Unraveling the Advancements in Seborrheic Dermatitis Treatment

“Bottom line, if you see seborrheic dermatitis, treat it. Maybe it's not all about the yeast and there's a bit more to this story, and it's time we ask some of the tough questions,” said Raj Chovatiya, MD, PhD, FAAD, associate professor at Rosalind Franklin University Chicago Medical School and the founding director of the Center for Medical Dermatology and Immunology Research, and Dermatology Times 2024 Fall Editor in Chief, as he summarized his take-home pearls in a few words. At the 2024 Fall Clinical Dermatology Conference for PAs and NPs, he presented the session "How Seb D Got Its Groove Back," which delved into the often overlooked realm of seborrheic dermatitis, affectionately referred to as Seb D by Chovatiya.¹

Chovatiya's passion for understanding and addressing seborrheic dermatitis stems from its status as an inflammatory disease that historically hasn't received the same level of attention as conditions like atopic dermatitis and psoriasis. This lack of focus has left significant gaps in our understanding of its epidemiology, burden, comorbidities, and treatment modalities. However, recent therapeutic developments, including the approval of topical roflumilast foam (Zoryve; Arcutis), have sparked renewed interest in this area of dermatology.

During the session, Chovatiya emphasized several key points regarding seborrheic dermatitis. First, he underscored its prevalence and the substantial burden it imposes on patients, often exacerbatedby inadequate treatment options. Traditional broad-acting topical therapies have fallen short in providing effective relief, highlighting the need for innovative approaches.

A pivotal aspect of Chovatiya’s discussion revolved around challenging conventional wisdom regarding the etiology of seborrheic dermatitis. While Malassezia, a type of yeast, has long been implicated as a primary causative agent, Chovatiya proposed a more nuanced perspective. He said, “I'm not here to say that it [Malassezia] isn't important, but I think that what we're realizing is that the immune system and the [skin] barrier probably have equivalent if not slightly more important roles in this regard.” Chovatiya co-authored a recently published study in the Archives of Dermatologic Research. “More Yeast, More Problems?: Reevaluating the Role of Malassezia in Seborrheic Dermatitis,” explored whether Malassezia yeast plays a crucial role in the pathogenesis of seborrheic dermatitis, or if immune dysregulation and skin barrier disruption are more prominent factors.²

The success of phosphodiesterase-4 (PDE4) inhibition in treating seborrheic dermatitis exemplifies this shift in therapeutic focus, offering hope for further advancements in the field. Chovatiya highlighted ongoing efforts to explore alternative treatment modalities, including Janus kinase (JAK) inhibition and hormone receptor (HR) agonism. While these approaches show promise, their efficacy and safety profiles require further investigation before widespread adoption.

Another challenge in managing seborrheic dermatitis lies in the complexity of treatment regimens, often involving multiple therapies targeting different affected areas of the body. He explained, “The scalp, the beard area, the chest, the arms, the legs—Each with different potencies, each with its own instructions — it really is a nightmare. And patients tell us, even in research that we've presented recently, that they want something that's simple, and something effective and something they're going to be able to use.” The advent of roflumilast foam represents a step in the right direction, offering a convenient, easy-to-use solution for individuals with seborrheic dermatitis, particularly in hair-bearing areas. “A foam-based treatment is a very logical choice for a disease that affects highly hair bearing areas,” Chovatiya said. He also recently sat on a panel that validated roflumilast foam, and their thoughts and data review were recently published in the Journal of Clinical and Aesthetic Dermatology.³

Chovatiya concluded with the need for further research, “With a lot of therapeutic development, we should be investing in addition to the actual mechanism itself, something that allows us to deliver it to where the disease affects people.”

Related content

Should Malassezia’s Role in Seborrheic Dermatitis Be Reconsidered?

Raj Chovatiya, MD, PhD: Evaluating Roflumilast Foam’s Inclusivity in Diverse Hair Types

Expert Panel Confirms Efficacy and Safety of Roflumilast Topical Foam for Seborrheic Dermatitis Across Diverse Hair Types

References

1. Chovatiya R. How Seb D got its groove back. Presented at: 2024 Fall Clinical Dermatology Conference for PAs and NPs; May 31-June 2; Scottsdale, AZ.
2. Chang CH, Chovatiya R. More yeast, more problems?: reevaluating the role of Malassezia in seborrheic dermatitis. Arch Dermatol Res. 2024;316(4):100. Published 2024 Mar 12. doi:10.1007/s00403-024-02830-7
3. Expert panel review further validates use of ZORYVE® (roflumilast) topical foam, 0.3% for treatment of seborrheic dermatitis across diverse hair types published in Journal of Clinical and Aesthetic Dermatology. News release. Arcutis Biotherapeutics. May 13, 2024. Accessed June 1, 2024. https://www.arcutis.com/expert-panel-review-further-validates-use-of-zoryve-roflumilast-topical-foam-0-3-for-treatment-of-seborrheic-dermatitis-across-diverse-hair-types-published-in-journal-of-clinical-and-aestheti/