An Overview of the Diagnosis and Management of Seborrheic Dermatitis

Abstract

Seborrheic dermatitis (SD) is a common chronic inflammatory skin disorder that mostly affects young adults in areas rich in sebaceous glands (scalp, face, and trunk). In adolescents and adults, SD clinical presentation may range from mild patches to diffuse scalp scaling. In infants, it mainly occurs on the scalp as yellowish, scaly patches (“cradle cap”). In adults, several environmental triggers are likely to promote SD development, along with fungal colonization by Malassezia spp., sebaceous gland activity, as well as immunosuppression, endocrine, neurogenic and iatrogenic factors. In children, early occurrence in the first trimester suggests the role of excessive sebaceous gland activity from maternal hormones, along with cutaneous microbiome alterations. The diagnosis of SD is usually clinical, and specific laboratory and/or instrumental investigations are seldom required. Treatment is aimed at modulating sebum production, reducing skin colonization by Malassezia spp., and controlling inflammation. In adults, mild-to-moderate scalp SD forms can be managed with topical antifungals (ketoconazole, ciclopirox, miconazole) or antiinflammatory (mild-to-moderate potency corticosteroids) or keratolytic/humectant (propylene glycol) agents. Recommended topical therapeutic options for mild-to-moderate facial or body areas SD include topical ketoconazole, ciclopirox, clotrimazole, mild-to-moderate potency corticosteroids, lithium succinate/gluconate, and topical calcineurin inihibitors ( off-label use ). In severe and/or resistant cases, the use of systemic antifungal drugs (terbinafine, itraconazole), as well as UVB phototherapy, may be considered. In children, scant scientific evidence supports the effectiveness and safety of topical drugs, and “cradle cap” is usually successfully managed with baby shampoos enriched with emollient agents and vegetable oils. Alternatively, similarly to adult scalp SD, medical device shampoos with antiinflammatory and antifungal properties, containing piroctone olamine, bisabolol, alyglicera, telmesteine, may be used. Beyond pharmacological treatments, an appropriate cosmetic approach, if correctly prescribed, may improve therapeutic outcomes.

Chemical Profile and Biological Effects of an Herbal Mixture for the Development of an Oil-in-Water Cream

“…Seborrheic dermatitis (SD) is a common inflammatory skin disease that is most frequently found in the infancy and middle-aged population, with a papulosquamous morphology in areas rich in sebaceous glands, especially the scalp, face, and body folds [ 1 , 2 ]. The prevalence of SD worldwide is approximately 5%, especially affecting young adults or adolescents [ 1 ].…”

“…The prevalence of SD worldwide is approximately 5%, especially affecting young adults or adolescents [ 1 ]. Its pathogenesis is multifactorial, and factors such as cutaneous microbiome alterations, excessive sebaceous gland activity, or immunosuppression appear to be involved in it [ 2 , 3 ]. Among microbiome alterations, the Malassezia yeast is often assumed to cause SD [ 3 , 4 ].…”

“…The management of SD involves the use of several therapeutic approaches, including topical corticosteroids and antifungals [ 1 , 2 ]. Due to their side effects and low tolerance, many patients search for safer alternatives, which often are natural remedies of different types [ 5 , 6 , 7 ].…”

Double-blind, randomized comparative study of 2% topical formulations of ketoconazole and sertaconazole in the treatment of seborrheic dermatitis of the scalp

“…Для него характерно появление эритематозно-сквамозных очагов сыпи в так называемых «себорейных» зонах: волосистая часть головы, спина, грудь. Выделяют младенческий и взрослый варианты себорейного дерматита [1,2,3,4,5,6].…”

“…Себорейный дерматит является мультифакториальным заболеванием, но отдельные факторы его патогенеза признаются ведущими [5]. К общим фактам риска относят возраст, мужской пол, повышенную активность сальных желёз, иммунодефицитное состояние, а также ряд неврологических и психиатрических синдромов и приём некоторых лекарств [12,13].…”