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Rezumat Summary
Dermatita seboreic (DS) este o afeciune inflamatorie Seborrheic dermatitis (SD) is a chronic inflammatory
cronic care afecteaz mai frecvent faa i scalpul. DS apare disease that affects more frequently face and scalp. DS
att la aduli ct i la copii, cu afectare preponderent a occurs in both adults and children, men are more often
sexului masculin. Etiologia bolii nu este pe deplin neleas, affected than women. The etiology of the disease is not fully
ns exist citai civa factori implicai n dezvoltarea understood, but there are several factors involved in the
dermatitei seboreice. Aspectul histopatologic al dermatitei development of seborrheic dermatitis. The histology of
seboreice este similar cu cel al psoriazisului, iar uneori doar
seborrheic dermatitis is similar to psoriasis, sometimes only
timpul clarific exact tipul afeciunii. Tratamentul trebuie
s fie non-agresiv, iar majoritatea pacienilor rspund la time will tell which disease is present. The treatment must
tratamentul topic care const n: ampoane, creme, loiuni be non-aggressive, and almost all patients can be treated
antifungice, dermatocorticoizi cu poten joas sau medie, successfully with topical therapy: antifungal shampoos,
geluri cu metronidazol. Terapia sistemic este rezervat creams, lotions, low to medium potency topical corti-
cazurilor severe i const n administrarea oral de costeroids, metronidazole gel. Systemic therapy is reserved
antifungice din clasa imidazolilor, isotretinoin sau for severe cases and consists of oral imidazoles, isotretinoin
corticosteroizi. or corticosteroids.
Cuvinte cheie: dermatita seboreic, antifungice, Key words: seborrheic dermatitis, antifungal,
corticoizi, imidazoli. corticosteroids, imidazoles.
Intrat n redacie: 18.02.2014 Received: 18.02.2014
Acceptat: 14.03.2014 Accepted: 14.03.2014
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Din punct de vedere clinic, DS a adultului se Clinicaly, adult with SD takes the form of
prezint sub forma unor placarde eritematoase, erythematous plaques, well defined, sometimes
bine delimitate, uneori pruriginoase, acoperite de itchy, covered by yellowish-white fat scaly of
scuame grase alb-glbui, de grosime variat. variable thickness. The lesions are localized in
Leziunile se localizeaz n regiunile bogate n sebaceous glands rich regions:
glande sebacee: - On scalp may start as a diffuse furfuracee
- la nivelul scalpului poate debuta sub forma peeling (dandruff or Pityriasis capitis) that
unei descuamri furfuracee difuze (mtrea sau evolves over time to typical appearance of
Pitiriazis capitis) care evolueaz n timp spre erythemato-squamous plaques extending
aspectul tipic de plci eritemato-scuamoase ce se beyond the tree line, forehead, retro and
extind i dincolo de lizier, pe frunte, retro i
periauricular, and in the ear canal , and
periauricular, precum i n conductul auditiv,
complicated by otitis externa. The lesions may
complicndu-se cu otita extern. De asemenea,
extend side-cervical.
leziunile se pot extinde latero-cervical.
- On face occupies the medial brow and
- la nivelul feei ocup zona medial a
sprncenelor i regiunea intersprncenoas interbrow region (glabela) nose trenches and
(glabela), anurile nazogeniene i brbia, precum chin, and the free edge of the eyeline (blepharitis
i marginea liber a pleoapelor (blefarita Seborrheic).
seboreic). - Chest, interscalp and especially pre-
- la nivelul toracelui, interscapular i mai ales breastbone carried circinate placards, polycyclic
presternal realizeaz placarde circinate, (eczemas figured Brocq mid-back).
policiclice (eczematidele figurate mediotoracice May also be affected flexion creases,
Brocq). especially axillary and inguinal. Also gland
Mai pot fi afectate pliurile de flexie, n special lesions may occur as a barely perceptible
cele axilare i inghinale. De asemenea, la nivelul erythema accompanied by a discreet fine
glandului pot aprea leziuni abia perceptibile sub desquamation, often passing unnoticed.
forma unui eritem discret nsoit de o descuamare SD at newborn occurs in the first 3 months of
fin, ce trec frecvent neobservate. life in the cephalic end, the parietal region and
DS a nou-nscutului apare n primele 3 luni fontanelle, in the middle part of the face and in
de via la nivelul extremitii cefalice, n the large folds. Evolution is slow, favorable, with
regiunea parietal i a fontanelei anterioare, n spontaneous resorption in 1-2 months. Extension
prile mediane ale feei, precum i la nivelul and generalization lesions performed a severe
pliurilor mari. Evoluia este lent, favorabil, cu complication - Leiner-Moussous scaling ery-
resorbie spontan n 1 - 2 luni. Extensia i throderma.
