Seborrheic Dermatitis, What do we know, and What is new
- MedReport Foundation
- 45 minutes ago
- 5 min read
Seborrheic dermatitis (SD) is a relapsing skin condition that affects 3 to 5 percent of the global population and known to be chronic. It affects parts of the skin that normally have a higher number of oil producing glands (sebaceous glands) such as scalp, eyebrows, cheeks, chest and back. It is a form of an autoimmune dermatitis triggered by skin own sebum (oil) which acts as the allergen that leads to an increase in the count of immune cells in the skin outer layer (1). That immune reaction is responsible for the classic symptoms of SD which include redness, soreness, irritation, itch and flakiness (2).
Causes and Clinical Presentation
The full pathophysiology of seborrheic dermatitis is not known. But it is understood that there
is a combination of factors involved which reflects the condition’s complex nature. Beside the
immune imbalance that initiate the inflammatory reaction to the excess oil, the yeast fungus
called Malassezia Furfur that lives naturally on skin is another culprit (4). The fungus thrives
on utilizing the sebum leaving behind long chain fatty acids as waste products on the skin
surface. And in large amounts these fatty acids make the skin irritated and itchy. Hormones
play a significant role in this condition as it is known that in most cases it starts at puberty.
Also, according to some studies, men are more affected than women (5). Other factors reported include genetic predisposition in some individuals that supports skin microbiome imbalance leading to fungal overpopulation. In addition to some environmental factors such as stress, seasonal changes, nutrition, immunity status and the co-existence of chronic health conditions such as diabetes or HIV (6).
Conventional and New Treatments
Over the years people tried many things to ameliorate symptoms associated with SD especially the itch and the visible flakes. Old remedies focused on loosening the scales with natural oils of olive and coconut. But when the fungal contribution was confirmed, topical antifungals became the most common treatment alone or in combination with descaling agents known as keratolytics, e.g. salicylic and lactic acid. Medicated shampoos containing an antifungal agent called ketoconazole 2% is considered the first line, the most potent and the gold standard treatment for moderate to severe cases. Other agents that were found effective against the Malassezia fungus with some benefits to the scalp skin barrier include selenium sulphide, coal tar and zinc pyrithione. The downside of using these antifungals is that they can dry hair and scalp (7).
Newer topical antifungals were introduced to the market in the recent years to achieve better
control without drying hair too much named as piroctone olamine, ciclopirox olamine and
climbazole, hence they can be used in daily shampoos. Also, tea tree oil, apple vinegar and aloe vera gel are natural alternatives, good enough to manage mild SD cases with minimal to no side effects (8). However, topical steroids such as hydrocortisone 1% cream and
Betamethasone 0.05% lotion can be still needed to control the inflammation in more stubborn cases. It is also documented that some SD cases were treated with topical antimicrobials like Miconazole and Metronidazole while results are controversial. Whereas systemic oral antifungals such as itraconazole and Terbinafine are recommended only as a last resort when all topical treatments fail to control the symptoms (9,10).
Currently, companies are developing shampoos and scalp lotions using combination of
additives to their main antifungal ingredient to improve performance and balance scalp oils.
Niacinamide is one of the trendy ingredients usually combined with zinc PCA (a water-soluble zinc salt) as together they reduce oil production and help enhance the barrier integrity (11).
Phototherapy and topical immune modulators known as calcineurin inhibitors are amongst the most recent approaches in SD management. In phototherapy, LED light is directed at the affected skin. This combined red and blue light has shown to slightly reduce inflammation especially on facial skin (12). On the other hand, calcineurin inhibitors are new compounds that are topical immuno-suppressants as they inhibit that calcineurin which is a chemical that has a significant role in the inflammatory cascade in SD and other skin inflammatory conditions (13). The FDA has recently approved more of these immune-modulatory drugs such as Roflumilast foam, Tapinarof cream, ruxolitinib cream as steroid free options that effectively reduce redness and scales and safe to use long term (14,15,16).
From a non-pharmaceutical perspective, people see some improvement when they limit yeast feeding diet such as sugars, refined carbohydrates and processed food. And when keeping stress under control, maximizing vitamin D and avoid oil-based skin and hair care products (17). An aesthetic approach known as QR678 Neo has grabbed attention recently that aims to injecting growth factors, vitamins, minerals and peptides directly to scalp to improve symptoms especially the accompanying hair loss (18).
References
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treatment of seborrheic dermatitis with QR678 and QR678 Neo- Aprospective pilot
study. J Cosmet Dermatol. Pubme [online]2023 Nov;22(11):3078-3087.
