Seborrhoeic Eczema

Seborrhoeic eczema is localized on the scalp, face, chest and between the shoulder blades, i.e. in places where seborrhoea often occurs. Vesiculation and weeping are very rare in these patients. The presence of seborrhoeids (rounded yellowish-pink erythematous spots covered with greasy yellowish scales) is a characteristic symptom. Copious stratified yellowish crusts and scales form on the scalp, the hairs on the affected areas are shiny and sometimes stuck together in bundles (pityriasis amiantacea), and seropurulent exudation is often found in the fold behind the ears. The patient complains of itching (sometimes very intensive), which may precede the clinical manifestations.

There is no unanimity of opinion to date in regard to the classification of seborrhoeic eczema. Some authors relate it to chronic seborrhoeic dermatitides. Others claim that it is a peculiar infectious disease caused by particular micro-organisms. We think that the term 'seborrhoeic eczema' is more correct because it reflects the essence and morphology of the pathological process. As to the microbial infection, it may play the role of an antigen in such patients. There is no room for doubt that disturbances in the neuroendocrine system and body reactivity are of pathogenic importance in this dermatosis. Seborrhoeic eczema, for instance, occurs in infancy, but is almost never encountered in the period between infancy and puberty; like seborrhoea it usually develops after puberty (the role of hyper-androgenia and hypo-oestrogenia).

Infantile Eczema

In children the eczematous process usually develops against the background of exudative diathesis, often as a result of hereditary altered immunological reactivity.

Most parents or close relatives of infants with eczema had manifestations of allergy on the skin, mucous membranes or in the internal organs in the past. It has been reported that if one of the parents (mainly the mother) has an allergic disease (bronchial asthma, allergic rhinitis, eczema, neurodermitis, etc.), the child has a 40 per cent chance of becoming ill, whereas if both parents are sick, the extent of the risk increases to 50-60 per cent. Children with exudative diathesis often have torpid foci of focal chronic infection, bronchial asthma, hay fever, acute respiratory infections, conjunctivitis, keratitis and gastro-intestinal disorders, and dysfunction of the liver and pancreas.

Children suffering from eczema often develop against the background of diminished immunobiological body resistance manifestations of alimentary allergy (to casein of mother's or cow's milk) and infectious allergic reactions which are often induced by foci of chronic infections and then by hypersensitivity to drugs and other chemicals.

The disease begins in infancy. Eruptions appear on the face and then spread to other body areas. The skin of the face becomes red and swollen, and copious coalescing exudative papules and small vesicles form on it; in places they are covered with massive brownish crusts which leave weeping eroded surfaces. Signs of intertriginous eczema may be found in the region of the gluteal and inguinofemoral folds. Besides the weeping foci described above, children with infantile eczema may have macular seborrhoeic eruptions (erythematous-squamous spots, seborrhoeids) on the face, trunk, and limbs. Infantile eczema is therefore characterized in most cases by the simultaneous presence of the signs of true, microbial, and seborrhoeic forms of eczema. The children are usually overfed, oedematous, they sleep badly and are excited. The lymph nodes are enlarged. Eosinophilia is a frequent finding. Infantile eczema occurs usually to the age of 3 years after which the process transforms to persistent diffuse or disseminated neurodermitis.