Integrative and alternative treatments for seborrheic dermatitis

Dr. RupaniThinking back to medical school basics, we learned of several “-rrheas”: Rhinorrhea (mucous), diarrhea (gastrointestinal waste), galactorrhea (milk). All relate to an abnormal corporeal discharge-certainly uninvited, undesired. So along comes “seborrhea,” our dermatologic term for an excess of sebum, a word often used synonymously with seborrheic dermatitis, but in fact not quite capturing the extent of the latter’s pathophysiology. We would be hard-pressed to convince our patients with red, flaky patches-those who complain of chronically dry skin that emollients do not seem to help-that really, their problem is oiliness. Instead, we expand upon that definition to include Malassezia yeast, and an inflammatory reaction to its presence on the skin.

While many conventional therapies are available (-azole antifungals, low potency steroid creams, topical non-steroidal anti-inflammatories) patients are increasingly distressed by the idea of a chronic condition, and are looking for a “root-cause” approach to its elimination. Others are hoping for more natural treatment options, with less risk for long-term side effects-hence, the growing interest in integrative solutions.  

Essential oils

Tea tree and borage are two topical essential oils which have both historic use and study data around seborrheic dermatitis. Satchell and colleagues linked the antimicrobial action of tea tree oil to the terpinen-4-ol molecule, and further demonstrated in a randomized controlled trial that daily use of a 5% shampoo yielded a 41% improvement in symptoms, as opposed to 11% in the placebo arm.¹ Borage seed oil is high in gamma-linolenic acid (GLA), purported to have anti-inflammatory benefits. The data is mixed on this, however; one study of infantile seborrheic dermatitis demonstrated 100% resolution within two weeks of topical borage oil application,² but a follow-up study by the same group failed to demonstrate clinical benefit.³

Of similar interest: 

Green tea shows promise in skin treatment

Next: Possibilities: aloe vera, supplements, homeopathy, diet, and vinegar

Aloe vera

Aloe, that spiky succulent with tenticular outgrowths, is an incredibly complex plant. Aloe vera extract differs in chemical composition based on soil and environmental climate, and contains numerous active compounds: salicylic acid, zinc, potassium, calcium, magnesium, and cholesterol, to name a few. It has antifungal and wound healing properties, with folk medicinal applications ranging from burns to frostbite. In limited studies for seborrheic dermatitis, it has been shown to help with associated scalp oiliness and hair loss.^4,5 In any case-it certainly can’t hurt, and tastes good to boot.

Supplements

Biotin is often recommended for patients with hair loss or nail fragility, with mixed data to support its use, but anecdotal benefits at higher doses. In a similar vein, this metabolic coenzyme may have its place in the therapeutic armamentarium for seborrheic dermatitis. In several studies of infants back in the 1970s, intravenous administration of biotin yielded clinical benefit on seborrheic dermatitis, although, admittedly, with lack of a control arm.⁶ Similarly, infants who were fed diets rich in egg yolks and liver, both rich in biotin, in the first few months of life, experienced improvement in seb derm symptoms, purportedly due to an increase in long-chain fatty acid synthesis.⁷ But, the times they are a-changing, and we would be hard pressed today to find pediatricians endorsing an early diet of liver and eggs, let alone parents interested in IV infusions to ameliorate cradle cap, in order to confirm this data.

Homeopathy

Samuel Hahnemann’s 200-year-old alternative medical system is based on the principles of “like cures like”-the notion that a disease can be cured by a substance that produces similar symptoms in healthy people, and “law of minimum dose”-the idea that the lower the dose of the medication, the greater its effectiveness. While this remains a highly debated and controversial system, with inconsistent results and limited scientific data to support its use, many patients incorporate elements of homeopathy into their medical care.  Smith and colleagues conducted a randomized, placebo-controlled, double-blinded study utilizing a homeopathic mixture of oral potassium bromide, sodium bromide, nickel sulfate and sodium chloride for the treatment of seborrheic dermatitis. The study group achieved significant improvement vis-à-vis the placebo group at p<0.02.⁸ Such data is difficult to reproduce and standardize, however.

Diet

Following a “yeast-free diet” is the new trend, and while there is no strong evidence to support this approach for seborrheic dermatitis (think: Malassezia is an external pathogen, and Candida elimination diets target a different organism altogether), many patients anecdotally feel that their condition worsens with heavy ingestion of refined sugars and simple carbs. The American Academy of Dermatology’s recent acne consensus guidelines include recommendations for a low dietary glycemic index, and the same counsel on complex carbs and whole grains, for anti-inflammatory purposes, would here apply.

Vinegar

Finally, vinegar has become an interesting panacea in some circles, with some touting a daily draught and others swearing by topical use. When the National Eczema Association conducted a Facebook poll on most popular home remedies for seborrheic dermatitis, apple cider vinegar figured prominently; so too, though, did topical baking soda…. So are users conducting their own mini Henderson-Hasselbalch titrations? And while seemingly innocuous, topical vinegar is rather caustic, with the potential for chemical burns,⁹ so it is important to counsel patients on dilution techniques.

So, while conventional remedies exist, nature’s bounty may offer some additional options to mitigate this particular “-rrhea.” As always, patients should be encouraged to discuss all supplements and topical botanical preparations with you, their skincare professionals, in order to avoid potential adverse effects.

Before you go, check this out:

Probiotics for healthy skin

Next: References

References:

1. Satchell AC, Saurajen A, Bell C, Barnetson RS. Treatment of dandruff with 5% tea tree oil shampoo. J Am Acad Dermatol. 2002;47(6):852-5.

2. Tollesson A, Frithz A. Borage oil, an effective new treatment for infantile seborrhoeic dermatitis. Br J Dermatol. 1993;129(1):95.

3. Tollesson A, Frithz A, Stenlund K. Malassezia furfur in infantile seborrheic dermatitis. Pediatr Dermatol. 1997;14(6):423-5..

4. Zawahry ME, Hegazy MR, Helal M. Use of aloe in treating leg ulcers and dermatoses. Int J Dermatol. 1973;12(1):68-73.

5. Klein AD, Penneys NS. Aloe vera. J Am Acad Dermatol. 1988;18(4 Pt 1):714-20.

6. Messaritakis J, Kattamis C, Karabula C, Matsaniotis N. Generalized seborrhoeic dermatitis. Clinical and therapeutic data of 25 patients. Arch Dis Child. 1975;50(11):871-4.

7. Nisenson A, Barness LA. Treatment of seborrheic dermatitis with biotin and vitamin B complex. J Pediatr. 1972;81(3):630-1.

8. Smith SA, Baker AE, Williams Jr JH. Effective treatment of seborrheic dermatitis using a low dose, oral homeopathic medication consisting of potassium bromide, sodium bromide, nickel sulfate, and sodium chloride in a double-blind, placebo-controlled study. Alternative Medicine Review. 2002;7(1): 59-67.

9. Bunick CG, Lott JP, Warren CB, Galan A, Bolognia J, King BA. Chemical burn from topical apple cider vinegar. J Am Acad Dermatol. 2012;67(4):e143-4.