Treatment methods for seborrheic dermatitis

Seborrhea develops in the so-called seborrheic zones - areas of the skin in which there are especially many sebaceous glands, about 400-600 per 1 cm2 1. These include:

scalp;
T-shaped area of the face (forehead, nasolabial folds, chin);
the central part of the chest and the upper part of the back between the shoulder blades.

Seborrheic dermatitis is a chronic inflammatory disease that develops when the yeast-like fungus Malassezia furfur begins to actively multiply in the affected areas. About 3% of the population suffers from manifestations of this disease, and young people are more susceptible to them, among whom the number of patients increases to 5%.2

The disease is considered quite common. It manifests itself especially often in the first years of a child’s life, as well as in people after 40 years of age. This age-related feature of the occurrence of seborrheic dermatitis is explained by the fact that it is during these periods of a person’s life that the sebaceous glands on the body work with high intensity.

Causes of occurrence and development

The development of seborrhea and seborrheic dermatitis is based on dysfunction of the sebaceous glands of the skin, which manifests itself in the fact that the glands begin to produce either too little secretion (sebum) or too much, in addition, the composition and consistency of the secretion also changes. Excess secretions are mixed with dust, dead skin cells and can serve as a substrate for the active reproduction of opportunistic microorganisms, most often fungi of the genus Malassezia, which are normally present on the skin of 90% of the population3. The metabolic products of this pathogen cause skin irritation and its inflammatory reaction, manifested in the form of redness and the appearance of papules covered with greasy crusts.

Why does the functioning of the sebaceous glands malfunction? Doctors identify many factors that can play a role in dysfunction of the sebaceous glands. Among them:

genetic predisposition;
changes in hormonal levels (increased levels of progesterone and androgens, decreased levels of estrogen - therefore, the disorder is often found in men), including in infancy, puberty, pregnancy, and chronic diseases;
decreased immunity due to chronic or infectious diseases, taking potent medications;
a lot others.

The ducts of the sebaceous glands open into the mouth of the hair follicle, so with seborrhea and seborrheic dermatitis, not only the skin, but also the patient’s hair suffers.

The problem may worsen as a result of prolonged exposure to heat or due to increased sensitivity of the skin to external irritants. At the same time, seborrheic dermatitis in children and adults can be severe, regardless of the number of active fungi on the skin.

Diagnosis of dermatitis

Which doctor should I contact for help, and what tests should I take?

Although identifying dermatitis is not difficult, it is necessary to determine the root cause and triggering factors.

In addition to collecting the patient’s medical history and general examination, you will need to diagnose hormonal levels, as well as study the functioning of the digestive organs.

Laboratory tests are prescribed to exclude endocrine disorders, in particular diabetes mellitus.

Additionally, a stool examination is carried out to determine the presence/absence of dysbacteriosis.

If the dermatologist deciphers the test results and detects pathological changes, the doctor will redirect the patient to specialized specialists.

Most often such doctors are a gastroenterologist and an endocrinologist.

How does seborrheic dermatitis manifest?

The disease affects certain parts of the human body. Typically this is:

scalp skin;
face;
behind-the-ear areas;
upper body (most often the area of the chest, shoulder blades);
large skin folds on the body (for example, groin area, armpits).

Seborrheic dermatitis in adults and children manifests itself in the form of local redness and papules covered with greasy scales.

The disease can also be recognized at an early stage in adults by the appearance of a sign such as dandruff. As the situation worsens, the scalp gradually begins to become covered with red spots; later they can merge, forming lesions with characteristic peeling of the skin. In advanced cases, when oily crusts peel away from the surface of the skin, a moist secretion is discovered underneath. If you do not take any measures to treat seborrheic dermatitis, then this problem may be complicated by the addition of an infection.

In addition to external signs of seborrheic dermatitis, patients often complain of itchy skin. As a result of constant scratching of the inflammation, even greater tissue injury occurs with a high risk of further infection.

