INTRODUCTION
Seborrheic dermatitis is a chronic inflammatory skin condition with an estimated global prevalence of 4.38%.1 The pathophysiology is not fully elucidated, though it involves lipid secretion by sebaceous glands, Malassezia proliferation, and a subsequent inflammatory response. Accordingly, primary treatment options include topical antifungals as well as steroidal and nonsteroidal anti-inflammatory agents. Topical roflumilast 0.3% foam, a phosphodiesterase-4 (PDE-4) inhibitor, was approved by the US Food and Drug Administration (FDA) in December 2023 for the treatment of seborrheic dermatitis in patients aged 9 years and older. Prior to its approval for seborrheic dermatitis, topical roflumilast 0.3% cream was approved for plaque psoriasis, and the oral formulation was approved for severe chronic obstructive pulmonary disease. Most recently, roflumilast 0.15% cream was also approved for atopic dermatitis.2 Although the safety and efficacy of topical roflumilast for seborrheic dermatitis have been demonstrated in two clinical trials, its onset of action and role in managing active flares remain unclear. Our case documents the rapid improvement in clinical appearance and symptoms after one day of twice-daily treatment with topical roflumilast 0.3% cream in a patient with severe seborrheic dermatitis.
CASE HISTORY
A 25-year-old female with no significant past medical history was urgently referred for rapid escalation of a facial rash associated with significant flaking and itching, believed to be contact dermatitis by the referring physician. The patient reported significant worsening over the past 24 hours after using a new facial wash; however, in the past experienced less severe, though similar, eruptions managed with triamcinolone 0.1% cream with some success. Physical exam was notable for broad white to faint pink thin, scaly petaloid plaques extending from the nasolabial folds to the forehead, glabella, bilateral cheeks, and chin with some peripheral hyperpigmentation. The patient was provided with samples of roflumilast 0.3% cream to be used twice daily, to then be followed by tacrolimus 0.1% topical ointment once daily, as well as pulse fluconazole 300 mg once weekly for 3 weeks. However, after one day of roflumilast use alone, the patient experienced significant improvement in scaling, erythema, and itch (Figure 1). The patient did not use tacrolimus and fluconazole and continues to use roflumilast 0.3% cream as needed.
