Opinion
Video
Navigating Seborrheic Dermatitis (SD): An Overview With Expert Perspectives
Author(s):
Dermatologists introduce this series providing and overview of seborrheic dermatitis (SD), highlighting common causes, contributing factors, and the various ways it may present in different patient populations.
Transcript
Linda Stein Gold, MD: Hello, and welcome to this HCPLive Peer Exchange entitled “Addressing Patient Needs and Seborrheic Dermatitis With Novel Therapies.” My name is Linda Stein Gold, and I’m the director of dermatology clinical research at Henry Ford Health in Detroit, Michigan. I am thrilled to be joined by my friends and colleagues. We’re all medical dermatologists. We all do clinical trials, and I’ll let each of them introduce themselves. We’ll start with Neal.
Neal Bhatia, MD: Hi, I’m Neal Bhatia. I’m director of clinical dermatology at Therapeutics Clinical Research in San Diego, California.
Shawn Kwatra, MD: Hi, I’m Shawn Kwatra. I’m a dermatologist at Johns Hopkins School of Medicine.
James Song, MD: Hello, I’m James Song. I’m the director of Clinical Research at Frontier Dermatology.
Adelaide Hebert, MD: And I’m Adelaide Herbert at the UT Health McGovern Medical School in Houston, Texas, where I serve as chief of pediatric dermatology.
Linda Stein Gold, MD: Our discussion will focus on the need for appropriate diagnosis and treatment of seborrheic dermatitis. We’ll also explore how we can optimize the patient experience by utilizing newer, targeted therapies. Let’s go ahead and get started. We know that seborrheic dermatitis is a chronic inflammatory skin disease, and this has a major impact on our patients’ overall quality of life. Shawn, maybe you can walk us through this. [Can you] talk a little bit about what is seborrheic dermatitis? Maybe a little bit about the pathogenesis.
Shawn Kwatra, MD: Yeah, so seborrheic dermatitis is an inflammatory skin disease, and it’s characterized by these arthmetis, so red, scaly patches and plaques that you have on areas where you have an increased number of sebaceous glands. So the face, the scalp, these are all common areas. I know we oftentimes see patients, and they have these bright lesions on the nasolabial folds as well. Seborrheic dermatitis is actually very prevalent. So around 5% of the entire population, and if you count dandruff, if it gets even higher than that, so very significant proportion of the population affected. In terms of pathogenesis, I like to think of a few key things. There seems to be a role for malassezia, so a fungal constituent on our skin. We know that the sebum or sebaceous glands are very important because of those geographical regions that are affected. Finally, we also know that there’s inflammation, and we know that there are certain cytokines that are involved as well.
Linda Stein Gold, MD: So, Shawn, it’s common. It’s really common. Do you feel like this is something that tends to flare up maybe more in winter or do you not see that so much?
Shawn Kwatra, MD: Absolutely. I think that there are environmental triggers. Humidity can be one of those factors. Also, the winter and low temperatures can definitely make the seborrheic dermatitis flare.
Linda Stein Gold, MD: I definitely see that in my practice. We know that it affects adults quite commonly, but Adelaide, it affects kids as well and it can be a little bit different. Can you walk us through that?
Adelaide Hebert, MD: Absolutely. Well, certainly, we can see 2 age ranges where children are affected with seborrheic dermatitis. It can start as early as [aged] 2 weeks and persist to 24 months. Usually, it’s done by 12 months. The common term often for the scalp is cradle cap, and parents and grandparents can recognize it very readily. It affects some unusual areas, including the diaper area and the axilla. In children it can affect the face, but the total body can be affected. It’s often confused with atopic dermatitis in these early arenas. We also see seborrheic dermatitis in adolescents as puberty or prepuberty at its onset, the sebaceous glands come of age, and indeed we see flares at that time. The third group, not in the pediatric realm, is [ages] 30 to 60 [years,] where we have a greater preponderance of seborrheic dermatitis occurring.
Linda Stein Gold, MD: So Adelaide, for a parent who has a baby with cradle cap, it can be challenging and emotionally devastating. What do you tell these parents? Is this something that goes away with time? What should they expect?
Adelaide Hebert, MD: Well, we can tell them it goes away in time, but that is not a very satisfactory answer for the parents sitting in front of me in the clinic. So we do offer some therapeutic options. We give the available over-the-counter products, which include antiseborrheic shampoos and so forth, sometimes some over-the-counter hydrocortisone or stronger prescription steroids if that’s indicated, if the child is really troubled with the condition. Reassurance, of course, is a key cornerstone of having these parents feel more comfortable [about] their child. We need to let them know this doesn’t scar. We need to let them know it will go away if they decline therapy, but it will take quite a bit of time. Most parents, if they’ve made the effort to come and see me in the clinic, waited for the appointment, paid the co-pay, they do want some intervention. And so we offer them some available products that can help remedy this very common childhood problem.
Linda Stein Gold, MD: Thanks. And James, this is a disease that can look different depending on your skin tone. For our patients with skin of color, it presents a challenge. Can you talk to us a little bit about that?
James Song, MD: Yes, Linda, it’s interesting. When you think about seborrheic dermatitis and skin of color, and you compare it to maybe some of our other papillose squamous conditions in darker skin types, which may look more purplish-gray or even hyperpigmented, seborrheic dermatitis has a tendency to look, very high-low-pigment. You actually have a loss of skin color. They do take on these very kind of characteristic shapes and patterns. We call these polycyclic or petaloid patterns, where they kind of look like flower petals. And unless you’re used to seeing seborrheic dermatitis in these different skin tones, it could actually lead to a lot of diagnostic confusion and delay. And so I think that’s just something that we need to do a better job of educating people on.
Linda Stein Gold, MD: So interesting. And I know it’s a challenge too when the scalp is so commonly affected, and then we have some patients who don’t wash their hair every day or every other day and maybe even not every week. So how do you address that challenge if somebody has scalp involvement?
James Song, MD: It is a challenge, Linda, because a lot of our treatments for seborrheic dermatitis [are] predicated on using a medicated shampoo every day or at least a couple of times a week. For patients who have Afro-textured hair or very tightly coiled hair, it’s much more susceptible to hair shaft breakage. And so, if you’re using these harsher shampoos, like selenium sulfide or zinc-based shampoos, it can really worsen that. So [for] my approach, I generally prefer leave-on products. I like oil-based vehicles, particularly like low-potency cortical steroids, as well as emollient-based foams. I feel like those are tolerated very well. Water-based solutions you have to be a little bit more careful of, especially if they’re using heat to straighten the hair, because that could undo some of that as well.
Linda Stein Gold, MD: Interesting.
Transcript was AI-generated and edited for clarity and accuracy.
