Psoriasis seborrhoic type L40.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Seborrhiasis

Definition
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Form of psoriasis vulgaris with weak, yellowish scaling. The picture reminds of a seborrhoeic eczema. Some authors refer to this mixed picture as seborrhiasis.

Localization
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trunk (here mainly in the seborrhoeic zones), capillitium and face (centrofacial)

Clinical features
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Preferably the capillitium is affected. Here characterized by a little sharply defined, flat, reddening (this can also be completely absent) with fine, non-sticky, white head scales. In contrast to seborrhoeic eczema, the hairline boundaries are usually exceeded. Itching is absent or only slightly pronounced.

Face: affected are the centrofacial "seborrhoeic skin areas" such as the middle of the forehead, perninasal region with yellow-red, marginalized, scaly, barely erupted plaques with different levels of scaling.

Trunk: Infestation of the central seborrhoeic zones (sweat ducts in the sternal region, along the spine, shoulder girdle). Figured, little or no itching, scaling of varying intensity, mostly localized, sharply defined, red or reddish-brown spots, papules or confluent plaques appear.

Diagnosis
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  • Defin: Rare type of psoriasis. Eminently chronic, stable and localized (plaque) psoriasis, occurring in the seborrheic zones and the capillitium.
  • Etiol: as in psoriasis general: multifactorial inheritance with incomplete penetrance.
  • Clinic: Sharply defined, symmetrical, only slightly increased in consistency (sometimes hardly palpable as plaque), homogeneously filled, but also anular, pityriasiform scaling, plaques that are loyal to the site
  • Lead sym. Scaly, barely elevated, sharply defined plaques (scaling varies depending on the pre-treatment)
  • Local (in order of frequency): Capillitium, centrofacial region, sternal region.
  • Course: Chronic inpatient, seasonal besertification in summer
  • Assoc. Symptom.: Itching rarely
  • Remarks: Alcohol and smoking are trigger factors for psoriasis.
  • Histol: parahyperkeratosis, mild acanthosis and papillomatosis, no Munro microabscesses
  • Laboratory: without relevance, DD Tinea (mycology)
  • DD: microbial eczema, seborrheic eczema
  • Prognosis: years of recurrent disease are to be expected. Spontaneous healing possible
  • Therapy:
    • local: Vit D3 analogues, glucocorticoids, UVB
    • systemic: low-dose fumarate p.o.TNF-alpha-blocker

Therapy
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  • Head foci: In case of light infestation, blank, rather drying shampoos like dermowas, mineral salt shampoos.
  • For medium to severe infestations, antimycotic preparations with azole derivatives such as ketoconazole (ket scale shampoo), clotrimazole (SD-Hermal Minute Cream) or ciclopirox (e.g. Batrafen S Shampoo) or salicylic acid (Stieproxal) have proven to be effective.
  • Alternatively tar-containing preparations such as LCD 5% in Lygal ointment or Ichthyol® -containing preparations such as Ichthosin cream or Ichthoderm cream.
  • Shampoos containing zinc pyrithione or selenium disulfide such as Desquaman can be helpful.
  • In the case of highly inflammatory components, topical glucocorticoids (e.g. pandulum cream, ecural ointment or solution) can also be used for a short time (!). Possibly combination preparations of glucocorticoids with tar addition (e.g. Alpicort), keratolytic preparations with salicylic acid (e.g. R155 ) or scaling shampoos like Criniton hair wash.
  • Facial foci: Successful are antimycotics like creams containing ketoconazole or ciclopirox (e.g. Nizoral cream; Batrafen cream). No oily ointment bases that are too greasy!
  • Alternatively, 1-2% metronidazole creams(e.g. metro cream, R167 ) or gels (e.g. metrogel), antibiotic-containing topicals such as 1-2% erythromycin cream ( R084, acne mycin) or solution (e.g. stiemycin solution, R086 ) can be used. In case of short-term (!) exacerbation glucocorticoid creams such as 1% hydrocortisone buteprate (Pandel cream) or 0.05% betamethasone V Lotio R030.
  • Good treatment results were reported with a therapy tacrolimus (protopic ointment) / pimecrolimus (Elidel).
  • Body foci: Antimycotics like creams containing ketoconazole (e.g. Nizoral cream). Also here no ointment bases that are too fatty! Sometimes 2% Clioquinol-Lotion R050 is also helpful, and ointments containing lithium (e.g. Efadermin) have been tried. Only in case of short-term (!) exacerbation glucocorticoid creams ( glucocorticoids, topical).
  • For skin cleansing alkali-free detergents (e.g. Eucerin), bath additives like wheat bran-oat straw extract (e.g. Silvapin).
    A good response can be expected from an accompanying UV therapy. A slow increase in dose is recommended.

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020