Increased activity of sebaceous glands and infection with malassezia group of yeasts are the two basic causes for seborrheic dermatitis. For any treatment to be effective both these factors have to be dealt with properly. Getting the seborrheic dermatitis basic facts correct is thus essential for learning how to get rid of the disease.
How to Get Rid of Seborrheic Dermatitis?
Management of seborrheic dermatitis involves patient education, treatment of the acute phase and treatment of chronic or recurrent seborrhea.
Patient Education on Seborrheic Dermatitis
- Patients should realize that seborrheic dermatitis has no cure.
- Regular washing of scalp is essential.
- Normal shampoo can be alternated with anti-seborrrheic shampoos.
- Hair tonics and lotions with alcohol base will dry the scalp and aggravate seborrheic dermatitis.
- Avoid high fat, high calorie, fast foods and cut down on alcohol.
- Managing stress will help keep the sebaceous activity under control.
Treating the Acute Phase of Seborrheic Dermatitis
- Topical corticosteroids reduce the inflammation of the lesions. Inflammation settles initially more quickly with corticosteroids than with antifungals, but the outcome after 4 weeks of treatment is similar.
- Relapses after stoppage of topical steroids treatment is common. Hence mild steroids combined with anti-fungals like ketoconazole, clotrimazole or miconazole gives prolonged relief. Once the acute inflammation is controlled plain anti-fungal creams are applied weekly twice for maintenance of disease control. Higher strength steroids like clobetasol are best avoided in seborrheic dermatitis.
- Oral antifungal drugs are recommended when seborrheic dermatitis is severe or resistant to topical treatment.
- Oral antibiotics may be required for crusting and oozing caused by secondary bacterial infection.
How to Treat Chronic Seborrheic Dermatitis
Management of recurrent seborrheic eczema involves control of seborrhea or increased sebaceous activity, elimination of the yeast malassezia, removal of thick scales and treatment of resistant cases.
- Control of Seborrhea: Dietary control and stress management is essential in keeping the hormone mediated seborrhea in check. Regular shampooing and avoidance of any offending medications and alcohol will also help. Creams containing anti-seborrheic agents like zinc acetyl methionate or undecylenic acid derivatives should be applied regularly and rubbed well into the scalp.
- Elimination of Malassezia: Anti-yeast solutions or creams (canestan, daktarin) should be applied to the scalp 2 to 3 times every week. Shampoos containing ketoconazole, climbazole, zinc pyrethrone, cyclopiroxolamine, undecylenic acid etc will keep the disease under control. Shampoos should be used daily till scaling disappears, then maintained at a once or twice weekly application. Other shampoos containing tar, salicylic acid or selenium sulphide will be complementary in resistant cases. Severe cases will require systemic antifungals.
- Removal of Thick Scales: Presence of thick scales calls for aggressive therapy. Overnight application of creams containing tar, urea or salicylic acid will help to remove the thick scales. Rubbing with a warm mineral oil and washing off will also be helpful in moderate scaling. If crusting and oozing is present, a course of antibiotic along with a steroid-antifungal combination for 5-7 days will clear the secondary infection. Then anti-yeast and anti-seborrheic treatment as outlined above can be continued.
- Treatment of Resistant Cases: Class IV or lower strength topical steroid creams, lotions or solutions will help in controlling acute flares. Treatment resistant cases should get a 1-2 weeks course of systemic anti-yeast medications like ketoconazole, itraconazole or fluconazole.Once the severity is reduced other topical measures can be continued. Narrow band UVB therapy was found effective in the treatment of resistant seborrheic dermatitis in many patients.
What is the Normal Course of Seborrheic Dermatitis?
Infantile seborrheic dermatitis may resolve spontaneously after a few weeks, most cases resolve by 8 months of age. Adult seborrheic dermatitis usually lasts for years showing a waxing and waning course. Seborrheic dermatitis worsens during winter and improves during summer months.
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Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
Hanish Babu - Dr.Hanish Babu, MD is a dermatologist and a feature writer on Suite101.com with more than 200 articles related to skin diseases on the ...
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