Do you have an itchy scalp?

In adults, seborrhoeic dermatitis usually affects the scalp and causes a bad case of dandruff.

Your scalp develops dry, flaky skin, and it begins to itch.

Whenever you are under stress, the itch worsens. Sometimes, blotches of redness appear on the skin, especially around your face, upper chest, back and groin area.

You may be suffering from a condition known as seborrhoeic dermatitis.

Seborrhoeic dermatitis is a common skin ailment that is similar to eczema. It causes flaky, white to yellowish scales to form on oily areas of the skin such as the scalp, face or inside the ear. It can occur with or without reddened skin.

As seborrhoeic dermatitis is very common, most people do not realise that it is a problem. They treat this as part of the growth process.

Cradle cap is the term used when seborrhoeic dermatitis affects the scalp of infants, and it usually clears after a few months.

In adults, seborrhoeic dermatitis usually affects the scalp and causes a high production of dandruff. Sometimes, it appears as scaly patches or red skin that can itch or burn.

A common chronic skin problem

Seborrhoeic dermatitis affects 2-10% of the general population. In a study published in 2008, the Chinese Journal of Dermatovenero-logy reported that the incidence of Asian adolescents aged 12-20 years affected by seborrhoeic dermatitis are, in Macao (2.66%), Guangzhou (2.85%), Malaysia (17.16%), and Indonesia (26.45%).

An infant suffering from cradle cap. Cradle cap is a form of seborrhoeic dermatitis: an itchy, flaky rash of unknown cause.

Seborrhoeic dermatitis affects areas where sebaceous glands (oil glands) are present in high density and are most active. This skin disorder causes scaling, erythema (reddening), and sometimes pruritus (itching), which progresses to flakiness, and when it becomes more severe, crusting of the skin.

Apart from the scalp, some commonly affected areas are the naso-labial folds (nose area), eyebrows, eyelids, behind the ears, face and centre of the chest.

According to Datuk Dr Noor Zalmy Azizan, a consultant dermatologist at Hospital Kuala Lumpur, seborrhoeic dermatitis is often under-diagnosed and under-treated. The reason is because even though this skin disorder can be uncomfortable and causes embarrassment, it does not really affect general overall health. Thus few patients make a fuss about it.

In infants, seborrhoeic dermatitis takes the form of cradle cap (yellowish scaling on the scalp) and inflammation of the groin folds that often manifests in the first few weeks of life.

Dr Zalmy explained that infantile seborrhoeic dermatitis does not necessarily cause extreme itchiness. Hence, the baby often appears undisturbed by the rash, and the condition is usually resolved when the baby is 12 months old.

In adults however, seborrhoeic dermatitis may take the form of red, yellow or whitish scaly patches on the scalp, behind the ears or on the eyebrows. It may look like a bad case of dandruff on their face!

Adults – usually those aged 30-60 – who are struggling with seborrhoeic dermatitis often live their lives feeling embarrassed at work and in their social life. They are often described as being dirty, unhygienic, and even drunk (the red face).

This skin disorder may need many repeated treatments before the symptoms go away.

Even though there is no specific cure for seborrhoeic dermatitis, there is a wide range of products available to treat its symptoms.

Consensus on treatment recommendations

To address specific issues of skin diseases, the Primary Care Skin Forum 2016 was held at the Hilton Kuala Lumpur earlier this year.

Along with the views and recommendations of experts, the forum also saw the launch of a new guidebook for seborrhoeic dermatitis, the Asia-Pacific Seborrhoeic Dermatitis Leaders’ Summit 2014: Consensus Recommendations for the Diagnosis and Management of Seborrhoeic Dermatitis in Asian Patients.

This guidebook summarises the consensus recommendations by Asian consultant dermatologists and consultant paediatricians regarding the diagnosis and management of seborrhoeic dermatitis within the Asian context.

Speaking at the event was University of Catania, Italy, Dermatology Department head and Dermatologist Residency Program director Prof Dr Giuseppe Micali, who highlighted the limitation of the current treatments for seborrhoeic dermatitis.

Seborrhoeic dermatitis is often under-diagnosed and under-treated.

“In my experience, when there’s inflammation, topical anti-fungal ointments are not very effective. So, we need a combination of therapies.

“There needs to be non-prescription agents, such as non-steroidal anti-inflammatories and antifungals that represent a promising approach in the management of some mild to moderate forms of seborrhoeic dermatitis, as demonstrated by in vitro and in vivo studies,” he said.

The quest for a non-steroidal anti-inflammatory treatment modality is urgent because most present treatments focus on using corticosteroids to treat the potential presence of fungi or other organisms on the surface of the skin. However, this group of drugs do have some unfavourable side effects, especially when used long-term or on sensitive areas of the skin such as the face and hands, or on children.

The side effects vary from mild and reversible thinning, to irreversible telangiectasiae (fine blood vessels becoming visible at the surface of the skin), striae distensae (marks similar in appearance to stretch marks) and Cushing syndrome (a round-shaped face, upper body weight gain, and skin that bruises easily).

With regular use, the steroids’ effectiveness may also be affected, and that may lead to the use of more potent steroids.

There may also be a risk of growth suppression and adrenal suppression in children with the use of topical steroids.

Recommendations by experts

One of the strongest consensus recommendations in the guidebook is the use of an anti-inflammatory agent that is non-steroidal and has anti-fungal properties as first line treatment.

This agent should help enhance the natural barrier of the skin (which is altered in seborrhoeic dermatitis), and subsequently restore its natural physiology.

The agent in question is a cream that has been shown to work within days in babies diagnosed with cradle cap, as presented in real patient case studies by Malaysian paediatricians during the launch of the guidebook.

The cream has been shown to be effective and well-tolerated for treatment of mild to moderate seborrhoeic dermatitis of the face, scalp and body. It has been shown to provide comparable results with topical steroid (desonide cream 0.05%), but with better relapse prevention rates.

The cream contains none of the immune-suppressing agents or steroids. On top of that, it is effective as single therapy (monotherapy) for the treatment of mild to moderate seborrhoeic dermatitis.

Prof Micali observed that the effectiveness of the cream is most likely due to a synergistic effect of piroctone olamine (antimycotic action), propylene glycol (keratolytic action), allantoin and glycyrrhetinic acid (anti-inflammatory action).

This non-steroidal, anti-inflammatory cream provides an effective option for the management of this disease.

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This article is courtesy of A. Menarini.