Treatment of facial seborrheic dermatitis with pimecrolimus cream 1%: an open-label clinical study in Korean patients

Clinical efficacy of a combination treatment of traditional Chinese medicine for scalp seborrheic dermatitis

OBJECTIVE

To evaluate the clinical efficacy of a combination treatment of traditional Chinese medicine (TCM) in scalp seborrheic dermatitis (SSD) of differing severity.

METHODS

Our study included patients with typical SSD who visited the Medical Research Center for Hair and Skin at our hospital. Symptoms were evaluated using a "16-point scale" developed at the center. Patients who had mild SSD were treated with Pi Fu Kang Xi Ye (PFKXY), those with moderate SSD were treated with PFKXY combined with Run Zao Zhi Yang Jiao Nang (RZZYJN), and those with severe dermatitis were treated with PFKXY and RZZYJN along with garlicin enteric-coated tablets. Patients were asked to revisit 4 weeks later to evaluate the efficacy.

RESULTS

Symptom scores of all patients decreased by (5.48 ± 2.51) after treatment as compared with before treatment, and the results of t-test and correlation test were significant (p < 0.01). The scores of patients with mild, moderate and severe SSD decreased by 3.14 ± 1.83, 4.90 ± 1.77, and 8.05 ± 2.21, respectively, after treatment as compared with before treatment. Among them, the changes in scores of patients with moderate dermatitis before and after treatment were significant in the t-test and correlation test (p < 0.01).

CONCLUSION

In this study, the combination treatment of TCM showed significant efficacy in the treatment of mild, moderate, and severe SSD, and the efficacy was stable, especially for patients with moderate SSD.

Establishment of clinical evaluation criteria for scalp seborrheic dermatitis

PURPOSE

To evaluate the three symptom indicators of scalp seborrheic dermatitis (SSD), namely scalp flaking, maximum erythema area, and pruritus, to develop a "16-point scale," to explore its relationship with the severity of SSD, and verify the reliability of the 16-point scale.

METHOD

A dermatologist evaluated patients with SSD using a 16-point scale, and statistically analyzed the collected data with the help of SPSS 26.0 software. The measurement data are expressed as (mean ± SD), and the intergroup comparison was done using a non-parametric test. We performed the correlation analysis using the bivariate correlation analysis method, and the relationship among non-normal distribution data variables were analyzed using Spearman's correlation coefficient. p < 0.05 indicated that the difference was statistically significant.

RESULTS

The total score of the "16-point scale" strongly correlated with the severity of disease, where scalp flaking had the strongest correlation. As compared with a single score, the correlation of the total score with the severity of disease was higher. The scoring range for mild patients was (0, 5], that for moderate patients was (5, 9], and that for severe patients was (9, 16].

CONCLUSION

A "16-point scale", consisting of items for adherent scalp flaking (0-10), maximum erythema area (0-3), and pruritus (0-3), was used to score the patients with SSD, and the total score was strongly correlated with and differentiated the severity of SSD. Recommended evaluation criteria: a total score of 0-5 points indicates mild SSD, 6-9 points indicates moderate SSD, 10-16 points indicates severe SSD. These criteria can help to standardize disease diagnosis and treatment, and efficacy assessment.

The Efficacy and Safety of Pimecrolimus 1% Cream versus Sertaconazole 2% Cream in the Treatment of Patients with Facial Seborrheic Dermatitis: A Randomized Blinded Trial

BACKGROUND

Facial seborrheic dermatitis (FSD) as a chronic inflammatory skin disorder is characterized by remission and exacerbation episodes. In most cases, FSD requires a long-term treatment.

OBJECTIVES

This study aimed to compare the efficacy and safety of pimecrolimus and sertaconazole in patients with FSD.

METHODS

In this double-blinded, and randomized trial 60 patients with FSD were included and instructed to topically apply either pimecrolimus 1% cream (30 patients) or sertaconazole 2% cream (30 patients) twice daily for 4-weeks. Assessment of the disease severity was performed at baseline, on day 14 and day 28, and 4 weeks after termination of treatment, based on Scoring Index (SI). The levels of satisfaction from treatment and side effects were also assessed in both groups.

RESULTS

Although the severity of disease reduced upon treatment in both groups, application of pimecrolimus caused a significant improvement as compared to the sertaconazole on day 14 and day 28 (P=0.002 and P<0.001, respectively). The rate of relapse was significantly lower in the pimecrolimus group as compared to the sertaconazole after 28 days of treatment termination (P=0.012). The highest level of satisfaction (46.7%) was observed on day 28 in pimecrolimus group. Both of topical treatments had acceptable safety profiles, however, pimecrolimus 1% cream showed more safety compared to the sertaconazole 2% cream, in the term of irritation (P=0.003).

CONCLUSION

This study showed that pimecrolimus was associated with a quicker response and fewer side effects as compared to sertaconazole in patients with FSD.

Treatment of seborrheic dermatitis: a comprehensive review

Seborrheic dermatitis (SD) is a chronic, recurring inflammatory skin disorder that manifests as erythematous macules or plaques with varying levels of scaling associated with pruritus. The condition typically occurs as an inflammatory response to Malassezia species and tends to occur on seborrheic areas, such as the scalp, face, chest, back, axilla, and groin areas. SD treatment focuses on clearing signs of the disease; ameliorating associated symptoms, such as pruritus; and maintaining remission with long-term therapy. Since the primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation, the most commonly used treatment is topical antifungal and anti-inflammatory agents. Other broadly used therapies include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, phototherapy, among others. Alternative therapies have also been reported, such as tea tree oil, Quassia amara, and Solanum chrysotrichum. Systemic therapy is reserved only for widespread lesions or in cases that are refractory to topical treatment. Thus, in this comprehensive review, we summarize the current knowledge on SD treatment and attempt to provide appropriate directions for future cases that dermatologists may face.

