Dall'Oglio Federica, Nasca Maria Rita, Gerbino Carlo, Micali Giuseppe
Dermatology Clinic, University of Catania, Catania, Italy.
Clin Cosmet Investig Dermatol. 2022 Aug 6;15:1537-1548. doi: 10.2147/CCID.S284671. eCollection 2022.
Seborrheic dermatitis (SD) is a common chronic inflammatory skin disorder that mostly affects young adults in areas rich in sebaceous glands (scalp, face, and trunk). In adolescents and adults, SD clinical presentation may range from mild patches to diffuse scalp scaling. In infants, it mainly occurs on the scalp as yellowish, scaly patches ("cradle cap"). In adults, several environmental triggers are likely to promote SD development, along with fungal colonization by spp., sebaceous gland activity, as well as immunosuppression, endocrine, neurogenic and iatrogenic factors. In children, early occurrence in the first trimester suggests the role of excessive sebaceous gland activity from maternal hormones, along with cutaneous microbiome alterations. The diagnosis of SD is usually clinical, and specific laboratory and/or instrumental investigations are seldom required. Treatment is aimed at modulating sebum production, reducing skin colonization by spp., and controlling inflammation. In adults, mild-to-moderate scalp SD forms can be managed with topical antifungals (ketoconazole, ciclopirox, miconazole) or antiinflammatory (mild-to-moderate potency corticosteroids) or keratolytic/humectant (propylene glycol) agents. Recommended topical therapeutic options for mild-to-moderate facial or body areas SD include topical ketoconazole, ciclopirox, clotrimazole, mild-to-moderate potency corticosteroids, lithium succinate/gluconate, and topical calcineurin inihibitors (). In severe and/or resistant cases, the use of systemic antifungal drugs (terbinafine, itraconazole), as well as UVB phototherapy, may be considered. In children, scant scientific evidence supports the effectiveness and safety of topical drugs, and "cradle cap" is usually successfully managed with baby shampoos enriched with emollient agents and vegetable oils. Alternatively, similarly to adult scalp SD, medical device shampoos with antiinflammatory and antifungal properties, containing piroctone olamine, bisabolol, alyglicera, telmesteine, may be used. Beyond pharmacological treatments, an appropriate cosmetic approach, if correctly prescribed, may improve therapeutic outcomes.
脂溢性皮炎（SD）是一种常见的慢性炎症性皮肤病，主要影响皮脂腺丰富区域（头皮、面部和躯干）的年轻人。在青少年和成年人中，SD的临床表现范围可从轻度斑块到弥漫性头皮脱屑。在婴儿中，它主要发生在头皮上，表现为淡黄色鳞屑斑（“摇篮帽”）。在成年人中，多种环境诱因可能促进SD的发展，同时还有马拉色菌属真菌定植、皮脂腺活动以及免疫抑制、内分泌、神经源性和医源性因素。在儿童中，孕早期发病提示母体激素导致的皮脂腺活动过度以及皮肤微生物群改变的作用。SD的诊断通常基于临床，很少需要进行特定的实验室和/或器械检查。治疗旨在调节皮脂分泌、减少马拉色菌属真菌定植并控制炎症。在成年人中，轻度至中度头皮SD可使用外用抗真菌药（酮康唑、环吡酮、咪康唑）、抗炎药（中低效糖皮质激素）或角质溶解/保湿剂（丙二醇）进行治疗。轻度至中度面部或身体部位SD推荐的外用治疗选择包括外用酮康唑、环吡酮、克霉唑、中低效糖皮质激素、琥珀酸锂/葡萄糖酸锂以及外用钙调神经磷酸酶抑制剂（）。在严重和/或难治性病例中，可考虑使用系统性抗真菌药物（特比萘芬、伊曲康唑）以及窄谱中波紫外线（UVB）光疗。在儿童中，很少有科学证据支持外用药物的有效性和安全性，“摇篮帽”通常使用富含润肤剂和植物油的婴儿洗发水成功治疗。或者，与成人头皮SD类似，可使用具有抗炎和抗真菌特性、含有吡罗克酮乙醇胺、红没药醇、甘油、替美司汀的医疗器械洗发水。除药物治疗外，如果正确处方，适当的美容方法可能改善治疗效果。
