Seborrhoeic dermatitis: Difference between revisions
→Treatments: Noted lack of references, use of weasel words "it is believed," citation needed for food treatments |
→Antifungal: Removed unsourced claims about food treatments |
||
Line 101: | Line 101: | ||
*[[Ketoconazole]] |
*[[Ketoconazole]] |
||
*[[Itraconazole]]<ref>Shemer A, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H.; Oral Itraconazole Seborrheic Dermatitis PMID: 18669136 [http://www.ncbi.nlm.nih.gov/pubmed/18669136]</ref> |
*[[Itraconazole]]<ref>Shemer A, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H.; Oral Itraconazole Seborrheic Dermatitis PMID: 18669136 [http://www.ncbi.nlm.nih.gov/pubmed/18669136]</ref> |
||
Anti-fungal foods such as [[ginger]], [[turmeric]], [[sage]], [[radish]], [[coconut oil]], [[oregano]] and [[olive oil]] when included in the daily diet may help in controlling the yeast growth. {{fact}} |
|||
=== Medications other than antifungals=== |
=== Medications other than antifungals=== |
Revision as of 20:07, 12 July 2010
![]() |
Seborrhoeic dermatitis | |
---|---|
Specialty | Dermatology ![]() |
Seborrhoeic dermatitis (also Seborrheic dermatitis AmE, seborrhea) (also known as "Seborrheic eczema"[1]) is an inflammatory[2] skin disorder affecting the scalp, face, and trunk causing scaly, flaky, itchy, red skin. It particularly affects the sebum-gland rich areas of skin.
Causes
The cause of seborrhoeic dermatitis remains unknown,[3] although many factors have been implicated.
![](http://upload.wikimedia.org/wikipedia/commons/thumb/f/f4/Seborrhoeic_dermatitis_head.jpg/200px-Seborrhoeic_dermatitis_head.jpg)
Stress
Seborrhoeic dermatitis may be aggravated by illness, psychological stress, fatigue, change of season and reduced general health.
In adolescents and adults, seborrhoeic dermatitis usually presents as scalp scaling (dandruff) or as mild to marked erythema of the nasolabial fold during times of stress or sleep deprivation.[4]
Nutritional hypo- and hyperalimentation
In children, excessive vitamin A intake can cause seborrhoeic dermatitis.[5]
Lack of biotin,[4] pyridoxine (vitamin B6)[4][6] and riboflavin (vitamin B2)[4] may also be a cause.
Fungal
![](http://upload.wikimedia.org/wikipedia/commons/thumb/e/ed/Seborrhoeic_dermatitis_example.jpg/200px-Seborrhoeic_dermatitis_example.jpg)
Alternatively, Seborrhoeic dermatitis is believed to be an inflammatory reaction related to a proliferation of a normal skin inhabitant, a yeast called Malassezia (formerly known as Pityrosporum ovale). The main species found in the scalp is M. globosa. It produces toxic substances that irritate the skin. Patients with seborrhoeic dermatitis appear to have a reduced resistance to the yeast.[citation needed]
Malassezia growth is supported by saturated, not unsaturated fatty acids. In all cases, pure, unsaturated FAs were unable to support growth of M. globosa or M. furfur. Interestingly, growth of both species was supported by saturated FAs. This is further evidenced by lard, which is rich in saturated triglycerides. Implications for Dandruff and Seborrheic Dermatitis: Previously, it has been shown that: 1.While number density of M. globosa and M. restricta do not directly correlate to dandruff presence or severity, removal correlates directly with amelioration of flaking. 2.In dandruff susceptible individuals pure OA, an unsaturated FA and Malassezia metabolite, induces flaking in the absence of Malassezia7 by direct effects on the host skin barrier. This finding, that Malassezia require saturated, and not unsaturated FAs, coupled with previous data, supports the following hypothesis:
Malassezia hydrolyze human sebum, releasing a mixture of saturated and unsaturated fatty acids. They take up the required saturated FAs, leaving behind unsaturated FAs. The unsaturated FAs penetrate the stratum corneum and due to their non-uniform structure breach the skins barrier function. This barrier breach induces an irritation response, leading to dandruff and seborrheic dermatitis.[7]
The widely present yeast, Malassezia furfur (formerly known as Pityrosporum ovale), is involved,[8][9] as well as genetic, environmental, hormonal, and immune-system factors.[10][11] The claim that seborrhoeic dermatitis is an inflammatory response to the yeast has not been proven.[12] Those afflicted with seborrhoeic dermatitis have an unfavourable epidermic response to the infection, with the skin becoming inflamed and flaking.
