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Non-Steroidal Topical Therapy for Facial Seborrheic Dermatitis

June 2020 | Volume 19 | Issue 6 | Original Article | 658 | Copyright © June 2020


Published online May 20, 2020

Jaime Piquero-Casals , Edgar La Rotta-Higuera , Juan Francisco Mir-Bonafé , Eduardo Rozas-Muñoz , Corinne Granger

aDermik Multidisciplinary Dermatological Clinic, Barcelona, Spain bEpidermos Dermatology and Aesthetics, Barcelona, Spain cDepartment of Dermatology, Hospital Son Llàtzer, Palma de Mallorca, España dDepartment of Dermatology, Hospital de San Pablo, Coquimbo, Chile eInnovation and Development, ISDIN, Barcelona, Spain

Abstract
Seborrheic dermatitis (SD) is a chronic, recurrent, inflammatory skin disorder occurring in areas rich in sebaceous glands. It manifests clinically as erythematous macules or plaques with varying levels of scaling and associated pruritus. Although the pathogenesis of SD has yet to be fully understood, Malassezia yeasts, hormones, sebum levels, and immune response are known to play important roles. Additional factors including drugs, winter temperatures, and stress may exacerbate SD. Current available treatments include antifungal agents, topical low-potency steroids, and calcineurin inhibitors.

We aimed to evaluate the effectiveness of a topical non-steroidal cream in treating facial seborrheic dermatitis (FSD). We performed a case series of 11 patients with mild or moderate FSD and a history of several previous treatments without improvement. The patients were treated for 8 weeks with a topical non-steroidal facial cream (NSFC) containing zinc PCA, piroctone olamine, hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2, and stearyl glycyrrhetinate. Signs and symptoms and tolerance were assessed before, during, and at the end of treatment.

All of the patients had improved symptoms of FSD (desquamation, pruritus, erythema, and stinging sensation); 81.8% showed an excellent response and 18.1% showed a good response. None of the patients had adverse effects.

J Drugs Dermatol. 2020;19(6): doi:10.36849/JDD.2020.5121

INTRODUCTION

Facial seborrheic dermatitis (FSD) is a chronic, recurrent dis-ease that can have a profound effect on quality of life.1,2 The clinical features include facial erythema and superficial scal-ing with flares and periods of improvement; symptoms are of itching or burning sensation.3 The role of the sebaceous glands and Malassezia yeast in susceptible individuals is part of the pathogenesis of FSD,4 and Staphylococcus epidermidis is now also considered an aggravating factor.5 Other relevant factors such as environmental insults, irritants, stress, certain foods, and lack of sleep can aggravate FSD.6,7,8

The pharmacological management of this condition includes topical antifungals, anti-inflammatories, and keratolytics. Topical corticosteroids such as hydrocortisone can be used to inhibit inflammation; however, their prolonged use is contraindicated due to potential side effects.9 Topical non-pharmacological therapy with cosmetics, cosmeceuticals, and medical devices improves the symptoms by improving the barrier condition and providing anti-inflammatory and antifungal benefits, avoiding the excessive or prolonged use of topical drugs.6 A non-steroidal facial cream (NSFC) was developed containing a combination of piroctone olamine, zinc salt of L-pyrrolidone carboxylate (PCA), hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2, and stearyl glycyrrhetinate. This topical product was previously studied and demonstrated excellent clinical short-term efficacy and good tolerance in patients with SD on the face and chest, with properties of skin barrier reinforcement.10,11 The product is thought to work due to the combination of ingredients, acting on the multiple pathogen-ic factors involved in SD: piroctone olamine is an antifungal, stearyl glycyrrhetinate has anti-inflammatory, antioxidant, and skin-soothing properties, dihydroavenantramide has anti-itch, soothing, antioxidant, and anti-inflammatory properties,12 zinc pidolate is sebo-regulating and astringent, acetamide MEA is a kerato-regulating humectant and conditioning agent, biosaccharide gum-2 is anti-inflammatory and soothing, hydroxyphenyl propamidobenzoic acid is anti-irritant, anti-itch, and antihistaminic, and polymethyl methacrylate is a hydrator and moisturization enhancer.6 We wanted to add further data on the clinical efficacy of this product by studying its use in a further number of patients.