The disease not only causes serious discomfort, but also worsens a person’s quality of life as a whole, provokes self-doubt, makes it difficult to establish contacts with other people, and prevents them from building close relationships with the opposite sex.

Hypoallergenic diet for pregnant and nursing mothers with atopic dermatitis

During breastfeeding, a number of dietary restrictions must be observed. In this case, the risk of the child developing atopic dermatitis is much lower. If the parents have been diagnosed with allergic reactions, bronchial asthma or atopic rhinitis, following a diet for dermatitis in adults (preferably at the stage of preparation for conception) is simply necessary.

A pregnant or breastfeeding woman should avoid the same foods that are prohibited for all adults suffering from an atypical reaction (see above).

Symptoms and forms/Types of seborrheic dermatitis

If we consider seborrhea and seborrheic dermatitis in children and adults, we can distinguish the following varieties:

Dry seborrhea. With this nature of the disease, the sebaceous glands produce an insufficient amount of secretion. As a result, the skin does not receive enough moisturizing components, dries out, and microcracks appear on its surface. Typically, dry seborrhea occurs without the formation of acute inflammatory foci. Instead, the patient is concerned about the separation of dry dandruff particles. Most often, this form of the disease is observed in adolescent children.
Oily seborrhea. The form differs from the previous one in that the sebaceous glands, on the contrary, work too actively and secrete a large amount of thick secretion. The substance glues together dead skin cells and is deposited on the hair, causing it to take on an unkempt appearance. The problem often affects young women.
Combined type. It is characterized by the presence of signs of both dry and oily seborrhea. The disease develops in various parts of the body and therefore causes serious discomfort. In most cases, this form is diagnosed in males.

Depending on the location of the foci of inflammation, seborrheic dermatitis of the scalp, face and torso is distinguished.

The first sign of damage to the scalp is the appearance of dandruff. In this case, the scalp can be either excessively dry or oily, and the scales can range from silvery-white in mild cases to dense fatty crusts in severe cases.

In patients with seborrheic dermatitis of the scalp, over time, the hair becomes sparse, thin, brittle and often falls out.

Focal inflammation on the face is considered no less common. This form of the disease mainly affects teenagers and young people under the age of 25. The cause of seborrheic dermatitis in this case is the high activity of the sebaceous glands in the facial area. During puberty, they begin to work more actively, which can provoke the development of the disease. On the face, rashes are often symmetrical, located in the forehead, nasolabial folds, wings of the nose, and eyebrows.

At the initial stage, the disease manifests itself in limited areas of inflammation, the surface of which is covered with white-yellow scales. The rash is accompanied by itching and constantly peels off. As the disease progresses, areas of inflammation may merge. In some cases, inflammation is aggravated by the addition of a secondary infection.

Sometimes the inflammation spreads to the skin of the eyelids. This leads to the development of seborrheic blepharitis. It is characterized by the formation of severe swelling of the eyelids, redness of the eyes, and the formation of cracks in the delicate skin in this area. At the eyelash growth line, inflammatory foci gradually begin to form with a characteristic separation of small scales and crusts. Because of this, patients have to literally “pry” their eyes out in the morning, since the eyelids stick together so much.

On the torso, seborrheic dermatitis is usually localized in the area of the sternum and shoulder blades. The disease occurs with the formation of foci of inflammation with clear boundaries, covered with yellowish scales.

The severity of seborrheic dermatitis varies from mild to severe and depends on the extent of skin lesions, severity of inflammation and intensity of itching.

Infantile seborrheic dermatitis is one of the first skin diseases that a child encounters. It develops against the background of immature functions of the skin and sebaceous glands in infants and manifests itself in the form of fatty yellow crusts covering the head (the so-called “baby cap”), sometimes the area of the eyebrows and cheeks.

Scalp dermatitis: problems in the endocrine system and hormonal levels

Changes in the functioning of the hormonal system do not always benefit the body.

In this case, they are expressed in increased proliferation of the fungus.

This phenomenon is due to the fact that it is sex hormones that control the secretion of the sebaceous glands.