Secondary to other medical conditions
The condition is one of the autonomic signs of Parkinson's disease.
Those with immunodeficiency (especially infection with HIV) and with neurological disorders such as Parkinson's disease and stroke are particularly prone to it.[13]
Symptoms
![](http://upload.wikimedia.org/wikipedia/commons/thumb/2/23/Seborrhoeic_dermatitis_example2.jpg/200px-Seborrhoeic_dermatitis_example2.jpg)
The condition's symptoms appear gradually and usually the first signs of seborrheic dermatitis are the flakes of skin called dandruff.[14] The symptoms may occur anywhere on the skin of the face, behind the ears and in areas where the skin folds. These are common sites that become red and flaky. The flakes can be yellow, white or grayish.[15] In more rare cases, redness and flaking may occur on the skin near the eyelashes, on the forehead or around the sides of the nose. Other body areas where these symptoms occur are the chest and upper back. The symptoms of seborrheic dermatitis can appear basically on any part of the body where there is certain amount of hair and therefore follicles which might became inflamed. A sign that the condition has become more severe is the formation of thick, oily and yellow scales which might appear on the forehead, around the sides of the nose or on the skin near the eyelashes.
In more severe cases, yellowish to reddish scaly pimples appear along the hairline, behind the ears, in the ear canal, on the eyebrows, on the bridge of the nose, around the nose, on the chest, and on the upper back.[16]
Commonly, patients experience mild redness, skin lesions and in some cases hair loss.[17] Other symptoms include patchy scaling or thick crusts on the scalp, red, greasy skin covered with flaky white or yellow scales, itching, soreness and yellow or white scales that may attach to the hair shaft.[18]
Seborrheic dermatitis can occur in infants younger than three months and it causes a thick, oily, yellowish crust around the hairline and on the scalp. Itching is not common among infants. Frequently, a stubborn diaper rash accompanies the scalp rash.[19] Usually, when it occurs in infants the condition resolves itself within days and with no treatment.
Many patients experience alternating periods of the symptoms, when they either improve or suddenly worsen. In adults, symptoms of seborrheic dermatitis may last from few weeks to even years.
The condition is referred to a specialist when it becomes painful, the individual suspects that the skin might have become infected or they have tried self-care therapy without success. Also, seborrheic dermatitis can cause discomfort and interfere in one's daily activities. Addressing the condition to a doctor is important in order to prevent potentially long-lasting damage to the hair follicles which may lead to hair loss.
Hair loss
Side effects to inflammation may include temporary hair loss. If severe outbreaks are untreated for extended intervals, permanent hair loss may result, because of damage to hair follicles.[citation needed]
It is still unclear if seborrheic dermatitis causes permanent hair loss, although the inflammation involves the hair follicles.[20] Some researchers claim that the yeast causing seborrheic dermatitis is the main cause of hair loss due to this condition. For others, hair loss can be a result of the many other factors combined: excess oil production by the oil glands due to reasons such as hormonal imbalance, stress, extreme hot or cold weather conditions, weakened immune system, Parkinson's disease, certain neurological conditions and keeping the scalp unclean.
Treatments
Dermatologist recommend topical treatments such as shampoos, cleansers or creams/lotions that contain antifungal, anti-inflammatory, sebo-suppressive or keratolytic ingredients:
One approach is to try different combinations of the usual agents: a dandruff shampoo, an antifungal agent and a topical steroid. If this fails, short-term use of a more potent topical steroid in a "pulse fashion" may put some refractory patients into remission and actually decrease the total steroid exposure. Therapeutic choices for pulse therapy may include a nonfluorinated class III steroid such as mometasone furoate (Elocon) or an extra-potent class I or class II topical steroid such as clobetasol propionate (Temovate) or fluocinonide (Lidex). The class III topical steroid should be tried first, but if the condition remains unresponsive, the clinician may then choose to use a class I agent. These more potent agents may be applied once or twice per day, even on the face, but must be stopped after two weeks because of the increased frequency of side effects. If the patient responds before the two-week limit, the agent should be stopped immediately. Adjuvant therapy including use of a dandruff shampoo, an antifungal agent, or both, is essential during the "pulse" period and should be continued as maintenance therapy after each pulse.
