#seborrheic dermatitis - an overview of the conventional and more aggressive treatments.

 

Seborrheic dermatitis is a common inflammatory disorder that affects:

1. the scalp where it causes scales, what is also known as dandruff (Pityriasis capitis).
2. the face where it causes erythema (redness) and scaling usually located in the nasogenial folds and eyebrows.

Its cause is unknown but its severity is highly associated with the presence of the yeast of Malassezia species. Because of this, its main treatment consists of applying a topical antifungal cream twice a day. Other treatments consist of applying creams with anti-redness properties (mostly for their moisturizing and anti-irritating properties).

However, these efforts are sometimes not enough and an oral treatment can be proposed (although no cure has been found to this date). This review article summarizes them:

• antifungals: some evidence, but a limitation is that monitoring of yeast count/density was not performed in half of the studies. 
  • Itraconzole: 200mg daily for the first week of the month then 200mg for the first two days of the remaining months for up to a year.
  • Terbinafine: 250mg daily  for 4 to 6 weeks then 250mg 12 days per month for 3 months. Comment: terbinafine is not usually effective against yeasts and there is probably an alternative mechanism to its mode of action.
  • Fluconazole: 50mg daily for 2 weeks or 200-300mg weekly for up to 4 weeks. 
  • Ketoconazole: 200mg daily for 4 weeks.
  • Pramiconazole: 200mg as a single dose.

• oral prednisone: one case report. 0.5mg/Kg for 15 days with progressive tapering.
• oral isotretinoin: one case report. 20mg daily in combination with topical ketoconazole.
• homeopathic preparation of potassium bromide, sodium bromide, nickel sulfate and sodium chloride. Here, effects take longer to be appreciated.