SEBORRHEIC DERMATITIS – THE FINAL GUIDE

Here we finally arrived to proposing this dermatological theme so long awaited. I immediately prefer to thank all those who have worked sending requests, suggestions, and I was inspired to spread out this small, but I hope as comprehensive as possible, report.

It is important to remember that the report in question is not intended as a replacement or as a supplement to a medical (dermatological) visit. Seborrheic dermatitis is a skin disease, and as such it should be taken care of by contacting a specialist.

Furthermore, this is not going to deal in the most absolute with the issue of diagnostic pathology, but rather with the different approaches to the same. If you have any doubt about diagnosis, I refer you to Dr. Lilies and to his section here in the forum.

Then I will provide you a list of different treatments to date with effective results, illustrating the substances involved in their usefulness, products available in Italian and European territory (or easily purchased online). Everything you find here is the result of my research at this time. Because we are in a field of medicine, where the discovery of effective molecules is constantly made, my report is unlikely to be considered definitive.

I invite you right now to post here your experiences, express your concerns, even share your path if you want. And remember, as it is written at the bottom of my signature: “Knowledge not shared is knowledge wasted.”

To make it easier and simplify reading, I decided that in the first instance you will need to refer to the molecules used (written in bold) and then to the products that contain them. I wanted to give priority to treatments used for seborrheic dermatitis of the scalp, however not lacking many references to products used for other areas of the body (e.g. the face).
Then adding that to the list it will make it easier to consult, right where there is a coincidence in the substances used for the treatment of dermatitis of the scalp and other parts of the body.

It seems clear to me that I didn’t write on all the shampoos and even less on the products for the face/body that exist for seborrheic dermatitis, those already listed in my writing are perhaps too many. I ask you right now anyway to refer only and exclusively to this report for all discussions (questions or opinions) relating to products for seborrheic dermatitis.

SEBORRHEIC DERMATITIS TREATMENT – WHAT YOU NEED TO KNOW

Ketoconazole

Product: Nizoral Scalp Fluid and face cream, Triatop shampoo, Oleocut shampoo and facial lotion matting, Bioesse shampoo gel, Aquasquam.

Ketoconazole has been the substance of choice for years to treat fungal infections, and in the case of seborrheic dermatitis is definitely the most famous and highly effective.
In particular, its action on dandruff was discovered by chance when looking at the improvement in patients who were then treated for other infections.
Nizoral shampoo, aside from the nice fuchsia color of the product, it is definitely a big treatment for very severe seborrheic dermatitis. For this motive, it is a drug (oh, yes, because it is precisely), that should be only used in selected cases with a rational weekly posology and especially not in the long term. It doesn’t definitively represent the chosen medium to treat this condition, simply because before resorting to it, other roads are viable, and the market offers many products that we will now see.
For a rational use, assuming washing my hair 3 times a week, it’s fine to use it 2 times a week, alternating it with a mild shampoo.
I happened to read here on the forum, and other sites dedicated to hair issues, that many users, at the first hint of dermatitis, or dandruff, use Nizoral, also motivated by the fact that it makes the hair thicker.
I repeat what has already been expressed previously, Nizoral should be used only in serious cases and if you are actually experiencing an improvement from an aesthetic point of view it’s the fact that the purpose of this product and it’s primary scope is to fight the dermatitis that causes the stems to fall off.

How does Nizoral work?

Applied topically 2% lotion allows for rapid removal of Pytirosporum Ovale and the attenuation of symptoms, without being absorbed in a meaningful way, which allows good safety in its use. In fact, ketoconazole normally does not involve local tolerability issues nor risk of sensitization. It should be applied twice a week for a period of 2-4 weeks, leaving it in contact with the hair for 5-10 minutes. Subsequently, 1 application every 7-14 days seems to prevent the recurrence of the problem, but long-term application may result in irritation.
If you’ve used topical corticosteroids it’s good to let pass two weeks before starting a treatment with ketoconazole in those areas.
As an alternative to Nizoral, definitely a good choice, is Triatop with a 1% concentration of ketoconazole.
If you want to have the active principle of ketoconazole, you can start with Triatop (indeed, it is preferable as a precaution) and then, if you are not satisfied, then resort to Nizoral.
Besides these well-known 2 shampoos, include the Oleocut shampoo (ketoconazole concentration to 2%, more vitamin B3) and Aquasquam shampoo (ketoconazole concentration to 2%).

Piroctone Olamine

Product: Sebamed anti-dandruff shampoo 400 ml, Biothymus shampoo for oily dandruff and dry, mousses, and also face and body cream and lotion, Ducray Kelual cream and Elution, Bioscalin dandruff, Biokap anti-dandruff shampoo (new formulation with delicate surfactants), Bioderma cream shampoo, Restivoil blue Cap, a number of Phyto shampoo, Biomineral Alpha 5 (sold as regulating sebum), Dercos Technique 2 blue packaging types, The Roche Posay Kerium in 3 formulations, Ducray Elution, Kuten Oil sebum regulating, Neutrogena nourishing shampoo, VEA dandruff shampoo, Oneida Omipharm 05 Ecoshampoo and finally Uriage creme facial emulsion.

