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Medical Edge Newspaper Column from Mayo Clinic
SEBORRHEIC DERMATITIS: A CHRONIC BUT CONTROLLABLE CONDITION
DEAR MAYO CLINIC: I’ve had seborrheic dermatitis for a very long time, and have used everything available to try to combat it. I’ve been told that it’s incurable. Is there anything new to try? — Niles, Ill.
ANSWER: Seborrheic dermatitis is a common disorder of the scalp that can also affect other areas — such as the eyebrows, sides of the nose, backs of the ears, chest, groin area and armpits — that are rich in an oil (sebum) produced by sebaceous glands. In addition to white flakes that shed from the scalp, SD is associated with greasy and inflamed skin; scaling; and the overproduction of a yeast-like fungus called Malassezia, which feeds on the oil and exacerbates the inflammation, scaling and flaking.
Although the precise causes of SD are not known, the sebum and fungus are thought, singly or together, to provoke an immune reaction and hence inflammation. Hormones and an individual’s genetic makeup are also thought to play roles.
In any case, while SD is typically a chronic condition, it is controllable.
Treatment options clear the skin of excess oil, reduce the fungus population, relieve inflammation, and remove built-up layers of skin and oil. Corresponding medications usually fall in one of two categories: 1) shampoos, which the patient applies to the scalp or other skin areas and then washes off; and 2) lotions, creams, solutions, foams or sprays that are applied to affected areas and then left on for the skin to absorb.
The classic antifungal agents are selenium sulfide (brand names include Selsun and Exsel), zinc pyrithione (DHS Zinc, Head & Shoulders), ketoconazole (Nizoral), and coal tar (DHS Tar, Neutrogena T/Gel, Polytar).
Coal tar is an anti-inflammatory agent as well. There is a wide array of corticosteroid anti-inflammatories, ranging from the weak — such as fluocinolone (Synalar) — to the strong, such as clobetasol (Temovate). The sensible strategy with steroidal preparations is to start out with a relatively mild medication and then move to a stronger agent, if necessary.
Meanwhile, salicylic acid (X-Seb, Scalpicin) may be used to “debride” unwanted tissue — that is, rid the skin of excess scale and oil by physically removing it.
Many of these options are probably familiar to you, and have apparently disappointed you, as you’ve used “everything available” without success. I wonder, though, if you’ve used them to maximum effect. In my own practice, I’ve found that a helpful strategy is for the patient to experiment with various shampoos and other products. Synergisms between these substances — specific antifungals, anti-inflammatories and debriding agents — used together can sometimes yield much better results.
New medications you might not have tried include fluocinolone acetonide (Capex), an anti-inflammatory corticosteroid shampoo, and Dermasmoothe F/S, which combines a corticosteroid solution with peanut oil to help remove thick scale. I often prescribe this latter drug in combination with other agents. The dermasmoothe is applied at night and, if applied to the scalp, covered with a shower cap. It is then washed off in the morning with a medicated shampoo.
Two other new agents, pimecrolimus (Elidel) and tacrolimus (Protopic), happen to be controversial. These anti-inflammatories do not contain corticosteroids (which, if used over long periods, can cause thinning of the skin). They feature immune-system-suppressing agents instead. And while they have been approved by the U.S. Food and Drug Administration for other conditions, the agency has not yet approved them for seborrheic dermatitis. Nevertheless, because many dermatologists are excited about these new options, the FDA has permitted their use for SD as long as the bottle carries a warning that the long-term side effects are as yet unknown.
Finally, for severe SD, ultraviolet-light treatment has sometimes been effective in reducing inflammation.
And one last observation: It’s always possible, given the unresponsiveness to treatment, that your problem is not SD but some other condition. It might be advisable to see your doctor so that he or she can consider other diagnoses.
— Catherine C. Newman, M.D., Dermatology, Mayo Clinic, Rochester, Minn.
Additional Resources:
Seborrheic Dermatitis
Appointment Information
More Information on Seborrheic Dermatitis
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2006 TRIBUNE MEDIA SERVICES, INC.
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