Pityriasis Steatoides: Causes, Symptoms and Treatment

Introduction:

Pityriasis is a non-pathogenic yeast-like fungus that causes a chronic papulosquamous inflammatory disorder in areas rich in sebum production, like the scalp, face, and trunk. The fungi produce spores and proliferate, resulting in seborrheic dermatitis. Seborrhea can be defined as the excess sebum production in an individual, considering their age and sex. The affected areas of the skin are erythematous and covered by greasy scales. The scales are yellow with a waxy texture. The area of skin under the lesion may have visible borders. It is commonly seen on the scalp, nose, eyebrows, ears, intra-scapula, and pre-sternum.

The condition often occurs intermittently with an active and inactive phase. Exacerbation is observed in the winter and spring, with decreased summer activity. It is mainly seen in people who sweat heavily. The excess production of sebum will also increase fungi proliferation.

What Is the Etiology of Pityriasis Steatoides?

• The exact cause of pityriasis steroids is not known. Some studies and reports suggest genetic evidence. During birth, the sebaceous glands are too small and are supported by the mother's androgen. As the child grows and attains puberty, the sebaceous glands enlarge due to increased androgen production, increasing sebum production.

• Initially, the sebum production is the same in males and females until the 16th year, after which the sebum production in males dramatically increases because of the presence of testicular androgens. However, in females, estrogen reduces sebum production, except in pregnancy.

• The yeast-like fungi pityrosporum of Malesseziz causes pityriasis steroids or classic seborrheic dermatitis.

What Are the Risk Factors for the Development of Pityriasis Steatoides?

• Age.

• Males are commonly affected.

• Increased activity of the sebaceous glands.

• Immunodeficiency conditions like renal transplantation, lymphoma, and acquired immunodeficiency syndrome (AIDS).

• Psychiatric and neurological disorders like stroke, Parkinson's, Alzheimer's, autonomic dysfunction, and depression.

• Treatment with immunosuppressants, psoralene, dopamine antagonists, and lithium.

What Is the Pathophysiology of Pityriasis Steroids?

The following sequence of events leads to classic seborrheic dermatitis.

• Initially, the skin's microbiota is disrupted.

• The T-cell activity and complement activation is diminished, resulting in an impaired reaction to Mlassezia sapp.

• Saturated fatty acids get to accumulate on the skin's surface.

• Atypical shedding of keratinocytes.

• Certain genetic factors will result in the disruption of the skin barrier.

• The yeast like fungi malassezia sapp. It will degrade the sebum and consume the fatty acids on the skin's surface. It will significantly alter the skin's lipid balance. Scientists successfully isolated the organism from skin lesions, and antifungal treatment helped resolve the skin lesions to a great extent.

What Is the Histopathology of Pityriasis Steatoides?

The microscopic appearance of the lesions is non-specific in pityriasis steatoides. The surface of the epidermis displays a lymphocytic infiltration, focal spongiosis (fluid accumulation in the intercellular spaces), acanthosis (thickening of the epidermis), and focal parakeratosis (nuclei retention in the stratum corneum). Shoulder parakeratosis is observed where parakeratosis is found in mounds around the hair follicles. The organism Malassezia is located in the stratum corneum of the skin. Severe condition cases are characterized by keratinocyte necrosis and leukocytoclastic (vasculitis of the skin capillaries).

What Are the Symptoms and Clinical Presentation of Pityriasis Steatoides?

The lesions are extensively seen in areas rich in sebaceous glands, like the face and scalp. The condition occurs in infants, too but is generally asymptomatic. Atopic dermatitis (eczema-like lesion) is a common presentation in children. Pruritis is a common presentation in adult lesions, especially on the scalp. Patients usually complain of a burning sensation; however, the history of atopic dermatitis is absent in adults.

On the skin lesions, salmon-colored plaques and papules are observed with fine scales and a yellowish crust is known as a greasy scale crust. The greasy scales are present in several locations but less often on flexural surfaces. The common symptoms in severe cases are

• Reddening of the skin of the face.

• Dandruff.

• Scaling.

• Hyper or hypo pigmentation with dyschromia in dark-skin individuals.

• Severe cases are frequently associated with acquired immunodeficiency virus, and early identification can significantly improve the outcomes.

• The most common site of occurrence is the scalp, face, and chest.

• It is commonly seen in the middle third of the face, involving the malar region. Medial aspects of the eyebrows, external ear canal, and post-auricular area.

• It also affects the nasolabial folds.

• Blepharitis is a frequent presentation with anterior lash line involvement.

• A typical presentation in children is known as a cradle cap. It involves a yellowish scaly crust on the crown and the front of the scalp. It develops from the serous ooze, bran-like scale, and greasy crust and covers the entire scalp.

How to Evaluate Pityriasis Steatoides?

A routine investigation is not necessary for classic seborrheic dermatitis. However, in severe cases, an HIV (human immunodeficiency virus) serology is performed. In elderly patients, the condition may be associated with Parkinson's disease, so clinical features specific to the disease must be recognized. The tests that can help in the differential diagnosis are

• Skin scrapings should be examined with potassium hydroxide.

• Swab collection for culture and sensitivity tests.

• Histological examination and immunofluorescence.

• Human immunodeficiency virus (HIV) serology.

• Blood zinc levels.

What Are the Treatment Strategies for Pityriasis Steatoides?

Frequently the treatment for pityriasis steatoides, aka classic seborrheic dermatitis, is uncertain and may last for a lifetime. The main treatment objectives are

• Removal of the adherend scales.

• Inflammation reduction.

• Reducing the number of organisms in the lesion.

Scale removal:

It involves hydrating the scalp and proper exfoliation by soaking it with a mild keratolytic cream containing two percent salicylic acid. Overnight coconut oil hair masks can be used, and it is more effective when used with a shower cap. The crust is thereafter removed by gentle scrub shampooing. The selectively effective shampoos for pityriasis steatoides are

• Ketoconazole two percent..

• Zinc pyrithione.

• Coal tar products.

• Alternative day use of cola tar shampoos.

Medications:

Topical corticosteroids are advised in creams, lotions, and sprays. A potent topical steroid is considered a short-term therapy, but the application is tapered and stopped because the steroids will cause atrophy skin. Acute forms of the condition usually respond well to milder corticosteroids like one percent hydrocortisone. Systemic steroids are used when the topic steroids fail in the remission of the lesions. Systemic antibiotics are administered in case of secondary bacterial infections.

Conclusion

Pityriasis steatoides is a benign condition that does not cause serious health issues. However, the greasy, scaly lesions are often associated with low self-esteem, psychological stress, embarrassment, and secondary infections with bacteria and other fungi. Therefore, early identification and intervention are necessary for better treatment outcomes. Though a complete cure is not an option for the condition, early intervention can cause the lesions to remain inactive for extended periods, improving the quality of life.