For Quick Alerts
For Daily Alerts

Sebopsoriasis: Causes, Symptoms, Diagnosis And Treatment

A condition wherein symptoms of both seborrheic dermatitis and psoriasis are exhibited is known as sebopsoriasis [1] . It is usually noticed on the face and scalp. It appears as red or yellow bumps and is slightly greasy. In the case of infants, this condition is known as cradle cap.

Sebopsoriasis can be treated as a transitional condition between psoriasis and seborrheic dermatitis. It shows the features of both these conditions. It describes a psoriasiform rash in a seborrheic distribution [2] . This tends to be the best description when a specific and precise form of diagnosis is not reached. However, with time, it becomes clearer as to which condition the patient has.

Read on to know more about this condition.

What Is Sebopsoriasis?

A person might be diagnosed with sebopsoriasis if he or she tends to show the symptoms of both psoriasis and seborrheic dermatitis both on the scalp as well as on the face. Let us understand what each of these diseases looks like.

  • Seborrheic dermatitis [3] : It is an inflammatory skin condition and is mostly located in oily areas (scalp or face). The symptoms are ideally dependent on the area of the body affected. The major symptoms noted are plaques, scaly skin, itchiness, skin redness, extremely greasy skin, loss of hair and skin redness.
  • Psoriasis [4] : Although the cause of this disease is unknown, it is usually related to an autoimmune system response that leads to the overgrowth of new skin cells. New skin cells grow more rapidly than the normal ones causing excess skin cells to build up on the surface of your skin. The major symptoms of psoriasis include dry skin, joint pain, itching and patches of red skin with silvery, thick scales.

Although this condition can be seen across all age groups, it is most common in childhood/adolescence. It is also seen to rapidly increase in patients who are over 50 years of age.

Causes Of Sebopsoriasis

The pathogenesis of sebopsoriasis is not fully understood. However, the following are thought to be the most likely causes:

  • An abnormal immune response to Malassezia yeasts [5]
  • A primary inflammatory dermatosis [6] that results in increased cell turnover. It causes scaling and epidermal inflammation.
  • A family history of seborrheic dermatitis/psoriasis

Symptoms Of Sebopsoriasis

More than the symptoms, it is the characteristics that work as a sign of sebopsoriasis. The following are the major features noticed [7] :

  • Greasy and yellowish scales in areas such as the scalp, nasolabial folds, over the sternum, eyebrows and behind the ears
  • Thick scales that have defined margins and are deep red in appearance
  • The silvery scale observed is less when compared to classic psoriasis
  • In some rare cases, scales appear on skin folds (intertrigo)

Diagnosis Of Sebopsoriasis

It is diagnosed by its clinical appearance. The doctor would also consider a detailed history of the patient followed by a thorough examination. Skin biopsy might be performed in some severe cases [8] . The results usually show histopathological features that are intermediate between seborrheic dermatitis and psoriasis.

Treatment Of Sebopsoriasis

The treatment involves addressing both seborrheic dermatitis and psoriasis. The treatment procedure usually involves trying a variety of treatments and testing. This is to check to what the skin responds to the best.

Treatments include the following:

  • Emollients: They keep the skin soft and prevent them from cracking. Topical keratolytics can remove scales [9] . They also work by inhibiting bacterial growth.
  • Topical corticosteroids: These reduce the inflammatory response [10] . You can get them in various forms - shampoo, gel, cream, solution or ointment. Potent corticosteroid is used during the initial days to gain control for a couple of weeks followed by a lower dosage/strength for long-term management [11] . Topical steroids should only be used intermittently.
  • Topical calcineurin inhibitors: These are usually prescribed when long-term treatment is required. Use of topical pimecrolimus cream [12] or tacrolimus ointment [13] seems to be quite effective as a treatment method.
  • Topical antifungals: Ketoconazole and ciclopirox are very effective in treating seborrheic dermatitis [14] . It has been found that the combined usage of a topical corticosteroid and ketoconazole shampoo is very effective as a treatment method.
  • Vitamin D-like compounds: Vitamin D derivatives can be used to reduce inflammatory response and scaling. However, calcipotriol (vitamin D derivative) [15] should not be used for the facial skin.
  • Coal tar products: Coal tar has anti-inflammatory and keratolytic effects [16] . However, some people can refrain from using preparations such as shampoo made using coal tar due to its smell and messy nature.
  • Systemic medications: The ideal medicines used to treat psoriasis are methotrexate, cyclosporine and acitretin [17] . However, they are used to treat sebopsoriasis only if it is identified to be a part of generalized psoriasis.
  • Phototherapy [18] : It is effective especially for people who have facial psoriasis. However, phototherapy with UVB (ultraviolet radiation B) is not effective for patients with sebopsoriasis.

The severity of your symptoms is the determining factor behind what treatment procedure your doctor uses. Based on the symptoms, your sebopsoriasis can be classified as follows [18] :

  • Mild: This form of rash does not affect the patient's quality of life. Mild routine skin care products can be used to control the symptoms.
  • Moderate: This can cause might discomfort and can have a negative effect on one's quality of life. The rash cannot be controlled through usual skin care measures.
  • Severe: This can cause severe physical and psychological discomfort. It cannot be controlled using topical treatment.

