• Finnish Medical Society Duodecim. Seborrhoeic dermatitis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Apr 19 [Various].

This is the current release of the guideline.

This guideline updates a previous version: Finnish Medical Society Duodecim. Seborrhoeic dermatitis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Jan 17 [Various].

Seborrhoeic dermatitis

Diagnosis
Management
Treatment

Dermatology
Family Practice
Internal Medicine

Health Care Providers
Physicians

Evidence-Based Medicine Guidelines collects, summarizes, and updates the core clinical knowledge essential in general practice. The guidelines also describe the scientific evidence underlying the given recommendations.

Patients with or suspected to have seborrhoeic dermatitis

Diagnosis

Assessment of clinical features

Treatment/Management

1. Remove the thick scales and decrease the amount of sebum with cream containing salicylic acid and sulphur
2. Decrease fungal growth (ketoconazole or selenium sulphide shampoo, topical treatment with creams containing imidazole derivatives, antimycotic, ultraviolet light)
3. Use symptomatic topical treatment (corticosteroid liniments or creams, moisturizing emollients)

• Signs and symptoms of seborrhoeic dermatitis
• Relapse rates after treatment

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

The evidence reviewed was collected from the Cochrane database of systematic reviews and the Database of Abstracts of Reviews of Effectiveness (DARE). In addition, the Cochrane Library and medical journals were searched specifically for original publications.

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

1. Quality of Evidence: High

   Further research is very unlikely to change confidence in the estimate of effect

   • Several high-quality studies with consistent results
   • In special cases: one large, high-quality multi-centre trial

2. Quality of Evidence: Moderate

   Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.

   • One high-quality study
   • Several studies with some limitations

3. Quality of Evidence: Low

   Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate.

   • One or more studies with severe limitations

4. Quality of Evidence: Very Low

   Any estimate of effect is very uncertain.

   • Expert opinion
   • No direct research evidence
   • One or more studies with very severe limitations

Systematic Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Peer Review

Not stated

The levels of evidence [A-D] supporting the recommendations are defined at the end of the "Major Recommendations" field.

Epidemiology

• Usually occurs in adults (aged 18 to 40 years) in areas rich in sebaceous glands
• Men are more commonly affected than women.

Symptoms and Signs

Sites of Predilection

• Affected skin areas in order of frequency
  • Scalp (see pictures 1 & 2*)
  • Face (see picture 3*); eyebrows, nasolabial creases (see picture 4*), "sideburn"  (see pictures 5 & 6*)
  • Ears and ear canals
  • Mid-upper parts of the chest and back ("perspiration creases") (see picture 7*)
  • Buttock crease (see picture 8*), inguinal area (see picture 9*), genitals (see picture 10*), and armpits (see picture 11*)
  • Only rarely becomes generalized

Clinical Picture

• Greasy or dry scaling of the scalp, sometimes a "cradle cap" (see picture 12*)
• Mildly scaling eczematous patches on the face at typical locations, often with itch and stinging
• Itch and inflammation of the ear canal
• Blepharitis
• Well-demarcated eczematous patches on mid-upper trunk.
• Intertrigo

Aetiology and Pathophysiology

• Increased layer of sebum on the skin, quality of the sebum, and the immunological response of the patient favour the growth of Pityrosporum yeast.
• Degradation of the sebum irritates the skin and causes eczema.

Diagnosis

• Based on the typical clinical presentation and location of the eczema
• In psoriasis (see the Finnish Medical Society Duodecim guideline "Psoriasis") the scales are thicker, and the sites of predilection are different (elbows, knees). Psoriasis often has a familial occurrence.

Treatment

• The treatment does not cure the disease permanently. Therefore it must be repeated when the symptoms recur, or even prophylactically (Peter & Richarz-Barthauer, 1995; Gee, 2005) [A].

Removing the Thick Scales and Decreasing the Amount of Sebum

• The scales can be softened with a cream containing salicylic acid and sulphur (but not Vaseline) or by wetting and washing.
• Seborrhoeic skin should be washed more often than usual.

Decreasing Fungal Growth

• Washing the scalp with ketoconazole shampoo (Peter & Richarz-Barthauer, 1995; Gee, 2005) [A] or selenium sulphide shampoo (Gee, 2005) [B]
• Topical treatment with creams containing imidazole derivatives
• Antimycotic on skin creases (rarely necessary)
• Sometimes ultraviolet light therapy

Symptomatic Topical Treatment

• Corticosteroid liniments for the scalp (from mild to potent) (Hersle, Mobacken, & Nordin, 1996) [C]
• Corticosteroid creams for other parts of the body (from mild to potent)
• Moisturizing emollients after washing
• Ketoconazole shampoo and corticosteroid liniments must often be combined in therapy-resistant cases.

*Note: All pictures identified in this summary can be found in the original guideline document (see "Guideline Availability" field).

Definitions:

Levels of Evidence

1. Quality of Evidence: High

   Further research is very unlikely to change confidence in the estimate of effect

   • Several high-quality studies with consistent results
   • In special cases: one large, high-quality multi-centre trial

2. Quality of Evidence: Moderate

   Further research is likely to have an important impact on confidence in the estimate of effect and may change the estimate.

   • One high-quality study
   • Several studies with some limitations

3. Quality of Evidence: Low

   Further research is very likely to have an important impact on confidence in the estimate of effect and is likely to change the estimate.

   • One or more studies with severe limitations

4. Quality of Evidence: Very Low

   Any estimate of effect is very uncertain.

   • Expert opinion
   • No direct research evidence
   • One or more studies with very severe limitations

None provided

Concise summaries of scientific evidence attached to the individual guidelines are the unique feature of the Evidence-Based Medicine Guidelines. The evidence summaries allow the clinician to judge how well-founded the treatment recommendations are. The type of supporting evidence is identified and graded for select recommendations (see the "Major Recommendations" field).

Appropriate diagnosis, management, and treatment of seborrhoeic dermatitis

Not stated

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness

• Finnish Medical Society Duodecim. Seborrhoeic dermatitis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Apr 19 [Various].

Not applicable: The guideline was not adapted from another source.

2001 Apr 21 (revised 2007 Apr 19)

Finnish Medical Society Duodecim - Professional Association

Finnish Medical Society Duodecim

Editorial Team of EBM Guidelines

Primary Author: Eero Lehmuskallio

Not stated

This is the current release of the guideline.

This guideline updates a previous version: Finnish Medical Society Duodecim. Seborrhoeic dermatitis. In: EBM Guidelines. Evidence-Based Medicine [Internet]. Helsinki, Finland: Wiley Interscience. John Wiley & Sons; 2007 Jan 17 [Various].

None available

None available

This summary was completed by ECRI on December 17, 2002. The information was verified by the guideline developer as of February 7, 2003. The summary was updated by ECRI on June 8, 2004, December 21, 2006, February 27, 2007, and January, 7, 2008.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.