Keywords

A 45-year-old woman presented with a three-year history of scaling and itching of the scalp. The patient had been treated with topical corticosteroids and antifungal creams, lotions and shampoos without improvement. No other dermatological or non-dermatological diseases were reported.

A physical examination of the scalp revealed an erythema, diffuse, yellow, thick scales and longitudinal yellow hair casts (Fig. 48.1). No other skin lesions were presented.

Fig. 48.1
figure 1

A 45-year-old woman with an erythema and diffuse yellow, thick scales. Moreover, longitudinal yellow hair casts are presented

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Based on the case description and the photographs, what is your diagnosis?

FormalPara Differential Diagnoses
  1. 1.

    Seborrheic dermatitis.

  2. 2.

    Scalp psoriasis.

FormalPara Diagnosis

Seborrheic dermatitis treated with Lucilia sericata larval secretions.

Discussion

Seborrheic dermatitis is a common eczamatous disorder that has a relapsing nature. It affects 1–3% of the immunocompetent individuals; and is more common in males compared to females. The disease is common in infants less than three months of age, adolescents, young adults and elderly. The frequency of the disease increases in the patients infected with Human Immunodeficiency Virus or who suffer from parkinsonism [1].

Malessezia furfur has a key role in the pathogenesis of seborrheic dermatitis; therefore the treatment concentrates on topical antifungal and anti-inflammatory agents [2]. The conventional treatment modalities are topical selenium sulphide/sulphur, zinc pyrithione, tar, bifonazole, lithium succinate, miconazole, benzoyl peroxide, ketoconazole, propylene glycol, fluconazole, corticosteroids, metronidazole, ciclopirox and terbinafine; and oral ketoconazole, itraconazole and terbinafine [3].

The secretions of Lucilia sericata larvae have been used in the treatment of ulcers and debriment of soft tissue wounds and necrotic debris for 20 years [4].

The presented patient was diagnosed with seborrheic dermatitis. She did not want to use topical formulations; therefore she was consulted in the Microbiology Department. Lucilia sericata larval secretions were used to treat the patient. The oxygen injection headpiece of the Beauty Instrument-Hydra Facial was used to spray sterile larval secretions on to the scalp with an atmospheric pressure of 4–5 units. The treatment was applied once a day for 20 days. A complete resolution of the skin lesions was achieved (Fig. 48.2).

Fig. 48.2
figure 2

A complete resolution of the disease

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Key Points

  • Seborrheic dermatitis is a common eczamatous disorder that has a relapsing nature.

  • The conventional treatment modalities for seborrheic dermatitis are topical selenium sulphide/sulphur, zinc pyrithione, tar, bifonazole, lithium succinate, miconazole, benzoyl peroxide, ketoconazole, propylene glycol, fluconazole, corticosteroids, metronidazole, ciclopirox and terbinafine; and oral ketoconazole, itraconazole and terbinafine.