Seborrhea is an inflammatory skin disease associated with an increase in the amount and change in the quality of sebum.
Seborrhea is manifested by a thickening of the stratum corneum, oily sheen and peeling of the skin. Seborrhea affects those areas of the scalp and torso where the sebaceous glands are most developed – the scalp, forehead, nasolabial triangle, auricle, anterior chest region and interscapular region. With the defeat of the scalp, thinning and thinning of the hair is observed.
As possible factors contributing to the occurrence of seborrhea consider genetic and metabolic causes, as well as the influence of the external environment.
Currently, the leading role of the pathogen Pitirosporum (yeast-like fungi) in the development of seborrheic dermatitis of the scalp and dandruff is confirmed by numerous clinical and laboratory studies. These yeast-like mushrooms are a permanent resident of healthy skin in more than 90% of the population.Mushrooms concentrate around the sebaceous glands and use their secret for growth and development.
Under adverse conditions, there is a violation of the protective function of the skin and sebaceous glands. In particular, the body loses its ability to control the growth of pitirosporic fungi, and their number increases significantly. The microflora of the scalp normally contains 30–50% of the pirosporum, with dandruff consisting of 75% of them.
Among the factors contributing to the activation of fungi, the leading place belongs to changes in the composition of sebum, which significantly violates the protective function of the skin. Among the reasons causing these changes, most dermatologists point out neurogenic, hormonal, immune.
It is well known that seborrhea is significantly exacerbated by nervous stress. Patients with various diseases of the nervous system are highly susceptible to the incidence of seborrhea, in various forms of its manifestation. Patients with cranial nerve palsies, paralysis of the trunk, Parkinson’s disease, etc. have a high susceptibility to the incidence of seborrhea.
As evidence of immunodeficiency in seborrhea, data are provided on the incidence among patients with severe immunodeficiency states: if in healthy people seborrhea occurs in 8% of cases, then in HIV-infected people it is observed in 36%, and in AIDS patients – in 80% of cases.
Hormonal imbalance also underlies the development of seborrhea. Sebum secretion and hair growth are under the direct control of male sex hormones. Against the background of genetic predisposition, changes in hormonal and immune status cause changes in sebum secretion and impaired skin defenses, which leads to the spread and increase in the number of fungi and the development of inflammatory foci with impaired immune skin response and sebum secretion.
Characteristic manifestations of seborrhea – peeling and inflammation of the skin, accompanied by itching. The classic version of seborrhea is the symmetric involvement of the scalp, the boundaries of the hair, eyebrows, eyelashes of the beard and mustache in the process.
Small white scales appear on the scalp. This variant of seborrhea is characterized by the absence of changes on the skin and is considered as dry seborrhea. Many patients with dandruff (a weak form of seborrhea) complain of pruritus.
If patients rarely wash their heads, the process progresses, captures new areas of the skin, and peeling becomes more abundant. Inflammatory changes in this variant of the course can be expressed slightly. Heavier seborrhea is characterized by red spots and plaques on the skin covered with scales, and in some cases scales with crusts and bloody crusts. The process may involve the skin of the forehead, the ear regions, the area of the ear passages, patients may complain of a feeling of permanent discomfort on the affected areas of the skin or severe itching. If treatment is not carried out, plaques may appear on the smooth skin of the face, back, chest, and in some cases be complicated by a bacterial infection.
Treatment should be approached differentially, depending on the manifestations.
Modern methods of treatment of seborrhea are based on data confirming its fungal origin. It is a specific antifungal treatment that is preferred over anti-inflammatory hormone therapy.
If the scalp is affected, shampoos containing ketoconazole, zinc and tar are prescribed. They are applied at least 2 times a week before the elimination of manifestations of seborrhea, but not less than one month. In the future, these funds should be used by patients as prophylactic agents at least 1 time in 2 weeks.
In mild forms of seborrhea with an arrangement of lesions on smooth skin, use an ointment, cream or solution of an antifungal drug, used 1-2 times a week for a month. In severe cases of the disease, characterized by the presence of foci with severe inflammation and dense layering of scales, before using antifungal agents, it is necessary to use exfoliating agents (salicylic acid, tar preparations, etc.) or soften the scales using oils with ketoconazole.
With the ineffectiveness of this therapy, topical hormonal ointments are added, and in severe cases, antifungal drugs are added to external therapy for one week: ketoconazole – 200 mg / day, terbinafine – 250 mg / day, fluconazole – 100 mg / day, etc. P. Perhaps the appointment of isotretinoin inside (as well as for the treatment of other severe forms of seborrhea). Treatment continues for four weeks. In the complex therapy include vitamins, anti-allergic drugs, sedatives, drugs for the normalization of the gastrointestinal tract.
It should be noted that it is ketoconazole that is most widely used in the treatment of seborrhea.
In the last decade, zinc-based shampoos (Head and shoulders, Friederm-zinc, etc.) have been widely used for the treatment of dandruff. The use of shampoos containing tar and exfoliating agents does not give a quick and stable effect, especially during a long-lasting process, since the elimination of seborrhea does not always lead to a quick elimination of the pathogenic flora that has become. And when you cancel or change the shampoo process occurs again.
Keto Plus is a combination drug containing zinc and ketoconazole.