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In this post we are going to deal with a very frequent topic, “dandruff” or pityriasis sicca. As you all know, dandruff consists of flaking of the scalp in the form of small, dry, whitish flakes that flake off easily and spontaneously in regular amounts. This disease represents the mildest spectrum of seborrheic dermatitis.

The seborrheic dermatitis (SD) or sebopsoriasis or seborrheic eczema The skin is characterized by the appearance of erythematous “red” areas with desquamation of more or less oily consistency located in the seborrheic areas of the skin, which are usually: scalp, nasolabial folds, eyebrows, ears, presternal and interscapular area, and sometimes in the regions of the folds.

We can differentiate between two forms of SD:

Infantile SD: it is a rash typical of the first months of life that disappears spontaneously by the third or fourth month. The so-called “cradle cap” that appears in the first or second week of life would be the earliest manifestation of infantile SD. It is important to emphasize that affected children are not more predisposed to suffer from the disease in adulthood. However, it is true that infantile SD could actually be the first manifestation of atopic dermatitis or infantile psoriasis.

2. SD of the older child or adult: In either location it is a very common skin disease that affects more men than women, with a prevalence of 1- 3% of the population. If we consider only SD located exclusively on the scalp, the prevalence amounts to 50% of young Caucasian adults. The most common age of onset of SD is between 30 and 60 years of age.

The causes of SD are not well known, although several factors appear to be involved. The increased secretion of the sebaceous glands favors the development of microorganisms of the Malassezia genus (yeast-like fungus), which would be responsible for the clinical picture. Other factors that influence the development of SD are:

– Neurological diseases such as Parkinson’s.
– AIDS: they are more likely to have seborrheic dermatitis.
– Psychological factors: based on the clear correlation between situations of emotional stress, fatigue and states of depression with the triggering of SD outbreaks.
– Climatic and environmental factors: cold and dry environment due to heating or air conditioning usually worsen the disease. In contrast, moderate sun exposure exerts a beneficial effect in most patients with SD.
– Nutritional factors: A diet rich in animal fats and poor in vegetables, as well as the intake of alcohol can also enhance the onset of SD.

TREATMENT

In babies, given the natural evolution of the process, aggressive treatments should be avoided. Crusts can be removed by applying petroleum jelly or oil for a few hours. Subsequently, low potency corticosteroid creams are applied on the reddened areas for a few days. Shampoos containing sulfur, zinc pyritone or pitches should be avoided.
In adults, SD evolves with remissions and exacerbations, despite the treatments administered, so the main reason for our action will be to control the disease. A wide arsenal of drugs is currently available for the treatment of SD. The use of each of them will depend on the age of the patient, the location and extent of the lesions as well as the phase of the disease (outbreak or quiescent phase).
General hygienic and cosmetic measures:
Frequent washing of the hair is advisable due to the function of dragging the scales, there is no problem because washing is daily, however, it should be remembered that alkaline soaps can precipitate or aggravate outbreaks because they are irritating to the skin. Hair dyes or other hair products should be avoided because they may aggravate the inflammation. In areas where the skin shows severe irritation, soap should be replaced by non-soap cleansing substances. It is also important to use moisturizing creams to avoid the sensation of tightness and burning that often accompanies the disease. Moisturizers may include substances such as ichthyol, biolysat hafnia or keluamide, which help to control outbreaks.
Topical treatment:
– Scalp: Treatment is based on the use of shampoos containing selenium sulfide at 1 – 2, 5%, imidazoles (ketoconazole 2%), zinc pyrithione, benzoyl peroxide, salicylic acid, juniper oil or detergents that can be used more frequently in outbreaks and then two or three times a week as maintenance. In addition, lotions with corticosteroids and/or salicylic acid can be used.
– Face and trunk: medium/low potency corticosteroid creams, with or without topical antifungals, are effective for the initial control of the outbreak, but cannot be used for long periods of time. Pimecrolimus 1% or tacrolimus 0.03% creams are effective and safe alternatives for both flare-up and maintenance.
Systemic treatment: only in severe cases is it necessary to resort to oral treatment with isotretinoin or oral itraconazole.

We hope that this review of the subject has helped you to better understand the disease and how it can be controlled.