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Symptoms of Seborrheic Dermatitis


Facial skin is thinner and more delicate than skin elsewhere and unlike most other areas has numerous densely packed large hair follicles and sebaceous glands. It also has a very distensible blood supply that reaches very near the surface. Two other features of facial skin set it aside from other areas - it is the area of skin most exposed to sunlight and airborne allergens and it is very important in social recognition and communication. All this may explain why some common rashes look different on the face while other skin disorders occur on facial skin alone.

Seborrhoeic dermatitis

This is a common distinctive form of eczema now believed to be due to infection with pityrosporum ovale - a yeast-like micro-organism that commonly lives on normal skin. Its name is misleading because it is not due to disease of the sebaceous glands and those with the condition do not necessarily have a greasy skin. It is best thought of as a 'constitutional' disorder, being a persistent skin problem in predisposed individuals. Although there is a type of dermatitis in infants that is labelled 'seborrhoeic', this is probably not the same disease. Seborrhoeic dermatitis is essentially an adults' disease.

Characteristically, diffuse red scaling patches occur in the nasolabial grooves, in and behind the ears and on the scalp and eyebrows. The front of the chest and the major body flexures may also be affected. In the elderly the disorder may spread to affect large areas of skin and may even become erythrodermic. Seborrhoeic dermatitis tends to flare at times of stress and lasts for several weeks or months before subsiding for a variable period.

Atopic dermatitis Facial skin is often involved in atopic dermatitis and the resulting appearance is characteristic. The skin seems dry and finely scaling but the front and sides of the neck may show a rippling or reticular pattern of pigmentation. There is slight pallor of the facial skin and extra creases below the eyes. This atopic creasing is probably the result of oedema and thickening from continual rubbing of the eyes due to irritation.

Allergic contact dermatitis This often picks out the face either because the sensitizing agent is airborne in the envir onment or because the allergen has been inadvertently transferred there by the hands (see Chapter 34). The eyelids and sides of the neck are the sites that are usually involved.

Perioral dermatitis This is a papular disorder of the face that is less common now than it used to be - probably because potent corticosteroids are less used on the face than they once were. This condition is distinguished by myriads of tiny papules occurring around the mouth, and responds quickly to oral tetracyline.

Psoriasis This does not often affect facial skin, and when it does it tends to look and behave like seborrhoeic dermatitis.

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