generalizarea leziunilor realizeaz o complicaie SD Etiopathogenesis is not completely
sever - eritrodermia descuamativ Leiner-
elucidated. It is believed that seborrhea is an
Moussous.
important predisposing factor, under the
Etiopatogenia DS nu este complet elucidat.
influence of androgens and probably genetically
Se consider c seboreea reprezint un factor
determined. Although familial cases were
predispozant important, aflat sub influena
hormonilor androgeni i probabil determinat observed, could not be determined a trans-
genetic. Dei s-au observat cazuri familiale, nu a missible way.2 Seborrheic area is susceptible to
putut fi stabilit un mod de transmitere.2 Terenul various external agents: Malassezia furfur /
seboreic este susceptibil la diferii ageni externi: Pityrosporum ovale (lipophilic yeast, saprophytic,
Malassezia furfur/Pityrosporum ovale ( levur with an important role in the production and
lipofil, saprofit, cu rol important n producerea maintenance of the immune mechanism of SD
i ntreinerea DS prin mecanism imunologic i and pro-inflammatory), microbial agents, dietary
proinflamator), ageni microbieni, factori factors (zinc and vitamin B deficiency, high-
alimentari (deficit de zinc, deficit de vitamina B, calorie diet, chronic alcoholism), HIV infection
regim hipercaloric, alcoolism cronic), infecia HIV through immunosuppression favoring over-
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prin imunosupresia ce favorizeaz dezvoltarea growth of yeasts (SD is one of the most common
exagerat a levurilor (DS este una dintre cele mai dermatological diseases in AIDS patients, 85% of
frecvente afeciuni dermatologice la pacienii cu them have diverse forms of seborrheic
SIDA, 85% dintre acetia au diverse forme de dermatitis)5, emotional stress and fatigue, high
dermatit seboreic)5, stresul emoional i humidity3,4. Also some internal diseases (obesity,
oboseala, umiditatea crescut.3,4 De asemenea, pancreatitis) and neurological (extrapyramidal
anumite afeciuni interne (obezitate, pancreatit) syndromes, organic psychosis) favors the
i neurologice (sindroame extrapiramidale, occurrence of SD6. This condition is common in
psihoze organice) favorizeaz apariia DS.6 patients with Down Syndrome and Hailey-
Aceast afeciune este frecvent i la pacienii cu Hailey disease7,8. There are some drugs
sindrom Down i boala Hailey-Hailey.7,8Sunt i criminalized in SD aggravation such as
unele medicamente incriminate n agravarea DS,
neuroleptics, but also drugs that cause SD by a
cum ar fi neurolepticele, dar i medicamente care
still unknown mechanism: chlorpromazine,
determin apariia DS printr-un mecanism nc
cimetidine, ethionamide, griseofulvin, interferon-
necunoscut: clorpromazin, cimetidin, etio-
, lithium, methyldopa, psoralen, etc.9
namid, griseofulvin, interferon-, litiu,
metildopa, psoralen, etc.9 Histopathological appearance of seborrheic
Aspectul histopatologic al dermatitei dermatitis is not very characteristic. At epidermis
seboreice nu este foarte caracteristic. La nivelul is observed a slight acanthosis, hyperkeratosis,
epidermului se observ uoar acantoz, parakeratosis, sponginess and sebum accumu-
hiperkeratoz, parakeratoz, spongioz, iar lation in the stratum corneum translates clinically
acumularea sebumului n stratul cornos se by the presence of fat scales. At dermis appears
traduce clinic prin prezena scuamelor grase. n edema and perivascular lymphocytic inflam-
derm apare edem i infiltrat inflamator limfocitar matory infiltrate.10
perivascular. 10 Differential diagnosis is made with:
Diagnosticul diferenial se face cu: psoriazis psoriasis (sometimes only time clarifies the type
(uneori doar timpul clarific tipul afeciunii), of disease), contact dermatitis, otomicosis (when
dermatit de contact, otomicoz (cnd leziunile lesions are in ear), atopic dermatitis (for SD in
sunt intraauriculare), dermatit atopic (n cazul children, but later onset atopic dermatitis is more
DS infantile, ns dermatita atopic debuteaz itchy and the most often it reveals a personal or
mai trziu, este mult mai pruriginoas i, de cele family history of atopy), pityriasis rosea (when
mai multe ori, se deceleaz un istoric familial sau lesions are extensive) Szary Syndrome and rash
personal de atopie), pitiriazis rozat (atunci cnd drug reactions (the last two suspicion arises
leziunile sunt extinse), sindrom Szary i erupie when seborrheic erytrodermia).10
postmedicamentoas (suspiciunea ultimelor In terms of evolution and prognosis, SD is a
dou se ridic n cazul eritrodermiei seboreice).10 chronic condition, it is kept under control (not
n ceea ce privete evoluia i prognosticul,
cure) and also are cited cases of overlap with
DS este o afeciune cronic, aceasta se ine sub
psoriasis.
