Sebaceous gland atrophy due to seborrheic dermatitis in a patient with alopecia: A potential pitfall.

Seborrheic dermatitis is an inflammatory condition that usually presents with erythema, scaly greasy papules, and plaques affecting sebaceous gland-rich areas and predominantly involving the face and scalp. The diagnosis of seborrheic dermatitis can often be rendered based on the clinical presentation. However, in certain cases, a biopsy can be useful to distinguish it from clinical mimics such as psoriasis, discoid lupus, and rosacea. Prominent sebaceous gland atrophy without scarring has been well-described as an important and relatively specific clue for psoriatic or drug-induced alopecia. However, sebaceous gland atrophy is not specific to psoriasis and has been demonstrated in seborrheic dermatitis, facial discoid dermatitis, and potentially may occur in other inflammatory dermatoses of the scalp. We report a 23-year-old female patient presenting with non-scarring hair loss and histopathological findings demonstrating mild androgenetic alopecia and changes of seborrheic dermatitis with dramatic sebaceous gland atrophy. The patient had no history or evidence of psoriasis clinically. Our case suggests that in patients with seborrheic dermatitis, sebaceous gland atrophy may complicate the evaluation of alopecia biopsies and should be recognized as a pitfall. Seborrheic dermatitis should be included in the differential diagnosis of alopecia biopsies showing prominent sebaceous gland atrophy.

Efficacy and Safety of Precision Cryotherapy to Treat Seborrheic Dermatitis of the Scalp.

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.

Sensitive Scalp: Diagnosis and Practical Management. / Cuero cabelludo sensible: diagnóstico y manejo práctico.

Sensitive scalp is sensitive skin located on the scalp. Sensitivity is considered primary in the absence of an associated scalp disorder and secondary when caused by conditions such as psoriasis, seborrheic dermatitis, and atopic dermatitis. The clinical manifestations of primary sensitive scalp are subjective. Common presenting symptoms are burning, itching, trichodynia, and dysesthesia, often coinciding with hair loss. Clinically, the skin appears normal or red. An objective diagnosis based on laboratory or histologic findings is not possible. Triggers may be endogenous (e.g., stress and emotional or psychopathological disturbances) or exogeneous (e.g., topical products and cosmetics). Treatment must be individualized. Options include pimecrolimus, hydration with hyaluronic acid, and mesotherapy with plasma rich in growth factors.

An Up-to-Date Approach to the Management of Seborrheic Dermatitis.

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.

Tacrolimus 0.1% versus ciclopiroxolamine 1% for maintenance therapy in patients with severe facial seborrheic dermatitis: A multicenter, double-blind, randomized controlled study.

BACKGROUND: No long-term maintenance therapy has been tested in patients with seborrheic dermatitis (SD). OBJECTIVE: We sought to compare the efficacy and tolerance of tacrolimus 0.1% ointment versus ciclopiroxolamine 1% cream as maintenance therapy for severe SD. METHODS: This double-blind randomized controlled study was conducted from 2014 to 2017 in 5 Dermatology Departments and 15 dermatology practices in France. Consecutive patients with severe and chronic facial SD were included. Patients were initially treated with desonide 0.05% cream twice daily for 7 days. Patients cleared after this open phase were randomized to receive tacrolimus 0.1% or ciclopiroxolamine 1% cream 2 times a week 24 weeks. The primary endpoint was disease-free-duration, defined as the time from randomization to first relapse. RESULTS: One hundred fourteen patients were randomized (tacrolimus, n = 57; ciclopiroxolamine, n = 57). Twelve patients relapsed in the tacrolimus group after a median delay of 91.5 days (range 15-195 days) versus 23 patients in the ciclopiroxolamine group (median delay, 27 days [range 13-201 days]). Comparison of disease-free duration curves showed that patients in the tacrolimus group had a longer duration of complete remission than those in the ciclopiroxolamine group (P = .018), corresponding to a hazard ratio of relapse of 0.44 (95% confidence interval 0.22-0.89; P = .022). LIMITATIONS: The theoretical sample size was not reached. CONCLUSION: Tacrolimus 0.1% is more effective than ciclopiroxolamine 1% as maintenance therapy for patients with facial SD.

Eyelid dermatitis in patients referred for patch testing: Retrospective analysis of North American Contact Dermatitis Group data, 1994-2016.

