Overview: Seborrheic Dermatitis

• Seborrheic dermatitis (SD) involves a predisposition toward a specific inflammatory desquamative reaction pattern in typically oily areas rich in Malassezia.

• An overabundance of or an inappropriate immune reaction to the common skin and follicular microflora species known as Malassezia (formerly Pityrosporum) has been both demonstrated and disputed in the literature.

• Since the identification of seven major strains of Malassezia in 1996, studies have begun to demonstrate which species are most predominant in SD in different populations.

• Malassezia globosa and Malassezia restricta predominate, according to some reports, and various other strains are reported to be associated with SD as well.

• Evidence both for and against an association with increased or altered sebum production has been presented, but increased sebum production leading to great greater growth of Malassezia seems to be a contributor.

Important points to consider

• Malassezia is a genus of fungi found to cause seborrhea and skin depigmentation commonly associated with tinea versicolor. It requires fat to grow and thus is common in sebaceous glands.

• Changing to antiinflammatory oils, controlling yeast on the skin and in the bowel, and calming the nervous system are mainstays in controlling seborrheic dermatitis.

• Many companies that produce probiotics claim to offer the absolute best species, combinations, or strains of bacteria. Clinicians are advised to start with an affordable Lactobacillus acidophilus or Bifidobacterium bifidus preparation and then add others to their personal pharmacopoeia as evaluation of a specific product is found to be convincing and its effects are confirmed to be beneficial. Different patients do better with different probiotic bacteria. Bifidobacterium bifidus is thought to be more beneficial initially.

Prevention Prescription

• Use a Mediterranean-type diet based on olive oil and fresh vegetables.

• Supplement with omega-3 essential fatty acids from fish oil, northern fish, and flaxseed.

• Reduce the intake of bread, cheese, wine, beer, and yeast. Reduce the intake of sugar, refined carbohydrates, and heated oils.

• Shampoo the scalp at least twice a week, with an antidandruff shampoo when necessary.

Integrative therapeutics review

• The following is an outline of therapeutic options for the treatment of seborrheic dermatitis. Determining which factors lead to the disease presentation in a given patient may improve the chances of success of a given therapy. For more severe or resistant cases, a progressive, sequential approach with multiple therapeutic avenues is recommended, with either intensification of treatments or addition of systemic pharmacologic agents, as indicated by the clinical response.

Antidandruff Shampoos

• Zinc pyrithione, selenium sulfide (Selsun), tat, or ketoconazole (Nizoral) shampoo is used for 5 minutes two or three times/week.

• If the patient has med one type with no clinical improvement, another can be tried.

Antiyeast Creams

• Ketoconazole cream 2% (Nizoral) or another pharmacologic or herbal substitute works well on the face and nonicaly areas.

Supplements

• Eicosapentaenoic acid and docosahexaenoic acid (fish oils) can be added at 1 to 2 g/day and titrated to clinical improvement.

• Other sources of omega-3 essential fatty acids-oily cold-water fish, such as salmon and sardines, three to five servings/week, and flaxseed oil, 1 teaspoon/day-can be used.

• Vitamin E 400 units/day should be given with these oils to prevent oxidation. Vitamin B comples, vitamin B, 500 mg.

• and biotin up to 8 mg/day may be beneficial in patients with resistant cases. Caprylic acid is taken at 100 to 200 mg two to three times/day

Nutrition

• A diet low in yeast and simple carbohydrates. especially one that eliminates bread, cheese, wine, beet, fermented foods, and starches, is helpful in patients with persistent cases.

• Some improvement may result from removal of other food allergens Adding probiotic bacteria such as Lactobacillas acidophilus, one capsule/meal, or live-culture yogurt may also help.

Botanicals

• The antiyeast botanicals grapefruit seed extract and Artemisia annua may be used at two to six capsules/day.

• Undecenoic acid, derived from the castor bean, is another antiyeast product (Formula SF 722 [Thorne Research, Sandpoint, Idaho), used at two to six capsules/day.

Pharmaceuticals

• Nystatin is used in slowly increasing doses from 0.5 to 6 million units/day

• Fluconazole (Diflucan) is taken at 100 to 200 mg/day for 2 weeks, for resistant cases. This agent is best used after dietary, herbal, and supplement methods have been employed to reduce the yeast flora and to attenuate the ecologic factors favoring yeast growth

• Triamcinolone solution or betamethasone valerate foam (Luxiq) once or twice daily can be used to relieve pruritus and inflammation.

Key Web Sources

• www.bolaticdermatology.com

• httpřemedicine.medscape.com/article/1108312-frestment

• http.//www.aal org/public/publications/pamphlets/common_seb_dermatitis

• http://en.wikipedia.org/wiki/Seborrhoeic_dermatitia