Treatment of seborrheic dermatitis: a comprehensive review

Borda, Luis J.; Perper, Marina; Keri, Jonette

doi:10.1080/09546634.2018.1473554

Cited by 88 publications

(65 citation statements)

References 98 publications

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“…However, strong challenges to this notion remain. A causal relationship and the exact role of Malassezia in SD pathobiology have not been firmly established . Additionally, a Malassezia aetiology cannot easily explain the effective treatment of SD symptoms with weak topical steroids, nor the much‐discussed relationship of SD to dandruff on the one hand, and psoriasis on the other.…”

Section: Introductionmentioning

confidence: 99%

Seborrheic dermatitis—Looking beyond Malassezia

Wikramanayake

Borda

Miteva

et al. 2019

Experimental Dermatology

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Seborrhoeic Dermatitis (SD) is a very common chronic and/or relapsing inflammatory skin disorder whose pathophysiology remains poorly understood. Yeast of the genus Malassezia has long been regarded as a main predisposing factor, even though causal relationship has not been firmly established. Additional predisposing factors have been described, including sebaceous activity, host immunity (especially HIV infection), epidermal barrier integrity, skin microbiota, endocrine and neurologic factors, and environmental influences. Genetic studies in humans and mouse models—with particularly interesting insights from examining the Mpzl3 knockout mice and their SD‐like skin phenotype, and patients carrying a ZNF750 mutation—highlight defects in host immunity, epidermal barrier and sebaceous activity. After synthesizing key evidence from the literature, we propose that intrinsic host factors, such as changes in the amount or composition of sebum and/or defective epidermal barrier, rather than Malassezia, may form the basis of SD pathobiology. We argue that these intrinsic changes provide favourable conditions for the commensal Malassezia to over‐colonize and elicit host inflammatory response. Aberrant host immune activity or failure to clear skin microbes may bypass the initial epidermal or sebaceous abnormalities. We delineate specific future clinical investigations, complemented by studies in suitable SD animal models, that dissect the roles of different epidermal compartments and immune components as well as their crosstalk and interactions with the skin microbiota during the process of SD. This research perspective beyond the conventional Malassezia‐centric view of SD pathogenesis is expected to enable the development of better therapeutic interventions for the management of recurrent SD.

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Section: Introductionmentioning

confidence: 99%

Seborrheic dermatitis—Looking beyond Malassezia

Wikramanayake

Borda

Miteva

et al. 2019

Experimental Dermatology

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“…For mild-to-moderate facial SD, topical drugs play a key role in the management by reducing erythema and scale production. These include corticosteroids and antifungals 9–14. The clinical efficacy of current therapeutic agents is widely demonstrated,9–11 although their prolonged use may cause some adverse effects, including skin atrophy, striae, telangiectasia, folliculitis, hypopigmentation, and tachyphylaxis in the case of corticosteroids, irritant contact dermatitis from the use of antifungals, and limitations due to the off-label use of metronidazole, benzoyl peroxide, lithium succinate/lithium gluconate, pimecrolimus, and tacrolimus.…”

Section: Introductionmentioning

confidence: 99%

<p>Clinical and instrumental evaluation of a new topical non-corticosteroid antifungal/anti-inflammatory/antiseborrheic combination cream for the treatment of mild-to-moderate facial seborrheic dermatitis</p>

Dall’Oglio¹,

Lacarrubba²,

Luca³

et al. 2019

CCID

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PurposeTopical agents play a key role in the management of facial seborrheic dermatitis (SD) by reducing inflammation and scale production. The aim of this open-label trial was to assess the efficacy and tolerability of a new non-corticosteroid, antifungal/anti-inflammatory/antiseborrheic cream containing piroctone olamine, stearyl glycyrrhetinate, and zinc PCA in the treatment of facial SD using clinical and instrumental evaluation.Patients and methodsTwenty adult subjects affected by mild-to-moderate inflamed facial SD were enrolled and instructed to apply the study cream twice daily for 60 days. Efficacy was evaluated at baseline, and at days 15, 30, and 60 by measuring the grade of desquamation, erythema, and pruritus using clinical evaluation, erythema-directed digital photography, colorimetry, and subject-completed Visual Analog Scale. Additionally, an Investigator Global Assessment (IGA) was assessed using a 5-point scale: excellent response (>80% improvement); good response (50%–80% improvement); mild response (<50% improvement); no response (no change); worsening.ResultsAfter 15 days, a statistically significant decrease from baseline was found in desquamation, erythema, colorimetric scores, and pruritus. At day 60, a significant further improvement for all evaluated parameters was recorded. Moreover, the IGA improved in 90% of patients, with an excellent response in 53% of cases. A good correlation was found between clinical and instrumental evaluations.ConclusionOur results indicate that the study facial cream represents an option to consider when dealing with mild-to-moderate SD, being effective, well-tolerated, and free of significant side effects, as confirmed by clinical and instrumental evaluation.

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“…Although symptoms are well‐known and treatable, many patients do not receive early care, and chronic disease can occur. Treatment is usually based on topical therapy and lifestyle management …”

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confidence: 99%

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population‐based study in 161 269 employees

et al. 2019

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Summary Background Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. Objectives To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. Methods In the course of voluntary company skin checks, full‐body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. Results In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35–64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9–18·1], onychomycosis (9·1%, 95% CI 8·3–10·0), tinea pedis (7·1%, 95% CI 6·3–7·8), rosacea (4·1%, 95% CI 3·6–4·7), acne (4·0%, 95% CI 3·4–4·5) and psoriasis (2·7%, 95% CI 2·3–3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0–2·3], contact dermatitis (OR 1·8, 95% CI 1·1–2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4–2·2), rosacea (OR 1·6, 95% CI 1·4–1·8), acne (OR 1·4, 95% CI 1·2–1·7), pyoderma (OR 1·4, 95% CI 1·1–1·8), tinea corporis (OR 1·4, 95% CI 1·0–2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0–1·7) and psoriasis (OR 1·2, 95% CI 1·0–1·5). Conclusions Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

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Treatment of seborrheic dermatitis: a comprehensive review

Cited by 88 publications

References 98 publications

Seborrheic dermatitis—Looking beyond Malassezia

Seborrheic dermatitis—Looking beyond Malassezia

<p>Clinical and instrumental evaluation of a new topical non-corticosteroid antifungal/anti-inflammatory/antiseborrheic combination cream for the treatment of mild-to-moderate facial seborrheic dermatitis</p>

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population‐based study in 161 269 employees

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