BACKGROUND: Eyelid dermatitis is a common dermatologic complaint. OBJECTIVE: To characterize patients with eyelid dermatitis. METHODS: Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data. RESULTS: Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group. LIMITATIONS: Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data. CONCLUSION: Patch testing remains a critical tool in evaluating patients with eyelid dermatitis.

Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016.

BACKGROUND: Hand eczema (HE) is a heterogeneous and burdensome disorder. OBJECTIVE: To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing. METHODS: Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113). RESULTS: Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ2, P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators. LIMITATIONS: No data on HE phenotype. CONCLUSION: HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE.

Targeted Delivery of Zinc Pyrithione to Skin Epithelia.

Zinc pyrithione (ZnPT) is an anti-fungal drug delivered as a microparticle to skin epithelia. It is one of the most widely used ingredients worldwide in medicated shampoo for treating dandruff and seborrheic dermatitis (SD), a disorder with symptoms that include skin flaking, erythema and pruritus. SD is a multi-factorial disease driven by microbiol dysbiosis, primarily involving Malassezia yeast. Anti-fungal activity of ZnPT depends on the cutaneous availability of bioactive monomeric molecular species, occurring upon particle dissolution. The success of ZnPT as a topical therapeutic is underscored by the way it balances treatment efficacy with formulation safety. This review demonstrates how ZnPT achieves this balance, by integrating the current understanding of SD pathogenesis with an up-to-date analysis of ZnPT pharmacology, therapeutics and toxicology. ZnPT has anti-fungal activity with an average in vitro minimum inhibitory concentration of 10-15 ppm against the most abundant scalp skin Malassezia species (Malassezia globosa and Malassezia restrica). Efficacy is dependent on the targeted delivery of ZnPT to the skin sites where these yeasts reside, including the scalp surface and hair follicle infundibulum. Imaging and quantitative analysis tools have been fundamental for critically evaluating the therapeutic performance and safety of topical ZnPT formulations. Toxicologic investigations have focused on understanding the risk of local and systemic adverse effects following exposure from percutaneous penetration. Future research is expected to yield further advances in ZnPT formulations for SD and also include re-purposing towards a range of other dermatologic applications, which is likely to have significant clinical impact.

Evaluation of the effects of COVID-19 pandemic on hair diseases through a web-based questionnaire.

AIM: Current quarantine conditions are a difficult process for individuals and can worsen the psychological state. Increased psychosocial stress can affect the course of many common "stress-sensitive" skin conditions. This study examined the possible effects of coronavirus disease 2019 (COVID-19) on hair and scalp diseases such as telogen effluvium (TE), alopecia areata (AA), and seborrheic dermatitis (SD) in individuals who had to stay at home for a long time and the patients' methods of dealing with these diseases. METHODS: The study was conducted using an online questionnaire. All the individuals were asked questions about pre- and post-pandemic TE, AA, and SD. Participants with complaints were asked what they did for treatment. RESULTS: During the pandemic, TE was seen in 27.9% of the participants, AA on the scalp was seen in 2.8%, AA on the face was seen in 2.5%, and SD was seen in 19.9%. Applying to a dermatologist for complaints during the pandemic was lower than before pandemic. TE was higher in women before and during the pandemic. CONCLUSION: It was found that the rates of referring to a dermatologist for the complaints before the pandemic varied between 15% and 28% and that these rates decreased significantly during the pandemic (2.5%-12.5%).

Implication of Perifollicular Clusters and Folliculotropic Distribution of Dendritic Cells in the Pathogenesis of Seborrhoeic Dermatitis.

The pathogenesis of seborrhoeic dermatitis is controversial and remains unclear. Malassezia is considered to be a commensal fungi and is found not only in the stratum corneum but also in hair follicles. It is an important pathogenic factor in seborrhoeic dermatitis. The aim of this study was to clarify the pathogenesis of seborrhoeic dermatitis, morphologically, through comparison with psoriasis vulgaris. Fifteen cases of seborrhoeic dermatitis, 7 of psoriasis, and 6 of normal skin were examined using routine histopathology, immunohistochemistry, and electron microscopy. Macrophages were found to be diffusely distributed in the upper dermis of seborrhoeic dermatitis and psoriasis. In contrast, a significant increase in the number of dendritic cells in the follicular epithelium and dendritic cell clusters in the perifollicular dermis were found only in seborrhoeic dermatitis. Ultrastructural examination of the clusters demonstrated that dendritic cells interacted with lymphocytes, macrophages, and other dendritic cells. In conclusion, folliculotropic distribution of dendritic cells as well as dendritic cell-immune cell clusters play an important role in the pathogenesis of seborrhoeic dermatitis.

