Seborrheic Dermatoses - Secretory Disorders

SEBORRHEIC DERMATOSES

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.

Clinical Manifestations

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 and excoriation.

Seborrheic 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 considered.

Medical Management

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.

Nursing Management

A 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 their feelings.