the nasolabial fold, often with scaling. Stress can cause flare-ups. The scales are greasy, not dry, as commonly thought. An uncommon generalized form in infants may be linked to immunodeficiencies. Topical therapy primarily consists of antifungal agents and low-potency steroids. New topical calcineurin inhibitors (immunomodulators) sometimes are administered.
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Affiliation(s)
- Robert A Schwartz
- University of Medicine and Dentistry at New Jersey-New Jersey Medical School, Newark 07103, USA.
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33
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Elish D, Silverberg NB. Infantile seborrheic dermatitis. Cutis 2006; 77:297-300. [PMID: 16776285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Diana Elish
- Department of Medicine, Flushing Hospital Medical Center, New York, USA
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Please explain the difference between seborrhea and psoriasis. Mayo Clin Health Lett 2005; 23:8. [PMID: 16299840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Trüeb RM. [Prescriptions for the unhealthy scalp. How to treat itching and dandruff]. MMW Fortschr Med 2005; 147:36-8. [PMID: 16128195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Affiliation(s)
- Jeffrey D Bernhard
- Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Britt H, Pan Y, Miller GC, Valenti L, Charles J, Knox S, Henderson J, Bayram C, Harrison C. Presentations of 'itch' in Australian general practice. Aust Fam Physician 2004; 33:488. [PMID: 15301163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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38
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Comacchi C, Hercogova J. A single mud treatment induces normalization of stratum corneum hydration, transepidermal water loss, skin surface pH and sebum content in patients with seborrhoeic dermatitis. J Eur Acad Dermatol Venereol 2004; 18:372-4. [PMID: 15096162 DOI: 10.1111/j.1468-3083.2004.00484.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abeck D. [Water alone is not enough. Proper cleansing is the basis of acne treatment]. MMW Fortschr Med 2004; 146:30-1. [PMID: 15347075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Lorette G. [Seborrheic dermatitis: frequent, but unknown]. Ann Dermatol Venereol 2004; 131:115. [PMID: 15160644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Lorette G. [Seborrheic dermatitis in the child]. Ann Dermatol Venereol 2004; 131:123-5. [PMID: 15160647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- G Lorette
- Service de Dermatologie, Département peau et morphologie, CHU de Tours, 37044 Tours
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44
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Information from your family doctor. Seborrheic dermatitis. Am Fam Physician 2003; 68:1611-2. [PMID: 14596453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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Usatine RP. A red rash on the face. J Fam Pract 2003; 52:697-699. [PMID: 12967541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Richard P Usatine
- Department of Family and Community Medicine, University of Texas Health Science Center, San Antonio, San Antonio, TX, USA
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Marquart-Elbaz C, Cribier B. [Facial dermatitis. Acne, rosacea, seborrheic dermatitis]. Rev Prat 2002; 52:2185-90. [PMID: 12602242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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47
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Affiliation(s)
- F Prigent
- Hôpital Saint-Michel, 75015 Paris, France
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48
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Walsh A. Alison's homemade keratolytic. Aust Fam Physician 2002; 31:699. [PMID: 12189657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Health tips. Treating itchy scalp. Mayo Clin Health Lett 2002; 20:3. [PMID: 11951831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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50
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Osusky P, Osuska M. [Current views on seborrheic dermatitis]. BRATISL MED J 2001; 101:616-7. [PMID: 11218960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Seborrhoeic dermatitis is a common polyaethiological chronic disease affecting mainly the skin of face and scalp. The paper informs about aetiopathogenetic factors and clinical signs of SD. It review the contemporary methods of both external and internal treatments. Topical antimycotic treatment focused on Pityrosporum ovale, which could be the main causative agent, is considered to be the most important approach.
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Affiliation(s)
- P Osusky
- Dermatovenerologická klinika LFUK a FN Bratislava.
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