Steroids have the greatest effect.

It was found that in women diagnosed with seborrheic dermatitis (eczema) of the epidermis or scalp, the concentration and ratio of testosterone and estrogen are impaired.

Laboratory analysis indicated increased testosterone levels with a simultaneous decrease in estrogen.

A change in the level of androgens in the body, namely their increase, can act as a hereditary disease or be a sign of some pathology.

Diseases that can occur with increased androgen levels:

congenital adrenal dysfunction
Stein-Leventhal syndrome
androsteroma (hormonally active tumor localized in the adrenal gland)
testicular cancer
hypercortisolism syndrome

Dermatitis of the scalp is often observed during adolescence in a child.

This is also due to natural hormonal changes.

In female patients, dermatitis more often manifests itself against the background of the onset of menstruation or diseases of the urogenital tract.

Scalp dermatitis: diseases of the central nervous system and autonomic system

In addition to the hormonal background, the nervous system and the autonomic system take part in the secretion of the sebaceous glands.

Thus, many patients with chronic pathologies, for example, excessive sweating or hypotension, experience increased sebum production.

This also applies to the central nervous system; it also takes part in the process of sebum secretion.

A large number of patients with pathologies of the nervous system (neurasthenia, neuroinfections, chronic depression, etc.) show signs of dermatitis.

Diseases that are most often accompanied by increased sebum production:

parasympathicotonia
shaking palsy
encephalitis Economo
epileptic disorder.

Treatment of seborrheic dermatitis: basic approaches and methods

The tactics and treatment regimen for seborrheic skin dermatitis are selected by the doctor based on the form in which the disease occurs and in which area the inflammation is localized.

If the disease is mild, then this form is characterized by the presence of a small amount of dry or greasy scales, moderate redness of the skin, and occasional mild itching. With this course of the disease, the doctor, as a rule, limits himself to external therapy. For example, with mild damage to the scalp, or dandruff, the doctor may recommend the use of Skin-cap shampoo. Apply shampoo to damp hair, then massage the scalp until foam forms and rinse thoroughly. After this, you need to reapply the shampoo, leave for 5 minutes, and rinse thoroughly with plenty of water. Skin-cap shampoo can be used both for exacerbation of seborrheic dermatitis according to the scheme 2-3 times a week, and for the prevention of further relapses 1-2 times a week.

When the disease occurs in moderate to severe form, the symptoms of seborrheic dermatitis become more pronounced. At this stage, brighter red spots appear on the skin, sometimes noticeable swelling forms on the skin, and the surface is covered with dense gray-yellow crusts. All this occurs against the background of severe itching, which is present almost constantly. Due to discomfort, the patient cannot work fully, it is difficult for him to concentrate on anything, and often in the acute phase of the disease a person experiences problems with sleep.

In this case, there are also generally accepted recommendations on how to treat seborrheic dermatitis. The measures taken are comprehensive; patients may be prescribed hormonal medications. Treatment of seborrheic dermatitis is prescribed by a doctor, based on the severity of the disease and the individual characteristics of the patient. One of the non-hormonal drugs for the treatment of seborrheic dermatitis is the drug Skin-cap. It inhibits the activity of the Malassezia fungus and helps reduce signs of inflammation and also helps reduce flaking. Depending on the location of the inflammatory foci, Skin-cap shampoo, cream or aerosol may be prescribed. Skin-cap aerosol, for example, is suitable for treating the scalp, and the cream is convenient to apply to the face. The duration of treatment for an exacerbation varies, usually it takes from two weeks to 1 month to completely eliminate the symptoms of the disease.

The use of shampoo, cream and aerosol Skin-cap helps to significantly alleviate the condition of seborrheic dermatitis. The active ingredient of the drug Skin-cap has the following effects:

provides anti-inflammatory effect;
suppresses the growth and reproduction of pathogenic fungi, which are the main cause of exacerbation of the disease;
inhibits the activity of bacteria that can increase inflammation.