Treating seborrheic dermatitis is quite difficult to achieve given that there seem to be more than just one factor contributing to its development, but the condition can be held under control with few measures. Controlling the disorder can be done by using various medicated shampoos or creams. Maintaining the scalp clean is mandatory for sufferers of seborrheic dermatitis and therefore using anti-dandruff shampoos which are effective may be one way of preventing getting this condition. Also, there are several special shampoos that contain sulfur, zinc or salicylic acid. A throughout cleaning of the scalp is the first step to be made in preventing and curing this condition because by having a proper scalp hygiene, the bacteria and fungus are removed and the likelihood of developing a follicular inflammation is reduced.
Some creams may also be used to treat hair loss due to seborrheic dermatitis. Topical cortisone creams are highly effective in minimizing the symptoms of this condition, especially inflammation and itchiness. These creams are only available on prescription. On the other hand, it is believed [by whom?] that garlic ingestion can help in minimizing the fungal infection on the scalp. Moreover, a change in the diet should be considered given that foods rich in antioxidants and beta-carotene are efficient in reducing the inflammation[citation needed].
Antifungal
OTC: Over the counter
- zinc pyrithione
- salicylic acid
- selenium sulfide
- ketoconazole 1%
- climbazole
- Piroctone olamine
- Clotrimazole
Prescription
Medications other than antifungals
- vitamin B6 ointment[25]
- Topical steroid:Chronic treatment with topical corticosteroids may lead to permanent atrophy and telangiectasia of the skin.[26][27]
- Pimecrolimus Elidel [28]
Isotretinoin (Accutane) at low dose 5 mg to 10 mg: As a last resort in refractory disease, sebosuppressive agent isotretinoin (Accutane) may be used to reduce sebaceous gland activity. However, isotretinoin has potentially serious side effects and few patients with seborrhea are appropriate candidates for therapy.
Phototherapy
Dermatologists recommend the use of photodynamic therapy also known as phototherapy which uses UV-A and UV-B laser or Red and Blue LED light to inhibit the growth of Malassezia and reduce the inflammation,[29][30][31]
Natural treatments
- Aloe Vera applied topically [32][33]
- Tea tree oil: diluted to 5% applied topically [34][35]
- Viola tricolor or Heartsease: applied topically. Is recognised by Germany's Commission E as Monograph 195 for the treatment of Cradle Cap a form of seborrheic dermatitis.[36][37][38]
- Honey apply diluted crude(raw)honey (90% honey diluted in warm water) every other day on the lesions with gentle rubbing for 2-3 mins. Honey is left on for 3 hr before gentle rinsing with warm water. Treatment is continued for 4 weeks.[39]
- Avocado Extracts: AV119[40] & 5-alpha Avocuta, also known as Butyl Avocadate[41] applied topically.
