The etiology of
seborrheic dermatitis is undetermined. That it is influenced by the relative
amounts of androgens and estrogens in the body seems clear. Investigations have confirmed the presence of a lipophylic,
pleomorphic fungus, called the Pityrosporum
ovale, in profuse numbers in most of the scalp lesions. This fungus
is accepted by some as the cause of the disease, and by others is regarded as a
saprophyte thriving in the favorable growth conditions provided by the
seborrheic skin. Other investigators have demonstrated that the P. ovale is
abundantly present on the scalps of patients who have no clinical signs of the
disease.
Many
patients with the disease have low basal metabolic rates, and eat excessively of sweets, starches, or fats.
Alcoholic drinks, chocolate or large amounts of cream, butter,
milk, or sweets are harmful. Apparently there is a deficiency of vitamin B
in some cases. Probably some of the various
expressions or seborrheic dermatitis are due
to different causes, including the staphylococcus and streptococcus which are
numerous in the crusts, and cause concurrent staphylococcic folliculitis and
Staphylococcic ec/ematoid dermatitis. In some instances the disease seems to be
mildly infectious, but is not regularly SO. It is made worse by conditions that
increase perspiration or sebaceous activity. Some cases bear such a close
clinical resemblance to psoriasis that there is some justification in thinking
their etiologies must be similar.
The pathologic findings are those of a low grade-
inflammatory process,
In the epidermis there are Spotty
parakeratosis, acanthosis and spongiosis and occasional vesicle formation. In
the corinin the subpapillary vessels are dilated, and there is a moderate!
perivascular infiltration with lymphocytes. These changes all vary considerably
in different grades of the condition, being more pronounced in the acute and
psoriasiform types. It is differentiated from psoriasis by the spongiosis and
vesicle formation, but often cannot be differentiated from eczema or other low
grade inflammations.
Treatment. The scalp usually should
be shampooed once a week, or if excessively oily, twice a week. Selenium sulfide shampoo suspension (Abbott) gives
excellent results but tends to make the hair oily if used too frequently. For
very oily scalps tincture saponis viridis or a 5 per cent solution of sodium
lauryl sulfate (U.S.P.) are better. Sebezon lotion containing 10 per cent
sodium sulfacetamide (Sehering) is extremely effective both on
the seal]) and skin.
It is applied
morning and night.
The following drugs are commonly
incorporated in scalp lotions and pomades. Considerable caution must be
exercised to obtain good pharmaceutical preparations which will cllect (he
desired clinical results. Hesorcin or betanaphthol should not be used on blond
or white hair, and mercury and sulfur should only be combined in the same
prescription if the red or yellow oxides ol mercury are used. Sulfur or
ainmoniated mercury are effective antiseptics but should never be used in the
same prescription. A moderate amount of alcohol in scalp lotions is definitely
antiseptic and there is no objection to its use. Any diving action from it may be avoided by the addition of oil to
the lotion, castor oil being usually incorporated in small amounts in lotions
to be used by men. Oils in seal]) lotions for women are to be avoided because
they tend to make the hair stringy. When oils are. used for women they are best
applied only immediately before shampooing but, if necessary, may be used more
often in the form of brilliantines.
Effective prescriptions for
the treatment of the scalp are as
follows:
R Resorcinol............................................................................. 4.0-15.0
Rctanaphtliol ........................................................................ 2.0
Alcohol ................................................................................. 120.0
Distilled water............................................................... q.S.
ad 240.0
Oil of violet or oil of bay......................................................... 0.24
Tincture
cudbear .................................................................... 0.5
M. and S.
For dark hair only. Violet color and odor for women. Hay odor and brown :olor
for men. Apply above lotion daily.
R Dilute
sulfurous acid ............................................................. 15.0
Alcohol ................................................................................. 120.0
Acetone ................................................................................ 15,0
Distilled water............................................................... q.S.
ad 240.0
M. and S. Very drying antiseptic lotion for
excessively oily scalp and hair.
R
Tincture capsicum ................................................................. 4.00
Chloral hydrate........................................................................ 8.00
Alcohol ................................................................................ 120.0
Oil violet or oil ncroli............................................................... 0.21
Distilled water................................................................ qs. ad 210.0
M. and S. Apply to scalp daily
with cotton (or dropper or toothbrush) and massage in, as directed, for three
minutes.
Mercury may
be substituted in similar prescriptions:
R Mercury bichloride .............................................................. 0.12-0.24
Resorcinol .......................................................................... 4.0-15.0
Spt. formic acid ...................................................................... 15.0
Alcohol..................................................................................... 60.0
Distilled water................................................................ q.s.
ad 210.0
M. and S.
Apply to scalp daily with dropper and massage in as directed. For use only when
hair is dark.
R Sol. coal tar.............................................................................. 8.0
Mercury bichloride.................................................................. 0.24
Alcohol
....................................................................... q.s.
ad 240.0
.VI. and S, For oily hair. Apply daily with
cotton,
