Seborrhea is excessive production of sebum (ie,
secretion of seba-ceous glands) in areas where sebaceous glands are normally
found in large numbers, such as the face, scalp, eyebrows, eyelids, sides of
the nose and upper lip, malar regions (ie, cheeks), ears, axillae, under the
breasts, groin, and gluteal crease of the buttocks. Seb-orrheic dermatitis is a
chronic inflammatory disease of the skin with a predilection for areas that are
well supplied with sebaceous glands or lie between skin folds, where the
bacteria count is high.
Two forms of seborrheic dermatoses can occur, an
oily form and a dry form. Either form may start in childhood and continue
throughout life. The oily form appears moist or greasy. There may be patches of
sallow, greasy skin, with or without scaling, and slight erythema (ie,
redness), predominantly on the forehead, nasolabial fold, beard area, scalp,
and between adjacent skin sur-faces in the regions of the axillae, groin, and
breasts. Small pus-tules or papulopustules resembling acne may appear on the
trunk. The dry form, consisting of flaky desquamation of the scalp with a
profuse amount of fine, powdery scales, is commonly called dandruff. The mild
forms of the disease are asymptomatic. When scaling occurs, it is often
accompanied by pruritus, which may lead to scratching and secondary infections
dermatitis has a genetic predisposition. Hormones, nutritional status,
infection, and emotional stress influence its course. The remissions and
exacerbations of this condition should be explained to the patient. If a person
has not previously been diagnosed with this condition and suddenly appears with
a severe outbreak, a complete history and physical examination should be
Because there is no known cure for seborrhea, the
objective of therapy is to control the disorder and allow the skin to repair
it-self. Seborrheic dermatitis of the body and face may respond to a topically
applied corticosteroid cream, which allays the secondary inflammatory response.
However, this medication should be used with caution near the eyelids, because
it can induce glaucoma and cataracts in predisposed patients. Patients with
seborrheic der-matitis may develop a secondary candidal (yeast) infection in
body creases or folds. To avoid this, patients should be advised to ensure
maximum aeration of the skin and to clean carefully areas where there are
creases or folds in the skin. Patients with persis-tent candidiasis should be
evaluated for diabetes.
The mainstay of dandruff treatment is proper,
frequent sham-pooing (daily or at least three times weekly) with medicated
shampoos. Two or three different types of shampoo should be used in rotation to
prevent the seborrhea from becoming resis-tant to a particular shampoo. The
shampoo is left on at least 5 to 10 minutes. As the condition of the scalp
improves, the treatment can be less frequent. Antiseborrheic shampoos include
those con-taining selenium sulfide suspension, zinc pyrithione, salicylic acid
or sulfur compounds, and tar shampoo that contains sulfur or sal-icylic acid.
person with seborrheic dermatitis is advised to avoid external irritants,
excessive heat, and perspiration; rubbing and scratching prolong the disorder.
To avoid secondary infection, the patient should air the skin and keep skin
folds clean and dry.
Instructions for using medicated shampoos are
reinforced for those with dandruff that requires treatment. Frequent shampooing
is contrary to some cultural practices; the nurse should be sensitive to these
differences when teaching the patient about home care.
The patient is cautioned that seborrheic dermatitis
is a chronic problem that tends to reappear. The goal is to keep it under
con-trol. Patients need to be encouraged to adhere to the treatment program.
Those who become discouraged and disheartened by the effect on body image
should be treated with sensitivity and an awareness of their need to express