Hello Group
,
Tim invited me to post here every once in a while. Seb derm is not
my specialty, but I do see a lot of cases with it overlapping
rosacea. The below article is very useful if you can get your hands
on the original paper. I will be meandering in here from time to
time to learn from you folks and hopefully help keep everyone
abreast of all the latest treatments.
I know this has probably been covered to death (I have not had a
chance to read all the posts), but the number one treatment by far
is oral antifungals. The number one reason they may fail is because
a patient stops too soon or does not pulse dose every 6 months to
remain in remission. Just be sure to monitor your liver enzymes if
you go this route.
The class of sodium sulfacetamide and sulfur creams/gels/ointments
and cleansers are also very good for both seb derm and rosacea, but
may be a little drying. Tehe 10% urea formulation from Rosula is
very moisturizing and the Urea is also an antikeratolytic which
helps with the flakes and penetration of the active med.
Thanks for the invite Tim. I wil try to pop my head if from time to
time and I am sure Tim will keep you all updated on anything I post
on the rosacea board that may be relevant to you folks.
Below is the abstract to the article. It probably has been posted
already so forgive me for any redundancy.
Regards,
Geoffrey
______________________________
Am J Clin Dermatol. 2004;5(6):417-22. Related Articles, Links
Role of antifungal agents in the treatment of seborrheic dermatitis.
Gupta AK, Nicol K, Batra R.
Seborrheic dermatitis is a superficial fungal disease of the skin,
occurring in areas rich in sebaceous glands. It is thought that an
association exists between Malassezia yeasts and seborrheic
dermatitis. This may, in part, be due to an abnormal or inflammatory
immune response to these yeasts. The azoles represent the largest
class of antifungals used in the treatment of this disease to date.
In addition to their antifungal properties, some azoles, including
bifonazole, itraconazole, and ketoconazole, have demonstrated anti-
inflammatory activity, which may be beneficial in alleviating
symptoms. Other topical antifungal agents, such as the allylamines
(terbinafine), benzylamines (butenafine), hydroxypyridones
(ciclopirox), and immunomodulators (pimecrolimus and tacrolimus),
have also been effective. In addition, recent studies have revealed
that tea tree oil (Melaleuca oil), honey, and cinnamic acid have
antifungal activity against Malassezia species, which may be of
benefit in the treatment of seborrheic dermatitis. In cases where
seborrheic dermatitis is widespread, the use of an oral therapy,
such as ketoconazole, itraconazole, and terbinafine, may be
preferred. Essentially, antifungal therapy reduces the number of
yeasts on the skin, leading to an improvement in seborrheic
dermatitis. With a wide availability of preparations, including
creams, shampoos, and oral formulations, antifungal agents are safe
and effective in the treatment of seborrheic dermatitis.
September 27th, 2005 at 11:51 am
I was curious as to what kind of effect long term usage of oral
antifungals can have, especially on the liver. I was always told they
could be quite dangerous so I’m interested in anyone’s experince with
them.
September 27th, 2005 at 10:00 pm
Yes, I’ve heard that too - hepatoxic is what I think they say. I’ve
heard that itraconazole is the most dangerous. How can we monitor our
liver enzymes? Blood tests? Also, I wonder why diflucan wasn’t
included on the list of oral antifungals.
Tim
September 30th, 2005 at 9:03 pm
Dr. Nase and group:
I still haven’t seen any evidence (studies or anecdotes) that anyone
has really been helped by oral antifungals. What is the preferred
treatment regimen? What oral antifungal is the safest and most
effective? How long should they be used? How do we monitor our liver
enzymes? Is there any literature out there on this?
Thanks,
Tim