The drug can be recommended to patients with any form of seborrheic dermatitis; treatment is possible for both adults and children over the age of one year. Products from the Skin-Cap line do not just eliminate the signs of the disease, they help keep the disease under control, preventing relapses.

Symptoms of seborrhea

With the dry version of seborrhea, most patients experience tangible signs that prompt them to consult a specialist and undergo treatment for seborrhea:

fine dandruff;
thinning and weakness of scalp hair;
increased hair loss per day compared to normal;
crusts and scratch marks on the scalp;
itching, dry peeling, burning of the scalp.

With seborrheic dermatitis, seborrheic alopecia may develop: the hair becomes thinner, weaker and dull, begins to split, loses its healthy appearance and shine, and may fall out rapidly.

The disease does not have a systematic effect on the body, but it makes you suffer from changes in the appearance of your hair, dries out the scalp, and with serious causes of its occurrence, emotional disorders are possible.

Treatment of dry seborrhea of the scalp is always aimed at eliminating provoking factors. It is necessary to establish what disorders the patient has and draw up a treatment plan for them first. If there is a pathogenic flora on the skin, you will need special cosmetics designed for seborrhea. In any case, the doctor will recommend products with a calming and anti-inflammatory effect - special shampoos, emulsions for application to the skin.

With seborrhea, it is important to establish the correct functioning of the gastrointestinal tract, establish a healthy daily routine with sufficient sleep and rest, and minimize existing stress. In addition to treatment, it is worth paying attention to physical activity and psycho-emotional health.

Features of SKIN-CAP release forms

The cream is quickly absorbed and softens and moisturizes the skin well and does not leave greasy marks on it. It is suitable for facial skin and affected surfaces that require moisturization.

The aerosol can be applied even to the scalp using a special nozzle, which is included in the kit, without touching the hair. It helps eliminate itching and dries out wet rashes.

Seborrhea shampoo effectively7 fights its manifestations on the scalp. Actively helps eliminate dandruff and itching, fights the root cause of the disease - pathogenic microorganisms. Ideal for preventing relapses.

Skin-cap shower gel is a cosmetic product that is indispensable for daily hygiene in cases where seborrhea affects the skin of the chest and back. It cleanses, soothes and moisturizes the skin, helps eliminate inflammation and restores the protective properties of the skin.

What is the prevention and treatment prognosis for dry seborrhea?

Prevention of seborrhea is carried out using measures to normalize lifestyle - sleep patterns, nutrition, activity, as well as by organizing proper hygiene of the scalp and hair.
At An-Tech Research Laboratories, great attention is paid to complex treatment and searching for the causes of the disease. This allows you not only to cope with seborrhea, but also to prevent its reoccurrence. Seborrhea is an unpleasant disease that clearly manifests itself visually. The sooner you contact a specialist, the sooner he can help you cope with the disease and cure your scalp. Back to list of articles

Prevention of seborrheic dermatitis

Patients with this disease need to know not only how to treat seborrheic dermatitis, but also learn the basic rules for preventing exacerbation of the disease. The main task in this case is to exclude those factors that can trigger the triggering of pathology development mechanisms.

Thus, as part of the prevention of seborrheic dermatitis, it is worth paying attention to several aspects:

following a certain diet;
compliance with personal hygiene rules;
quality skin care;
maintaining an active and healthy lifestyle;
timely treatment of concomitant diseases.

Scalp dermatitis in conditions caused by immunodeficiency

With an active decrease in the protective properties of the immune system, the fungus rapidly multiplies, moving into the pathogenic phase.

Conditions caused by decreased immunity can be primary or secondary.

In the first case, we are talking about the human immunodeficiency virus.

In the second - about a decrease in immunity in acute respiratory infections, acute respiratory viral infections, diabetes mellitus, and chronic pathologies.

In the case of persistent and prolonged immunodeficiency, dermatitis progresses to a chronic form.

It is extremely difficult to treat effectively.

Usually, medications can reduce the severity of the symptoms of the disease.

