Dermatology in India
Systematic review of oral treatments for seborrheic dermatitis.
Gupta AK, Richardson M, Paquet M.
J Eur Acad Dermatol Venereol. 2014 Jan;28(1):16-26. doi: 10.1111/jdv.12197. Epub 2013 Jun 26.
- Seborrheic dermatitis (SD) is a common inflammatory disorder which affects:
- the scalp where it creates flaking of the skin or what is known as common dandruff (Pityriasis capitis).
- the face where it creates erythema (redness) and scaling usually localized to the nasogenial folds and the eyebrows.
- Its cause is unknown but it is strongly linked with regards to its severity to the presence of a yeast of the Malassezia species. Because of this, its main treatment consists of applying a topical antifungal cream twice a day.
- Other treatments consist of applying OTC (over-the-counter) creams with anti-redness properties (mostly for their moisturizing anti-irritating properties).
- However, these measures are sometimes not enough and an oral treatment can be proposed (although no cure has been found to this date). The following review article summarizes them:
- antifungals: some evidence, but the problem is that monitoring of yeast count/density was not performed in half of the studies. Also many stuies were not randomized-control trials (RCT).
- Itraconzole: 200mg daily for the first week of the month then 200mg for the first two days of the month 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. In our clinical experience we have seen some effect and the studies performed included mild to moderate SD (wheareas the other studies only included moderate-to-severe SD, or unresponsive to conventional treatments)
- 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, one RCT with 53 patients showing a maximum effect after 15 weeks (www.almedrev.com/publications/7/1/59.pdf)
Contributors
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
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