Turkiye Klinikleri Journal of Dermatology

.: REVIEW
Seboreik Dermatit
Seborrheic Dermatitis: Review
Mustafa AKSOYa, Deniz AKSU ARICAb
aDeri ve Zührevi Hastalıkları AD, Harran Üniversitesi Tıp Fakültesi, Şanlıurfa
bDeri ve Zührevi Hastalıkları AD, Karadeniz Teknik Üniversitesi Tıp Fakültesi, Trabzon
Turkiye Klinikleri J Dermatol. 2016;26(2):90-100
doi: 10.5336/dermato.2015-47766
Article Language: TR
Full Text
ÖZET
Seboreik dermatit (SD) klinik olarak eritemli kepekli yamalarla karakterize, kronik, tekrarlayan inflamatuar bir deri hastalığıdır. İnterskapular ve presternal alanlar, periauriküler bölge, yanaklar, nazolabial ve nazofasiyal kıvrımlar, glabella, kaşlar ve saçlı deri gibi sebase bezlerden zengin alanlarda yerleşir. Özellikle adolesan ve postadolesan yaş grubunu etkileyen SD, genel populasyonda %3-5, gençlerde %1-3 oranında görülür. İmmün yetmezlikli hastalarda daha yüksek oranlarda görülen SD, infantil başlangıçlı SD ve erişkin başlangıçlı SD olarak iki gruba ayrılabilir. Nedeni tam olarak bilinmeyen, etiyolojisinde birçok faktörün rol oynadığı multifaktöriyel bir hastalıktır. Bu faktörler stres, androjenler, depresyon, yorgunluk, mikroanjiyopatik olabilen vasküler bozukluklar, basınç değişiklikleri gibi atmosfer değişiklikleri, mevsimler, giyim, beslenme biçimleri ve yiyecek allerjileri, otoimmünite, klimakterik değişiklikler, Malassezia furfur, başka nedenlerle alınan ilaçlar, riboflavin, piridoksin, biyotin eksiklikleri gibi birçok faktördür. Seboreik dermatit lezyonlarının histopatolojisi, psöriyazis ve spongiyotik dermatitin histopatolojik bulgularının kombinasyonu şeklindedir. Klinik olarak ayırıcı tanısı ise tutulan lokalizasyona göre değişiklik göstermesidir. Hastalığın şiddetine, morfolojik değişikliklere ve önceki tedavilere verilen yanıta göre seçilen tedavi, daha çok alevlenmeleri kontrol altına almaya yöneliktir. Antifungaller, retinoidler, kortikosteroidler ve fototerapi, bu amaçla kullanılan sistemik tedavi seçenekleridir. Aynı amaç için kullanılan topikal tedavi seçenekleri çok çeşitli olup, salisilik asit, kömür katranı, ardıç katranı, selenyum sülfit, çinko piritiyon gibi keratolitik ajanlar; azoller, alilaminler, benzilaminler, hidroksipiridonlar gibi antifungaller; takrolimus ve pimekrolimus gibi immünmodülatörler; kepek şampuanı, antifungal ajanlar ve topikal steroidleri içeren kombine tedaviler; lityum süksinat, lityum glukonat gibi lityum bileşikleri; kortikosteroidler; metronidazol; 1-24 dihidroksikalsiferol; çay ağacı yağı; 'borage' yağı; aloe vera ekstresi; propilen glikol gibi birçok seçeneği içerir. Bu çalışma, SD etiyopatogenezi, kliniği ve tedavisi ile bu alanda mevcut güncel literatürleri içermektedir.

Anahtar Kelimeler: Dermatit,seboreik; etiyoloji; tedavi; tanı
ABSTRACT
Seborrheic dermatitis is a chronic relapsing inflammatory skin disorder clinically characterized by scaling and poorly defined erythematous patches. Seborrheic dermatitis has a distinctive distribution in areas rich in sebaceous glands - the scalp, eyebrows, glabella, nasolabial and nasofacial folds, cheeks, peri-auricular skin, presternal and interscapular areas. SD especially affecting adolescence and postadolescence is seen in both general and young population with ratios 3-5%, 1-3%, respectively. Seborrheic dermatitis seen at higher rates in patients immunocompromised, can be divided into infantile-onset SD and adult-onset SD. Seborrheic dermatitis is a multifactorial disease that many factors play a role in it?s ethiology, although the reason of SD is exactly unknown. These factors are stress, androgens, depression, fatigue, vascular disorder which can be microangiopathic, athmosphere changes such as pressure alteration, seasons, clothing, eating habits and food allergies, autoimmunity, climacteric changes, Malassezia furfur, taking medications for different reasons, riboflavin, prydoxine, biotine deficiency. Histopathology of seborrheic dermatitis is similar to the combination the histologic features of psoriasis and spongiotic dermatitis. Clinical differential diagnosis, varies by held localization. Medical treatment is mostly intented to control exacerbations and changes according to the severity of disease, morphological changes and response to prior treatments. Systemic treatment options used for this purpose antifungals, corticosteroids, retinoids, and phototherapy while; topical treatments; it consists of other treatment options such as; keratolytic agents as salicylic acid, coal/juniper tar, selenium sulfide, zinc pyrithione; antifungal such as azoles, allylamines, benzylamines, hydroxypyridones; immunomodulatory agents such as tacrolimus, pimecrolimus; combination therapy comprising dandruff shampoo, topical corticosteroids and antifungal agents; lithium compounds such as lithium succinate, lithium gluconate; corticosteroids; metronidazole; 1-24 dihydroxy calciferol, tea tree oil, aloe vera extract, propylene glycol, borage oil. This review contains etiopathogenesis, clinical and treatment of SD and current literature available in this area.

Keywords: Dermatitis, seborrheic; etiology; therapy; diagnosis

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