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2012 test year clinical medical practitioners counseling: seborrheic dermatitis
etiology and pathogenesis
many believed that genetic, metabolic changes in sebum, microbial parasites, neurological disorders and eating habits and other factors. Has been speculated that this disease was caused by an increase in sebum secretion and changes in the composition of the curb, so that the original exists in the normal flora on the skin affects the skin caused by a large number of growth and reproduction.
recent reports in the literature that the disease is due to the epidermal growth too fast, the cuticle cells do not have enough time to fully mature, the results of the stratum corneum caused by nuclear retention.
(a) causes
The disease is caused by multiple factors. With age, gender, most cases have a genetic tendency to increased androgen levels, leading to an increase in sebum secretion. In addition, seborrhea often seen in nervous system diseases such as Parkinson’s disease (Pakinson syndrome), especially in advanced disease, sebaceous glands may be higher than normal level of 2 times; in arteriosclerosis, diabetes, adrenal gland tumor, some breast cancer patients and patients with epilepsy have increased sebum secretion phenomenon.
(B) the pathogenesis
seborrhea of the disease is based on the occurrence of secondary inflammation. Recently it has been considered as an increase in sebum secretion and other changes in the composition of the curb, so that a large number of oval Pityrosporum growth and reproduction of cutaneous infection caused by primary and secondary allergy, seborrheic with innate qualities, but the mode of inheritance is unknown. In addition, seborrhea increase the body’s susceptibility to bacteria, such as exists in the skin of non-pathogenic Corynebacterium acne blooms, caused by inflammation of the decomposition of free fatty acids. Sebaceous gland suppuration is also a factor. Neonatal sebaceous gland activity significantly, infant seborrhea, after androgen from the mother with the gradual disappearance of leaving seborrhea reduced. Sebaceous gland activity gradually decreased with age until puberty, from 18 to 40 years of age began to increase, reduce the symptoms to old age, more men than women. In addition, psychological factors, eating habits, addicted to alcohol and tobacco can stimulate Benbingfasheng. Coronary heart disease, hypertension, heart failure, B vitamins and the lack of a higher incidence in patients, AIDS patients can also be found the incidence of this disease.
manifestations and diagnosis
common in more sebum, hairy, sweating part. Began in the scalp, symptoms can be the face, ears, armpits, chest and back, the Ministry of umbilical fossa and suprapubic development.
lesions can be divided according to the performance of different
dry and wet categories.
mostly dry scaling erythema damage, mostly moist papules, vesicles, scratching can produce erosion, oozing, and form yellow crusts. Often severe itching, slow the disease, recurrent. Seborrhea occur in the area, often limited to the scalp can be serious to the face, nasolabial fold, eyebrows, eyelids, backs and chests central umbilical fossa and the groin or axilla development. Early lesions follicular papules, gradual integration into the sizes of red and yellow patches, greasy scales overlying scab, and might was mild exudative eczematous dermatitis, restricted to a particular site or generalized and even the development of erythroderma. As the location and severity of damage to the different clinical manifestations are also differences.
1. scalp began to chaff-like small pieces of white or greasy scaly patches, later expanded into a clear boundary of the integration of large patches, base a little red, mild itching, severe performance greasy scales of round plaques may be associated with thick crust or exudate, and follicles as the center of red papules, severe cases the whole of the scalp were covered with greasy smell of thick crust, accompanied by hair loss.
2. face, ears, ears and neck usually spread from the head, yellow red or white greasy scales and crusts. Eyebrow and the surrounding diffuse erythema, scaling, and few eyebrows due to scratching. Eyelid involvement was blepharitis can be serious were erosive ulcers, scar left after healing. Ear after the erosion, flushing and chapped, can be unilateral or bilateral, more common in girls and young women, seborrheic otitis externa more common in older patients.
3. beard common in middle-aged men, the hair follicle with mild swelling, a small light brown scab, often referred to as Some of the performance of hair follicles and a greasy scaly pustules, red around the base, causing hair follicle damage and scar formation. May have involved the scalp and pubic bone.