Is Sebopsoriasis Curable?

Currently, there is no cure for this condition [19] . Your doctor will work with you to identify the best way to treat and manage the symptoms such that there is no or minimal effect on your quality of life. Doctors can also conclude what triggers the rash so that such triggers can be avoided in the future. Sometimes, the symptoms can get aggravated due to an outside cause such as allergies, stress, obesity or environmental conditions such as rough weather [19] .

View Article References
  1. [1] Park, J. H., Park, Y. J., Kim, S. K., Kwon, J. E., Kang, H. Y., Lee, E. S., … Kim, Y. C. (2016). Histopathological Differential Diagnosis of Psoriasis and Seborrheic Dermatitis of the Scalp.Annals of dermatology,28(4), 427–432.
  2. [2] Döring, H. F. (1985). Therapy and etiology of sebopsoriasis.Zeitschrift fur Hautkrankheiten,60(24), 1940-2.
  3. [3] Gary G. (2013). Optimizing treatment approaches in seborrheic dermatitis.The Journal of clinical and aesthetic dermatology,6(2), 44–49.
  4. [4] Di Meglio, P., Villanova, F., & Nestle, F. O. (). Psoriasis.Cold Spring Harbor perspectives in medicine,4(8), a015354.
  5. [5] Sparber, F., & LeibundGut-Landmann, S. (2017). Host Responses toMalasseziaspp. in the Mammalian Skin.Frontiers in immunology,8, 1614.
  6. [6] Alsaad, K. O., & Ghazarian, D. (2005). My approach to superficial inflammatory dermatoses.Journal of clinical pathology,58(12), 1233–1241.
  7. [7] Döring, H. F. (1985). Therapy and etiology of sebopsoriasis.Zeitschrift fur Hautkrankheiten,60(24), 1940-2.
  8. [8] Icen, M., Crowson, C. S., McEvoy, M. T., Dann, F. J., Gabriel, S. E., & Kremers, H. M. (2009). Trends in incidence of adult-onset psoriasis over three decades: a population-based study.Journal of the American Academy of Dermatology,60(3), 394-401.
  9. [9] Marks, R. (1978). Techniques for the evaluation of emollients and keratolytics.J. Soc. Cosmet. Chem,29(7), 433.
  10. [10] Kapp, A., Papp, K., Bingham, A., Fölster-Holst, R., Ortonne, J. P., Potter, P. C., ... & Thurston, M. (2002). Long-term management of atopic dermatitis in infants with topical pimecrolimus, a nonsteroid anti-inflammatory drug.Journal of Allergy and Clinical Immunology,110(2), 277-284.
  11. [11] Kragballe, K. (2009). Management of difficult to treat locations of psoriasis. InManagement of Psoriasis(Vol. 38, pp. 160-171). Karger Publishers.
  12. [12] High, W. A., & Pandya, A. G. (2006). Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation.Journal of the American Academy of Dermatology,54(6), 1083-1088.
  13. [13] Kroft, E. B. M., Erceg, A., Maimets, K., Vissers, W. H. P. M., Van Der Valk, P. G. M., & Van De Kerkhof, P. C. M. (2005). Tacrolimus ointment for the treatment of severe facial plaque psoriasis.Journal of the European Academy of Dermatology and Venereology,19(2), 249-251.
  14. [14] Ratnavel, R. C., Squire, R. A., & Boorman, G. C. (2007). Clinical efficacies of shampoos containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment of seborrhoeic dermatitis.Journal of dermatological treatment,18(2), 88-96.
  15. [15] Oranjea, A. P., Marcouxb, D., Svenssonc, Å., Prendivilled, J., Krafchike, B., Toolef, J., ... & of Montrealb, U. (1997). Topical calcipotriol in childhood psoriasis.Journal of the American Academy of Dermatology,36(2), 203-208.
  16. [16] Fluhr, J. W., Cavallotti, C., & Berardesca, E. (2008). Emollients, moisturizers, and keratolytic agents in psoriasis.Clinics in dermatology,26(4), 380-386.
  17. [17] Flytström, I., Stenberg, B., Svensson, Å., & Bergbrant, I. M. (2008). Methotrexate vs. ciclosporin in psoriasis: effectiveness, quality of life and safety. A randomized controlled trial.British Journal of Dermatology,158(1), 116-121.
  18. [18] Pirkhammer, D., Seeber, A., Hönigsmann, H., & Tanew, A. (2000). Narrow‐band ultraviolet B (TL‐01) phototherapy is an effective and safe treatment option for patients with severe seborrhoeic dermatitis.British Journal of Dermatology,143(5), 964-968.
  19. [19] Döring, H. F. (1984). Treatment of sebopsoriasis.Dermatology,169(Suppl. 1), 125-133.
Story first published: Saturday, May 18, 2019, 9:00 [IST]
Desktop Bottom Promotion