- Monarda fistulosa[42]
Supplements
- Probiotics Lactobacillus casei[43] and Lactobacillus paracasei[44]
- Lactoferrin [45]
- Vitamin B7 Biotin
- Vitamin B6
- Vitamin B2
- Vitamin B3: Nicotinamide, also known as Niacinamide
- Zinc [46][47][48][49][50][51]
Diet
There is evidence that there is relationship between seborrheic dermatitis and intestinal yeast, such as candida.[52] An antifungal diet consisting of the elimination of sugar should reduce seborrheic dermatitis.[53][54]
Alternative treatments
Applying milk of magnesia may help clear up seborrheic dermatitis; one may apply on the face while showering and rinse off at the end of the shower.[55]
See also
References
- ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
- ^ "seborrheic dermatitis" at Dorland's Medical Dictionary
- ^ http://www.medicinenet.com/seborrhea/article.htm
- ^ a b c d Schwartz RA, Janusz CA, Janniger CK (2006). "Seborrheic dermatitis: an overview". American Family Physician. 74 (1): 125–30. PMID 16848386.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ MedlinePlus Encyclopedia: Hypervitaminosis A
- ^ Nutritional Neuropathy at eMedicine
- ^ http://www.pgbeautygroomingscience.com/role-of-lipid-metabolism-in-seborrheic-dermatitis-dandruff.html
- ^ Hay RJ, Graham-Brown RA (1997). "Dandruff and seborrhoeic dermatitis: causes and management". Clinical and Experimental Dermatology. 22 (1): 3–6. doi:10.1046/j.1365-2230.1997.d01-231.x. PMID 9330043.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Nowicki R (2006). "[Modern management of dandruff]". Polski Merkuriusz Lekarski (in Polish). 20 (115): 121–4. PMID 16617752.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Johnson BA, Nunley JR (2000). "Treatment of seborrheic dermatitis". American Family Physician. 61 (9): 2703–10, 2713–4. PMID 10821151.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Janniger CK, Schwartz RA (1995). "Seborrheic dermatitis". American Family Physician. 52 (1): 149–55, 159–60. PMID 7604759.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Parry ME, Sharpe GR (1998). "Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast". The British Journal of Dermatology. 139 (2): 254–63. doi:10.1046/j.1365-2133.1998.02362.x. PMID 9767239.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html
- ^ "Dermatitis Seborrheic Treatment". Retrieved June 11, 2010.
- ^ "Seborrheic Dermatitis". Retrieved June 11, 2010.
- ^ "Dermatitis". Retrieved June 11, 2010.
- ^ "What is Seborrheic Dermatitis?". Retrieved June 11, 2010.
- ^ "Symptoms". Retrieved June 11, 2010.
- ^ "Dermatitis". Retrieved June 11, 2010.
- ^ "Seborrheic Dermatitis and Dandruff". Retrieved June 11, 2010.
- ^ Faergemann J, Jones JC, Hettler O, Loria Y (1996). "Pityrosporum ovale (Malassezia furfur) as the causative agent of seborrhoeic dermatitis: new treatment options". The British Journal of Dermatology. 134 (Suppl 46): 12–5: discussion 38. doi:10.1111/j.1365-2133.1996.tb15652.x. PMID 8763461.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Shemer A, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H.; Oral Itraconazole Seborrheic Dermatitis PMID: 18669136 [1]
- ^ [2]
- ^ Leeming JP (1993). "Use of topical lithium succinate in the treatment of seborrhoeic dermatitis". Dermatology (Basel). 187 (2): 149–50. PMID 8358107.
- ^ Murray, Michael; Pizzorno, Joseph (1997). "Encyclopedia of Natural Medicine" (Revised 2nd Edition) Three Rivers Press. ISBN 0-7615-1157-1[page needed]
- ^ Smith JG, Wehr RF, Chalker DK (1976). "Corticosteroid-induced cutaneous atrophy and telangiectasia. Experimental production associated with weight loss in rats". Archives of Dermatology. 112 (8): 1115–7. doi:10.1001/archderm.112.8.1115. PMID 952530.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ Scheinfeld NS (2005). "Seborrheic dermatitis". Skinmed. 4 (1): 49–50. doi:10.1111/j.1540-9740.2005.03961.x. PMID 15654167.
- ^ Firooz A, Solhpour A, Gorouhi F, Daneshpazhooh M, Balighi K, Farsinejad K, Rashighi-Firoozabadi M, Dowlati Y (2006). "Pimecrolimus cream, 1%, vs hydrocortisone acetate cream, 1%, in the treatment of facial seborrheic dermatitis: a randomized, investigator-blind, clinical trial". Archives of Dermatology. 142 (8): 1066–1067. doi:10.1001/archderm.142.8.1066. PMID 16924062.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Wikler JR, Janssen N, Bruynzeel DP, Nieboer C (1990). "The effect of UV-light on pityrosporum yeasts: ultrastructural changes and inhibition of growth". Acta Dermato-venereologica. 70 (1): 69–71. PMID 1967880.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Calzavara-Pinton PG, Venturini M, Sala R (2005). "A comprehensive overview of photodynamic therapy in the treatment of superficial fungal infections of the skin". Photochem Photobiol. PMID 15629243.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Tim Maisch,a Rolf-Markus Szeimies,a Giulio Jori*b and Christoph Abels (2004 [3]). "Antibacterial photodynamic therapy in dermatology".