control (nu se vindec) i, de asemenea, sunt
citate cazuri de overlap cu psoriazis.
DS Treatment
Tratamentul DS Because SD is a disease with chronic
Datorit faptului c DS este o afeciune cu evolution, sometimes constitutional, it will
evoluie cronic, uneori constituional, ea va require treatment of attack, continued with one
necesita tratament de atac, continuat obligatoriu mandatory maintenance over long periods of
cu unul de ntreinere, pe perioade lungi de timp time (even years).
(chiar de ani de zile). Since there is no etiopathogenic treatment of
Deoarece nu exist un tratament etio- this disease, SD treatment is based on removing
patogenic al acestei afeciuni, tratamentul DS se favoring factors mentioned above (fight
bazeaz pe nlturarea factorilor favorizani seborrhea with reducing medication or with
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glabr a feei i a toracelui anterior (leziunile de lesions on posterior thorax are unresponsive and
foliculit pitirosporic de pe toracele posterior nu may even be aggravated).
rspund i pot fi chiar agravate). In case of bacterial superinfection is
n cazul suprainfeciei bacteriene se recommended to combine a 1 g tetracycline type
recomand asocierea unui antibiotic de tip of antibiotic per day or doxycycline 100 mg per
tetraciclin 1 g pe zi sau doxiciclin 100 mg pe zi, day for 3-4 weeks.
timp de 3 - 4 sptmni. In SD with tendency to extension can also be
n DS cu tendin la extensie se mai pot folosi used corticosteroids in moderate doses (20-30 mg
corticosteroizi n doze moderate (20 - 30 mg prednisone per day) and in short cures.
prednison pe zi) i n cure scurte.
Treatment of seborrheic blepharitis
Tratamentul blefaritei seboreice
Seborrheic blepharitis treatment is usually
Tratamentul blefaritei seboreice se face, de
made with an ophthalmologist. It is given low
obicei, mpreun cu oftalmologii. Se admi-
potency topical corticosteroids (beware of
nistreaz corticosteroizi topici cu poten joas
glaucoma, steroid-induced rosacea), topical
(atenie la glaucom, rozaceea indus de steroizi),
antibiotics, creams with imidazole and eye
antibiotice topice, creme cu imidazol i splarea
ochilor cu ampon. washing with shampoo.
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tratamentele anterioare. n formele de debut, n dominate the clinical table are indicated
care mtreaa domin tabloul clinic, sunt indicate shampoos with acting on Pityrosporum ovale -
ampoane cu aciune asupra Pityrosporum ovale - ketoconazole, zinc pyrithione, selenium sulfide,
ketoconazol, zinc pirition, sulfur de seleniu, tars.
gudroane. In acute forms with erythemato-squamous
n formele acute, cu plci eritemato- plaques on scalp, face and trunk add combina-
scuamoase la nivelul pielii capului, feei i tions of topical antiseborrhea, antifungal,
trunchiului, se adaug asocieri de topice corticosteroid and eventually antibacterial. For
antiseboreice, antifungice, dermatocorticoizi i severe cases, extensive, resistance, systemic
eventual antibacteriene. Pentru cazurile severe, treatment is associated with oral itraconazole,
extensive, rezistente, se asociaz tratamentul corticoids and possibly antibiotics.
sistemic cu itraconazol oral, corticoizi i eventual
antibiotice.
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Adresa de coresponden: Ana Mihaela Ungureanu Correspondance address: Ana Mihaela Ungureanu
AMR AMR
Str. Ionel Perlea nr 10 Str. Ionel Perlea no 10
Bucureti Bucharest
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