4. trunk is common in men over 20 years of age, occur in the chest and shoulder blades, the beginning of the small red-brown follicular papules, greasy scales overlying, evolved through, the center of the formation of fine cured bran-like scales, the edge of a dark greasy red scaly papules and larger patches of the ring. Another kind of seborrheic dermatitis pityriasis rosea, round or oval-shaped yellow or dark spots film, and only a small marginal scales, clear boundaries, healing center, a ring damage.
5. Ministry common in the axillary folds, groin, under breasts and umbilical fossa, common in 30 to 50 years old, especially the obese middle-aged. Lesions of erythema showed a clear boundary, on the greasy scales, such as disseminated erythema kind of friction cracks, swelling. Since local sweating, easy to secondary infection, skin lesions or improper treatment can develop. Genitals are tired timely, can form circular scales and skin erythema and exfoliation, showing sub-acute or chronic eczema, lichen-like erythema, such as psoriasis-like performance without the typical features of seborrheic dermatitis.
6. extensor limbs limbs more common than the flexor side, showing yellow red or pink patches, as scratching, erosion and the like can be formed eczema.
7. babies seborrheic dermatitis 2 to 10 weeks after the birth of the baby, scalp, forehead, ears, eyebrows, nose, cheeks, etc. appear circular groove and folds erythema, clear boundary overlying scaly, erythema can be Extended integration of adhesion and a greasy yellow scab, oozing between erosion, inflammation more significantly, symmetry occurs, slightly itchy, usually in children 3 weeks to 2 months recovery. If you continue to heal, often associated with infant atopic dermatitis complicated, but also secondary bacterial infection or candida infection. Baby without adult hair follicle damage and seborrhea.
seborrheic dermatitis clinically varied, and some slow progress, recurrent. Some may be limited to the head. Or distributed in some other parts of the body, due to itching, scratching can cause erythroderma, folliculitis, boils, swollen lymph nodes go far. Also caused by improper handling of contact dermatitis or eczema-like change.
in seborrhea zone in red and yellow greasy scaly patches, clear boundary, consciously itching, chronic, diagnosis easier.
TCM and Syndrome: Chinese medicine, disease is a congenital anomaly or too Gaoliang endowment Atsumi, damp, and sense of Feng Xie, Yu in the skin, heat on steam (oil steatorrhea) due. Or diet, resulting in less blood loss, blood deficiency and dry skin dystrophy (dry steatorrhea) is made.
diseases easily confused
1, head and facial psoriasis damage spread into a sheet, the realm of clear, thick scales, touch of rugged, non-shedding hair, short hair, gathered together in bundles, severe damage can be connected into a large, extended to front hairline, invasion, and the forehead of a few centimeters. Scrape off scales with film phenomenon (ie scales scraping, its bright red under a thin film) and bleeding (ie, scuffing film may be scattered in small bleeding points), the film is the phenomenon of bleeding and damage to important psoriasis characteristics.
2, pityriasis rosea occur in the neck, trunk, proximal extremities, oval-shaped rash, central slightly yellow, slightly higher marginal uplift, pale red, with white on the chaff-like scales. The beginning of the individual damage, known as nevus; nevus getting big, up to 2 ~ 5cm in diameter or larger, and sometimes have 2 or 3 nevus appear together, 1 to 2 months after having a small red spot , occurred in the trunk at, rash striae consistent with the long axis, usually 4 to 6 weeks to subside on their own, do not relapse.
3, ringworm of the body swell and narrow edge damage. State clearly that extended around the central ring to recover damages. Itching, patients often have a history of hand, foot and onychomycosis.
4, pemphigus erythematosus mainly distributed in the face, neck, backs and chests are central. Began to have symmetrical facial erythema, and crusting overlying scales, neck and chest and back with blisters appear on the basis of erythema, crusts formed after rupture, Nissl positive sign. (That is, to put pressure on the blister roof, you can see around the blister fluid to penetrate the epidermis; stretch of Canbi blister wall, causing further stripping the surrounding skin; more important is the appearance of normal skin is also a rub that is broken).
5, rosacea-like dermatitis involving the scalp is not. Eyebrows and nasolabial fold is not a good site, and more long-term hormone preparations treated with medication history.