Risk Factors for Seborrhoeic Dermatitis Flares: Case-control and Case-crossover Study.

Patients with flares of seborrhoeic dermatitis were compared with control outpatients seen during the same time-period in a case-control study, and with themselves while in remission in a case-crossover study. All patients consulted the same office-based dermatologist. During the study period, 189 cases and 189 controls were included in the case-control study, and 81 cases in the case-crossover study. Multivariate analysis was performed. Case-control study results were the following: past history of tobacco consumption (odds ratio (OR) 2.2 (95% confidence interval (CI) 1.1-4.6)), conflict as a dispute during the past month (OR 10.6 (95% CI 1.0-114.3)), alcohol consumption on a regular basis (OR 10.2 (95% CI 2.0-52.6)), and higher level of stress during the past month (OR 8.2 (95% CI 3.4-19.9)). Case-crossover study results were the following: higher level of stress during the past month (OR 4.5 (1.7-12.2)), association borderline significant for higher level of alcohol consumption (OR 5.4 (0.8-34.9)). These risk factors for flares of seborrhoeic dermatitis should be taken into account carefully in the daily management of seborrhoeic dermatitis.

Diaper rashes can indicate systemic conditions other than diaper dermatitis.

BACKGROUND: Although the majority of rashes in the diaper area are caused by irritation from urine and feces, irritant diaper dermatitis; IDD, there are some less common but potentially serious cutaneous eruptions associated with systemic diseases that should not be discounted. METHODS: This prospective descriptive study aimed to explore variation in cutaneous disease in the diaper area. It was conducted as a prospective descriptive study between October 2016 and November 2019 in the pediatric department of a tertiary-level hospital. RESULTS: Three hundred consecutive patients with rashes in the diaper area were enrolled. The most common diagnosed was IDD (125 cases; 41.7%), followed by rashes exacerbated by the diaper (101 cases; 33.67%) and non-diaper-related rashes (74 cases; 24.67%). CONCLUSIONS: Our finding suggests that when diagnosing rashes that occur in the diaper area, general pediatricians should consider, in addition to IDD, the possibility of less-common conditions. The simultaneous presence of cutaneous lesions at other sites was linked to diagnoses of systemic diseases other than IDD, (P < 0.001).

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population-based study in 161 269 employees.

BACKGROUND: Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. OBJECTIVES: To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. METHODS: In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. RESULTS: In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). CONCLUSIONS: Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

Ostraceous Psoriasis Presenting as Koebner Phenomenon in a Tattoo

Psoriasis is a common dermatologic condition with a variety of morphologic presentations. These variations include the less common hyperkeratotic form, psoriasis ostracea, defined as having pronounced adherent scales resembling an oyster shell. Of the ostraceous cases that have been reported in the literature, many occur as generalized outbreaks in patients with long-standing history of psoriasis. Rarely does this remarkable variant occur as a direct flare from a cutaneous insult. In these situations, when a pre-existing dermatosis appears in response to a traumatic insult to skin, the process is referred to as the Koebner phenomenon. In addition to lichen planus and vitiligo, psoriasis is a commonly known condition that can present as a Koebner reaction. In this atypical case, the authors present a 21-year-old male with remarkable ostraceous psoriatic lesions precipitated by an upper arm tattoo, demonstrating the Koebner phenomenon.

Chronic Nasolabial Fold Seborrheic Dermatitis Successfully Controlled With Crisaborole.

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Skin diseases of the vulva: eczematous diseases and contact urticaria.

Skin diseases in the vulvar area include a variety of disorders many of which have a chronic course with significant morbidity. It is important to be aware of the symptoms, signs and diagnostic tools in order to optimise treatment. Herein, the most common eczematous diseases of the vulvar area, i.e. lichen simplex chronicus, seborrhoeic dermatitis, atopic dermatitis, irritant contact dermatitis, and non-systemic and systemic allergic contact dermatitis are reviewed. Allergic contact urticaria is also described.