Fluconazole and its place in the treatment of seborrheic dermatitis--

new therapeutic possibilities.

Zisova LG.
Source
Department of Dermatology and Sexually Transmitted Diseases, Medical University, Plovdiv, Bulgaria.
Abstract
Seborreic dermatitis is a subacute or cronic disease of te s!in, a"ecting te
seborrea a#icted areas and presenting $it erytema and des%uamation. Te
in&ammatory reaction to$ards te fungi Malasse'ia spp. is considered to ave a
basic etiologic connection $it tis disease. Ta!ing into consideration te
patogenesis, treatment of te dermatitis sould be directed to$ards eradication of
Malasse'ia spp., reduction of te s!in lipids, and suppression of te in&ammatory
response. A $ide variety of agents presented in di"erent forms((ointments,
sampoos and drugs((can o"er %uic!, safe and e"ective treatment alternatives. Te
purpose of te present study $as to monitor te terapeutic e"ects of te anti(
fungal drug &ucona'ole in patients $it seborreic dermatitis. )e compared t$o
study groups of patients* +roup ,((-. patients $it seborreic dermatitis stage ,, ,,
and ,,,, treated $it &ucona'ole, /0 mg1day for t$o $ee!s. As topical terapy $e
applied clobetasol propionate 0.0/2 ointment. After te completion of te
terapeutic course, 3/2 of te patients in tis group $ere clinically cured and teir
symptoms faded a$ay. 4ifteen percent of te sub5ects in tis group((mainly stage ,,,
seborreic dermatitis patients, so$ed partial but signi6cant clinical improvement.
Te speci6c fungal test for Malasse'ia spp. on Dixon agar $as negative in 782 of
te cases in tis group. +roup ,,((eleven patients $it similar clinical indexes $ere
treated $it &ucona'ole /0 mg1day only, for te same time period. Te terapeutic
results in tis group $ere also satisfactory((89./2 of te patients $ere cured and
:3./2 so$ed clinical improvement. ,n .;2 of te patients te speci6c test for
Malasse'ia spp. $as negative after treatment. 4lucona'ole treatment in patients
$it seborreic dermatitis proves to be successful, e"ective and safe.
PM,D* 9:7930/8 <PubMed ( indexed for M=D>,?=@
Seborroea a"ects scalp, s!in on cest
Publised*
4riday, 4ebruary 99, -099
Seborroea is a common form of s!in ec'ema tat occurs in parts of te body $it
ig oil AsebumB production. Body areas tat are commonly a"ected include te
scalp, ears, face, cest, and folds of s!in, suc as te underarms or te s!in belo$
breasts or overanging abdominal folds. Te cause of seborroea is un!no$n,
altoug a yeast tat often lives on te s!in, Malasse'ia furfur, may play a role.
Cne common manifestation of seborroea tat a"ects te scalp is dandru". Scalp
seborroea can also present as tic!, &a!y, localised patces of scale. Cn te face,
seborroea produces reddis(bro$n, dry(loo!ing, or tic!, greasy scales on te
eyebro$s, sides of te nose, and beind te ears. Deddis, scaly patces may also
appear in te folds of s!in mentioned above.
Altoug s!in a"ected by seborroea may feel Edry,F moisturising only ma!es tem
redder. Scalp seborroea and dandru" do not cause permanent air loss. Cften,
scalp seborroea doesnGt even itc signi6cantly. Seborroea can appear during
infancy, starting sortly after birt and lasting several monts. ,t may a"ect te
scalp Acradle capB, or produce scaly patces on te body. Adults of all ages may
develop seborroea, too, especially on te scalp and face. Some people $o ave
$ea!ened immune systems, suc as tose on cemoterapy or tose $it H,I
disease or certain neurological disorders, may ave very severe seborroea. ,t is
important to empasise, o$ever, tat seborroea is a very common condition.
What treatments are available for seborrhoea?
Treatment of dandru" is directed at 6gting te s!in in&ammation. Tis is done
eiter directly, by using cortisone(based creams and lotions A$ic reduce
in&ammationB, or by reducing te yeast tat builds up on scaly areas and adds to
te problem.
What doesnt help seborrhoea?
J Moisturising* Moisturising lotions donGt do muc more tan smoot out scales and
ma!e patces loo! redder.
J S$itcing brands of sampoo* Sampoo doesnGt cause dandru". Ho$ever,
medicated sampoos can elp.
J Kanging air(care routines* Tere is no ErigtF sampoo or conditioner, nor is
tere a EcorrectF number of times to sampoo per $ee!L seborroea and dandru"
are not caused by excessive sampooing Edrying out te scalp.F Hair dyes and
conditioners do not cause or aggravate dandru".
J S$itcing antiperspirants* )en underarms are red from seborroea, almost
anyting $ill ma!e tem redder, including antiperspirants, even toug tey are
only aggravating te seborroea and not causing it.
What over-the-counter products can help?
J Medicated sampoos* Mou can tese eiter all of te time, or 5ust once or t$ice a
$ee!, depending on o$ severe your symptoms are. ,f te problem %uiets do$n or
disappears, stop and use nonmedicated sampoos. ,f one !ind of sampoo $or!s
for a $ile and Eruns out of gas,F s$itc to anoter. 4or resistant cases, you can
even alternate t$o di"erent types.
J Kreams* T$o additional types of medication tat elp seborroea are cortisone
creams and antifungal creams. Kortisone creams reduce in&ammation. Tey are
safe to use on te face and $ill often elp in 5ust a couple of days $en applied
t$ice daily. Tese products also are available as scalp lotions tat are applied once
a day, preferably on damp air after sampooing. Mou can use scalp cortisone
creams togeter $it medicated sampoos.
J Antifungal creams are often e"ective, apparently because tey reduce te
number of yeast organisms living on te s!in. As $it sampoos, creams sould be
applied until te seborroea subsides. )en te seborroea comes bac! Aand it $ill,
sooner or laterB, te creams sould be used again.
What can the doctor prescribe?
Mour pysician or dermatologist can recommend prescription(strengt sampoos or
antifungal and cortisone creams tat are stronger tan tose available over te
counter, yet are not too strong to use on te face. Tere also are cortisone(based
li%uids, gels, and foams tat you can apply to te scalp tat $onNt leave your air
limp and matted. As $it all seborroea treatments, prescription(strengt sampoos
and cortisone creams calm do$n your s!in or scalp sensitivity, but tey canNt stop
te seborroea from coming bac!. Most people, o$ever, only ave to treat teir
condition from time to time $en it becomes itcy or noticeable.