ECZEMA SEBORRHOICUM

Synonym: Dermatitis seborrhoica.

Eczema seborrhoicum is a combination of derma-
titis and seborrhoea. The seborrhoea manifests
itself as a general oiliness of the skin, especially
of the face and scalp, or by the formation of dan-
druff in the latter situation. Adherent, dirty gray
or yellowish, greasy scales, composed of epithelial
debris and sebaceous material, are very apt to form
and are nearly always accompanied by more or less
inflammation of the adjacent skin. The association
of these two is characteristic of eczema seborrhoi-
cum. Sometimes little plugs which extend into the
patulous sebaceous ducts can be made out on the
under surface of the scales. On the scalp the dis-
ease may be irregularly diffused, but often in that
location and most commonly upon the face and
trunk the lesions are fairly sharply circumscribed
round or oval patches, from ⅛ to 1 inch or more
in diameter. They are of a characteristic yellowish
red, and the redness is frequently more pronounced
at the periphery, as is the scaliness, so that the
lesions often appear ringlike, though they seldom
clear up entirely at the center. They may coalesce
and the borders form gyrate figures or the patches
themselves may have a somewhat segmental ar-
rangement. There is rarely any palpable infiltra-
tion of the skin. Next to the scalp the favorite lo-
cation of the lesions is upon the chest over the
sternum or on the back between the scapulae. They
occur frequently upon the face, especially in the
geno-nasal sulci, also on the forehead in the eye-
brows and on the bearded region in men. In the
axillary and genito-crural folds, on account of the
maceration, patches assume more the appearance of
ordinary eczema. Not very often the disease be-
comes general and the macules are found widely
scattered, though usually more profusely on the up-

per half of the trunk. The lesions are practically
never present on the body without some evidence of
the disease existing at the same time on the scalp.
The disease is very persistent, but varies in its dis-
tribution and severity. It occurs in both sexes and
at all ages. Itching is the only subjective symptom
and is rarely troublesome. The disease is probably
parasitic and contagious. **DIAGNOSIS:** Patches
of ordinary *eczema* are more inflamed, more red and
less yellow, much more infiltrated, rarely sharply
marginate, often moist, never greasy; they rarely
have the typical distribution of eczema seborrhoi-
cum, are not necessarily associated with seborrhoea
of the scalp, and the itching is much more intense.
*Pityriasis rosea* has an acute onset and runs a self-
limited course. It rarely involves the face, never
the scalp and seldom occurs just over the sternum;
the lesions do not assume segmental arrangement;
they are dry, sometimes crinkly, and salmon color
rather than yellow; the scales are not greasy.
*Psoriasis* has a predilection for extensor surfaces,
especially the knees and elbows; the scales are
more plentiful, dry and silvery white and the patches
are bright red. **TREATMENT:** There is practi-
cally no permanent cure, but by constant care the
disease may be reduced to a mild seborrhoea which
can be held in check. Sulphur—one drachm to the
ounce of unguentum aquae rosae—is the most reli-
able remedy. It may be applied daily at first and
then at longer and longer intervals as the condi-
tion improves. If any irritation is produced the
amount of sulphur should be reduced. The addition
of 3 per cent salicylic acid sometimes adds to the
efficacy of the ointment. Resorcin, 3 to 10 per cent,
in vaselin, or as a lotion in dilute alcohol, is also
valuable.

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