Comparison of different regimens of pimecrolimus 1% cream in the treatment of facial seborrheic dermatitis

BACKGROUND

Pimecrolimus 1% cream has already been proved to be an effective and safe alternative to treat seborrheic dermatitis. However, the treatment periods were inconstant in previous studies.

OBJECTIVE

To evaluate the comparative efficacy of pimecrolimus 1% cream with different regimens for the treatment of facial seborrheic dermatitis.

METHOD

Thirty patients with facial seborrheic dermatitis were enrolled and randomly distributed to three groups. Patients of Group 1 were treated with topical pimecrolimus cream 1% twice daily for 2 weeks and then a moisturizer cream twice daily for 2 weeks. Patients of Group 2 were treated with pimecrolimus cream 1% twice daily for 2 weeks and then once daily for another 2 weeks. Patients of Group 3 had a consecutive course of pimecrolimus cream 1% twice daily for 4 weeks. Objective symptoms, subjective symptoms, and dermatology life quality index (DLQI) were measured at weeks 0, 2, 4, and 6.

RESULTS

At week 4, the clinical severity scores of all three regimens significantly decreased (P<.01). The improvement of total severity score in Group 3 was more remarkable than groups 1 and 2 (both P<.05). This effect was maintained until the end of the study in Group 3. Life quality of all three groups was significantly improved at week 4 (P<.001), while there was no statistical difference on the improvement of life quality among three groups.

CONCLUSION

We recommend pimecrolimus 1% cream could be applied twice a day for 4 weeks to treat seborrheic dermatitis.

Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review

BACKGROUND

Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition.

OBJECTIVE

Our objective was to critically review the published literature on topical treatments for facial SD.

METHODS

We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies.

RESULTS

A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment.

CONCLUSION

Promiseb^®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials).

Seborrheic Dermatitis and Dandruff: A Comprehensive Review

Seborrheic Dermatitis (SD) and dandruff are of a continuous spectrum of the same disease that affects the seborrheic areas of the body. Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD can affect the scalp as well as other seborrheic areas, and involves itchy and flaking or scaling skin, inflammation and pruritus. Various intrinsic and environmental factors, such as sebaceous secretions, skin surface fungal colonization, individual susceptibility, and interactions between these factors, all contribute to the pathogenesis of SD and dandruff. In this review, we summarize the current knowledge on SD and dandruff, including epidemiology, burden of disease, clinical presentations and diagnosis, treatment, genetic studies in humans and animal models, and predisposing factors. Genetic and biochemical studies and investigations in animal models provide further insight on the pathophysiology and strategies for better treatment.

Maintenance Therapy of Facial Seborrheic Dermatitis with 0.1% Tacrolimus Ointment

BACKGROUND

Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment.

OBJECTIVE

The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD.

METHODS

During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect.

RESULTS

The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well.

CONCLUSION

The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.

Evaluation of a Topical Anti-inflammatory/Antifungal Combination Cream in Mild-to-moderate Facial Seborrheic Dermatitis: An Intra-subject Controlled Trial Examining Treated vs. Untreated Skin Utilizing Clinical Features and Erythema-directed Digital Photography

OBJECTIVE

To evaluate if nonprescription topical agents may provide positive outcomes in the management of mild-to-moderate facial seborrheic dermatitis by reducing inflammation and scale production through clinical evaluation and erythema-directed digital photography.

SETTING

Open-label, prospective, not-blinded, intra-patient, controlled, clinical trial (target area).

PARTICIPANTS

Twenty adult subjects affected by mild-to-moderate facial seborrheic dermatitis were enrolled and instructed to apply the study cream two times daily, initially on a selected target area only for seven days. If the subject developed visible improvement, it was advised to extend the application to all facial affected area for 21 additional days.

MEASUREMENT

Efficacy was evaluated by measuring the grade of erythema (by clinical examination and by erythema-directed digital photography), desquamation (by clinical examination), and pruritus (by subject-completed visual analog scale). Additionally, at the end of the protocol, a Physician Global Assessment was carried out.

RESULTS

Eighteen subjects completed the study, whereas two subjects were lost to follow-up for nonadherence and personal reasons, respectively. Day 7 data from target areas showed a significant reduction in erythema. At the end of study, a significant improvement was recorded for erythema, desquamation, and pruritus compared to baseline. Physician Global Assessment showed improvement in 89 percent of patients, with a complete response in 56 percent of cases.

CONCLUSION

These preliminary results indicate that the study cream may be a viable nonprescription therapeutic option for patients affected by facial seborrheic dermatitis able to determine early and significant improvement. This study also emphasizes the advantages of using an erythema-directed digital photography system for assisting in a simple, more accurate erythema severity grading and therapeutic monitoring in patients affected by seborrheic dermatitis.

Adult seborrheic dermatitis: a status report on practical topical management

Seborrheic dermatitis is a common chronic-recurrent inflammatory disorder that most commonly affects adults; however, a more transient infantile form also occurs. The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor. The adult form of seborrheic dermatitis affects up to approximately five percent of the general population. The disorder commonly affects the scalp, face, and periauricular region, with the central chest, axillae, and genital region also involved in some cases. Pruritus is not always present and is relatively common, especially with scalp disease. A variety of treatments are available including topical corticosteroids, topical antifungal agents, topical calcineurin inhibitors, and more recently, a nonsteroidal "device "cream. This article reviews the practical topical management of seborrheic dermatitis in the United States, focusing on the adult population.