Psoriasis seborrhoic type L40.8

Trunk (here mainly in the seborrheic zones), capillitium and face (centrofacial).

The capillitium is preferentially affected; characterized here by a less sharply defined, extensive reddening (this can also be completely absent) with fine, non-adherent, white scaling of the scalp. In contrast to seborrhoeic eczema, the hairline boundaries are usually exceeded. Itching is absent or only slightly pronounced.

Face: The centrofacial "seborrhoeic skin areas" such as the middle of the forehead and the perninasal region are affected, with yellow-red, marginalized, scaly, barely elevated plaques with varying degrees of scaling.

Torso: Infestation of the central seborrheic zones (sweat grooves in the sternal region, along the spine, shoulder girdle). There are figured, little or no itching, scaling of varying intensity, mostly localized, sharply defined, red or red-brown patches, papules or confluent plaques.

• Definition: Rare type of psoriasis. Eminently chronic, stable and localized (plaque) psoriasis occurring in the seborrheic zones and on the capillitium.
• Etiology: as in psoriasis, with multifactorial inheritance with incomplete penetrance
• Clinic: sharply defined, symmetrical, only slightly consistent (sometimes barely palpable as a plaque), homogeneously filled, but also annular, pityriasiform scaling, localized plaques
• Main symptoms: scaly, barely elevated, sharply defined plaques (scaling varies in severity depending on pre-treatment)
• Localization (in order of frequency): Capillitium, centrofacial areas of the face, sternal region
• Course: chronic stationary, seasonal improvement in summer
• Associated symptoms: itching only rarely
• Indications: Alcohol and smoking are trigger factors for psoriasis.
• Histology: parahyperkeratosis, slight acanthosis and papillomatosis, no Munro microabscesses
• Laboratory: without relevance, DD tinea (mycology)
• DD: microbial eczema, seborrheic eczema
• Prognosis: Recurrent course for years is to be expected. Spontaneous healing possible.
• Therapy:
  • local: vitamin D3 analogs, glucocorticoids, UVB
  • systemic: low-dose fumarates p. o., TNF-alpha blockers

Head foci:

• For light infestations, blank, rather drying shampoos such as Dermowas, mineral salt shampoos
• For moderate to severe infestations, antifungal preparations with azole derivatives such as ketoconazole (Ket dandruff shampoo) or clotrimazole (SD-Hermal minute cream), ciclopirox (e.g. Batrafen S shampoo) or salicylic acid (Stieproxal) have proven effective.
• Alternatively, preparations containing tar such as LCD 5 % in Lygal head ointment or preparations containing ichthyol such as Ichthosin cream or Ichthoderm cream
• Shampoos containing zinc pyrithione or selenium disulphide such as Desquaman can be helpful.
• Topical glucocorticoids (e.g. Pandel cream, Ecural fatty ointment or solution) can also be used in the short term (!) if there is a strong inflammatory component. Possibly combination preparations of glucocorticoids with added tar (e.g. Alpicort), keratolytic preparations with salicylic acid (e.g. R155 ) or descaling shampoos such as Criniton hair wash.

Facial lesions:

• Antimycotics such as creams containing ketoconazole or ciclopirox (e.g. Nizoral cream, Batrafen cream) are successful. Do not use ointment bases that are too greasy!
• Alternatively, 1-2 % metronidazole creams(e.g. Metrocreme, R167) or gels (e.g. Metrogel), topical preparations containing antibiotics such as 1-2 % erythromycin cream(R084, Aknemycin) or solution (e.g. Stiemycine solution, R086) can be used. In case of exacerbation, short-term (!) glucocorticoid creams such as 1 % hydrocortisone buteprate (Pandel cream) or 0.05 % betamethasone V lotion(R030).
• Good treatment results have been achieved with tacrolimus (Protopic ointment) or pimecrolimus (Elidel).

Body lesions:

• Antimycotics such as creams containing ketoconazole (e.g. Nizoral cream). Again, no oily ointment bases! A 2 % clioquinol lotion(R050) may also be helpful, and ointments containing lithium (e.g. Efadermin) may be tried. Glucocorticoid creams(glucocorticoids, topical) in the short term (!) only during exacerbations.
• For skin cleansing, alkali-free detergents (e.g. Eucerin), bath additives such as wheat bran-oat straw extract (e.g. Silvapin)
• A good response can be expected from concomitant UV therapy. Slowly increasing the dose is recommended.