The main activity of Pirictone Olamine is anti-fungal, but the surprising thing is the studies done for the case of ketoconazole, which declare effectiveness against androgenentic alopecia. It goes without saying that I have no interest, nor desire to recommend these 2 molecules to combat androgenetic alopecia, for the simple fact that those who have had the opportunity to read in these years, have realized, as I did, and are skeptical when faced with isolated studies or worse, marketing a claim not supported by adequate scientific evidence. Suffice it is to say that some studies from the USA (and how you’re wrong), examined some shampoos containing Piroctone Olamine (specifically, this is the Neutrogena Shampoo) and there it provides also some aid in combating androgenetic alopecia. Of course, you also know how to think bad sins, but hardly is wrong, yes, guess what?!! In the study, however, Neutrogena shampoo was a support shampoo therapy along with propecia. That’s precisely, we understand each other. In any case, that’s fine in cases of dandruff.

Selenium Sulfide

Product: Selsun Blue shampoo, Dercos della Vichy in various formulations, Ducray Squanorm, Kerium shampoo, Elvive Anti-dandruff Active selenium S Elvive at the supermarket).

Selenium, a main ingredient of all shampoos mentioned above, reduces the replacement speed of the cells of the surface layer of the skin. Also carries a fungicide action that makes it effective, but with less lasting results compared to ketoconazole. It is also seen that it can affect hair discoloration, so be careful if you have dyed hair, in order to avoid an unpleasant aesthetic effect. In fact, selenium is also used to decolorize glass.

Ciclopirox Olamine

This molecule has been appearing lately in many products used to fight seborrheic dermatitis. In fact, the name of the active ingredient gives specific instructions for Onychomycosis, a toenail disease formed by pathogenic fungi. You may report in the first instance Mycosquam 4% shampoo, that as its name refers, contains as many as 4% of ciclopirox. It’s a shampoo to be used as needed or in attack phase, and the convenient thing is that it possesses a convenient spout so that you do not apply the product liberally. There is also Stiprox shampoo version Bump (or attack) and other formulations for maintenance, and Ducray Kelual DS.

Tioconazole

Product: Trosi DS shampoo. and mousse cleanser, Tiomousse. Tioconazole is a broad-spectrum anti-fungal. Lately, we have seen patients prescribed both Trosi DS as shampoo, mousse, and face cream, and it has been found a good result on cases of medium seborrheic dermatitis. I also want to mention Tiomousse, besides having tioconazole also has salicylic acid (very much used component for this condition, in combination with other molecules), lactoferrin and polidocanol, the latter useful to relieve itching (it is also found in some formulations in products for atopic dermatitis).

Zinc Pyrithione

Product: Znp Shampoo, Sde Zinc Shampoo, Kelual DS, Mavi balsam, Aminotril shampoo, Biothimus dermodetergent skin and hair, Crinefor Shampoo, Alfaacid shampoo, Bioesse shampoo Skin, Ducray Kelual DS and Biopoint dandruff shampoo.

Between the compress: Propso Cap

Definitely Zinc Pyrithione is not useless at all to combat the problem of seborrhoeic dermatitis, and it has been seen that used once a week, has been shown to reduce dandruff, but even after prolonged treatment it doesn’t provide a complete resolution of the symptoms. It also has a fungi static and antimicrobial action, although it is not yet known which is the mechanism of action. In fact, in my view, notice why it is not widely used alone, but it is preferred to bind it to other molecules. A well known example is that of Kelual DS shampoo, manufacturer Ducray which, as stated on the label, is useful in cases of medium seborrheic dermatitis. In fact, the innovative ingredient here, if we want to say it, is that of Keluamide, and INCI aside, the formulation which affects our survey, ciclopirox olamine is, by our friend zinc pyrithione and precisely by the aforementioned keluamide. In my journey I found it to be not infallible, then a shampoo, at first glance unknown, i.e. Aminotril, struck me because it contains triaminodil that you use in some lotions against androgenetic alopecia.

Finally, note Biopoint, available at the supermarket or in perfumery, where the wording is fine, but nevertheless washing off thanks to the presence of silicone, very useful if you want to keep your hair clean for several days. Some 400 ml of product is not even just at an altogether honest price. Last on the list, but certainly not least, is the Propso Compress Cap. The main ingredient of Propso Cap is Silymarin, a plant extract derived from a plant, seeds of Silybum marianum, normally known as milk thistle. It’s really a treatment to recommend, because, aside from good non-aggressive formulation, the positive results are not missed. Dosage: attack time: 15-20 days (every day, or every other day).

