Scientific collaboration between Professor Marco Toscani and Dr. Pasquale Fino, Chair of Plastic, Reconstructive and Aesthetic Surgery, Umberto I Health Center – “Sapienza” University of Rome.
Seborrheic dermatitis is a very common scalp condition characterized by the presence of yellow and oily flakes on the skin.
It is associated with erythema, small scaly, and intense itching.
Seborrheic dermatitis is a well-known condition but is still not easily identifiable. Many men and women starting from puberty have oily, greasy, shiny and thickened skin with large hair follicles, especially noticeable around the nose and mouth, forehead, torso, scalp (affected by so-called oily dandruff).
Seborrheic dermatitis appears in these individuals. It is characterized by red, reddish-yellow or dark red skin patches, covered with small and medium sized, thick and greasy flakes, sometimes appearing as scaly formations with blisters that are not easily noticed.
Seborrheic eczema is a typical form surrounded by seborrheic dermatitis limited to certain areas of the body, found at the level of the sternum and shoulder blades, characterized by various round patches with clearly defined convex edges. Another form is characterized by pityriasiform and psoriasiform patches. Complications of seborrheic dermatitis are: eczematization (the most common complication), external otitis, occipital and nuchal eczema, umbilical eczema, areola eczema in women and lastly perineum-genital eczema.
Often, seborrheic dermatitis is located on the scalp and along its edges. An irregular patch often emerges from the scalp onto the forehead called a “seborrheic crown”. It is important to remember that seborrheic dermatitis in and of itself does not cause hair loss.
The etiopathogenesis of seborrheic dermatitis is not completely clear. Recognized concurrent causes are bacterial, fungal (Malassezia), infectious, mechanical, irritative, psychosomatic and sebaceous dysfunction (most probably of genetic origin) factors. In the case of seborrheic dermatitis sebum undergoes a chemical transformation. In fact, a reduction of triglycerides, squalene and cholesterol occurs.
Hair treatments like lotions and shampoos are commonly used as local anti-seborrheic treatments. Non-halogenated corticosteroids in the form of gels or lotions are very effective. Antibiotics and antifungal treatments may also be used. Positive results have also been achieved by using retinoic acid and ketoconazole, general purpose antifungals.
Hyperseborrhea or hypersecretion of sebum is simply a scalp problem due to an excessive production of sebum caused by hyperactivity of the sebaceous glands. Immediate symptoms of hyperseborrhea are scalp itchiness and pain. However, a later symptom is hair loss.
Changes in the hair shaft lead to deterioration with the appearance of ruined or damaged hair.
In healthy hair, the cuticle is whole, with overlapping shingles. Hair with whole ends appears shiny, elastic and brushes easily.
Scalp pain and irritation (or trichodynia) are pathological conditions that affect both women (in a greater percentage) and men (in a lower percentage). The pain felt on the scalp, spontaneous or caused by treatment, and in particular around the roots of the hair, may be more or less intense, alternating at times between periods of disappearance, associated with burning, tingling or itching.
Seborrheic hair loss is a form of premature hair loss that generally afflicts men in their youth (onset between 20 and 30 years of age), mainly affecting the frontal region and the crown. The cause, as the name of the condition suggests, is related to an excess production of sebum that provokes or accelerates hair loss.
A shedding of hair is considered physiologically normal when hair loss is limited to around one hundred hairs per day. During an individual’s life hair grows, falls out and regrows around twenty times. Each cycle, especially for females, may last up to six years and if hair loss is found within this time frame, it is considered absolutely physiological.
The sebaceous glands are glands that secrete sebum, an oily, acidic substance with a pH of 3.5. They are connected laterally to the hair follicle. Sebaceous glands are found with a density of approximately 100/cm2 throughout all areas of the skin. In the human body, they are located across the entire surface of the skin, except for the palms of the hands and the soles of the feet.
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