{{cite journal}}
: Check date values in:|year=
(help); Cite journal requires|journal=
(help); External link in
(help)CS1 maint: multiple names: authors list (link) CS1 maint: year (link)|year=
- ^ "WHO Monographs on Selected Medicinal Plants - Volume 1: Aloe Vera Gel". World Health Organization. Retrieved 2008-03-18.
- ^ Feily A, Namazi MR (2009). "Aloe vera in dermatology: a brief review". Giornale Italiano Di Dermatologia E Venereologia. 144 (1): 85–91. PMID 19218914.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Gupta AK, Nicol K, Batra R (2004). "Role of antifungal agents in the treatment of seborrheic dermatitis". American Journal of Clinical Dermatology. 5 (6): 417–22. doi:10.2165/00128071-200405060-00006. PMID 15663338.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ Satchell AC, Saurajen A, Bell C, Barnetson RS (2002). "Treatment of dandruff with 5% tea tree oil shampoo". Journal of the American Academy of Dermatology. 47 (6): 852–5. doi:10.1067/mjd.2002.122734. PMID 12451368.
{{cite journal}}
: Unknown parameter|month=
ignored (help)CS1 maint: multiple names: authors list (link) - ^ http://www.botanical.com/botanical/mgmh/h/hearts10.html
- ^ Matthias Augustin: 6.46 Stiefmütterchen In: Phytotherapie bei Hauterkrankungen, S.226-227; Elsevier, Urban & Fischer 2004. ISBN 978-3-437-56120-7 Volltext
- ^ Meyer, S.; Vogt, T.; Landthaler, M.; Karrer, S. (2005). "Einsatz von Phytopharmaka in der Dermatologie". Der Hautarzt. 56: 483. doi:10.1007/s00105-005-0949-y.
- ^ Al-Waili NS (2001). "Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff". European Journal of Medical Research. 6 (7): 306–8. PMID 11485891.
{{cite journal}}
: Unknown parameter|month=
ignored (help) - ^ Donnarumma G, Buommino E, Baroni A, Auricchio L, De Filippis A, Cozza V, Msika P, Piccardi N, Tufano MA. Effects of AV119, a natural sugar from avocado, on Malassezia furfur invasiveness and on the expression of HBD-2 and cytokines in human keratinocytes. Exp Dermatol. 2007 Nov;16(11):912-9. PMID: 17927574 [4]
- ^ Piccardi N, Piccirilli A, Choulot JC, Chadoutaud B, Msika P; Pharmacological and Clinical Activities of 5-Alpha Avocuta : Application for the Management of Androgenic Disorders [5]
- ^ Zhilyakova ET, Novikov OO, Naumenko EN, Krichkovskaya LV, Kiseleva TS, Timoshenko EY, Novikova MY, Litvinov SA. Study of Monarda fistulosa essential oil as a prospective antiseborrheic agent. Bull Exp Biol Med. 2009 Oct;148(4):612-4. PMID: 20396753
- ^ . PMID 19367116.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ A.G. Gueniche , D. Philippe , P. Bastien , E. Buyukpamukcu , P. Reygagne , I. Castiel(Clichy; France)Oral supplementation with probiotic Lactobacillus paracasei ST improves dandruff condition [6] [7][verification needed]
- ^ Kiratli H, Irkeç M, Orhan M (2000). "Tear lactoferrin levels in chronic meibomitis associated with acne rosacea". European Journal of Ophthalmology. 10 (1): 11–4. PMID 10744199.
{{cite journal}}
: CS1 maint: multiple names: authors list (link) - ^ . PMID 11586012.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 9486690.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 9309801.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 2947051.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 161345.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 111624.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 2533189.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 2556862.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ . PMID 2939630.
{{cite journal}}
: Cite journal requires|journal=
(help); Missing or empty|title=
(help) - ^ Graedon, Joe; Graedon, Teresa (2008-04-17). "The People's Pharmacy". Atlanta Journal Constitution Evening Edge. Atlanta Journal Constitution. p. 15.