Sulfa and Tar

Product: Silky shampoo, sulfa-based, Sde Tar Shampoo, Tarmed shampoo, Crinefor shampoo, Euphidra pine tar Shampoo.
Both of these principles have a very shallow anti fungal action and are poorly effective. To avoid doubt when it comes to tar, we refer to that plant, because the use of the mineral in cosmetics is prohibited by law, at least in EU Member States.

No, I would not personally refer to this if I wanted to find an actual useful remedy in case of seborrheic dermatitis. I also have read that colloidal sulphur and tar are useful minerals for psoriasis (which we do not consider here though).
It can be said that apparently they have an efficacy comparable to that of ketoconazole, but not thanks to an anti fungal activity, but for their anti-inflammatory action. After stopping the treatment the problem returns quickly in a high percentage of cases. Only controlling the inflammation is not as important as the suppression of the pytirosporum ovale. If used for a long time corticosteroids can cause undesirable side effects

Last, but not of least importance is ALUKINA (a compound containing kalinite, glycyrrhetinic acid and retinyl palmitate) representing a novelty treatment for seborrheic dermatitis.

Its trade name is Aluseb, and is now in the form of cream, for applying calmly on the face. Soon in respect to hair treatment, just apply Aluseb cream on the scalp for at least 1-2 hours before shampooing (some dermatologists suggest letting it act all night long and then shampoo the next morning).

What can you say about this cream? It was a prodigious in the treatment of facial seborrheic dermatitis, according to the review that I have read on the web. It’s important to note that Alukina is nothing else than the association of rock alum (aluminum bisulphate and potassium), 18-beta acid glycyrrhetinic acid and vitamin A palmitate.

How do I use it:

The ointment is used for two weeks, applying it twice a day (morning and evening), after washing with a mild, neutral detergent, not very aggressive to the skin. Care must be pursued, where appropriate, for at least two weeks, but in stubborn cases the cream can also be applied for long periods without causing substance-resistance (reduction of effectiveness) problems.
Alukina cream dramatically reduces the risk of relapse: Dermatitis tends to recur at a rate much lower than, for example, with cortisone treatments. My advice after the retention period is gradually reduce the applications or otherwise to alternate with standard soothing creams.

French alternative: SEBODIANE

For those who have the possibility to buy directly in France, or even online through many e-commerce sites, there is a patented molecule capable of controlling the production of sebum, s-reguline, together with other elements such as linoleic acid, and from here you have created a range of products (facial day emulsion, night serum intensive, shampoo) specific for seborrheic dermatitis. We are talking about SEBODIANE.
The positive findings were many, and I must also say that the price is very good, because it’s well below the average for an ordinary drugstore cream or shampoo. It promises a solution in a few days, but let us remember that we are not talking about cortisone, it’s always smart to alternate products. I refer you to the site that explains in detail the treatment and how it is used: http://en.noreva-laboratoires.com/dermatological/sebodiane-41/

A SPECIAL MENTION: TOPICAL CORTICOSTEROIDS

A SPECIAL MENTION: TOPICAL CORTICOSTEROIDS

Exclusively pharmacological product: Ecoval Scalp Fluid, Locoidon, Scalpicin, Elocon lotion, Olux foam.

For the treatment of seborrheic dermatitis, you could note that topical corticosteroids have a comparable efficacy to ketoconazole, but not thanks to an anti fungal activity, but for their anti-inflammatory action. After stopping treatment the problem returns quickly in a high percentage of cases. They only control inflammation, which is not as important as the suppression of pytirosporum ovale.

If used for a long time, corticosteroids can cause undesirable side effects.

What to say? Meanwhile, visit a dermatologist and finally consider that each physician prefers a certain approach. What I can only say is, as regards to my modest and humble opinion, from personal experience, use them as needed, and of course gauge their use on the basis of concentration. Olux is powerful, and definitely brings more overuse damage than benefits. The rebound effect of cortisone is known to all. Among all the products mentioned, Locoidon and Scalpicin, are the ones that allow a more prolonged use that usually goes in cycles, and can be done without ever overdoing it.

COUNCIL FOR THE ELIMINATION OF SCALES:

In addition to the above products whose active ingredients have been explained, a great and simple remedy is to make a compress 2 hours before shampoo. In the case of abundant scales or scabs, you can extend the compress time up to 3-4 hours. Recommended is sweet almond oil, or even better, borage oil. I realize, however, the not negligible cost of borage oil. Then as a first choice, in terms of cost and availability, sweet almond oil is fine. The only rule is to buy 100% pure oil, all the more added to α-tocopherol acetate (vitamin E), which acts as an antioxidant. If you have doubts about the purity of the oil carefully read the ingredients, which must be a maximum of 2.