But they rarely eliminate it completely.

Diet for dermatitis

The diet for seborrheic dermatitis should be based on healthy foods containing a small amount of fat. These include a variety of cereals, lean meats and fish, and always fresh vegetables and fruits.

It is important not only to eat well and properly, but also to follow some recommendations for cooking. Thus, the most preferred options for heat treatment of products are boiling, baking, steaming or grilling without adding oil.

Mixed seborrhea

Mixed seborrhea has characteristics of dry and oily varieties. In particular, patients note that the skin on the face in the middle part is oily, and on the cheeks it is dry. Especially a lot of fat is released in the areas of the crown, chin, forehead, and nose. In other places the fat content is moderate or insufficient.

Doctors also note that a person may be bothered by dry dandruff and oily skin on the face.

Symptoms of mixed seborrhea:

inflammatory process on the cheeks, scalp, chin, forehead, chest, nose;
in the area of inflammation, the skin becomes rough;
redness, itching;
increased secretion of sebum on the forehead, but decreased secretion in other areas of the face;
peeling in the area of increased activity of fat-secreting glands, yellowish or gray scales;
peeling of dry areas of skin.

All the factors listed above as causes of other types of the disease can provoke mixed seborrhea. Most often the problem is associated with hormonal changes or disruptions. Heredity plays an important role. Stress and anxiety can also contribute to the growth of fungi.

Maintaining personal hygiene

Patients with seborrheic dermatitis are recommended to injure the inflammation as little as possible. Personal hygiene rules include cleansing the skin twice a day using special products with a low pH. To cleanse the skin, it is prohibited to use aggressive agents such as laundry or tar soap.

General recommendations for maintaining personal hygiene:

the use of washcloths or sponges with hard fibers is excluded;
For a while, you should avoid cleansing your skin with scrubs and peels containing abrasive particles and aggressive chemical compounds;
During water procedures, it is recommended to use dechlorinated water; for this purpose, it is recommended to first settle or filter it;
the duration of water procedures should be reduced to 10-15 minutes;
when choosing shower products, choose products without dyes and fragrances, with a low pH;
use towels with soft bristles, and it is better to blot your skin with them rather than rub them;
to reduce the likelihood of skin injury when combing, try to cut your nails as short as possible;
Avoid using other people's personal hygiene items.

What does dandruff look like?

White flakes, clearly visible on dark clothes, are nothing more than dandruff. It consists of scaly particles of keratinized skin, appears at the roots of the hair, and then easily falls off. Most often, the disease is provoked by the activity of the Malassezia fungus. It is present on the skin of every person, but only under certain conditions does it begin to multiply and cause dandruff.

When the fungus on the scalp becomes active, a person feels itchy. Depending on the reasons that caused the spontaneous reproduction of microorganisms and the characteristics of the sebaceous glands, seborrhea (this is what the disease accompanied by peeling is called) is divided into dry, oily, and mixed. It can also manifest itself in other forms.

Skin care rules

Skin care prone to symptoms of seborrheic dermatitis is primarily focused on normalizing the functions of the sebaceous glands. It is important not only to reduce sebum production, but also to ensure skin hydration.

General care recommendations:

Try to reduce the use of comedogenic makeup, as it can cause clogged pores.
Use care products that do not contain alcohol. It irritates the skin, dries it out, causing the sebaceous glands to work more actively.
For care, choose special cosmetic products designed for seborrheic skin.

Medical treatment of acne and seborrhea

There are skin diseases that are treated by both dermatologists and cosmetologists. These include things that everyone may have, that you may not pay attention to, but that you really want to get rid of, since it affects the aesthetic appearance of the skin. So, these are problems that spoil the appearance and cause not so much physical as mental suffering. We will focus here only on the most common ones - Acne, seborrhea and various formations on the skin.

Acne vulgaris or juvenile acne

Acne

– the most common skin disease in adolescents and young people, that is, the most socially active part of the population. This unpleasant disease affects about 85% of people aged 12 to 25 years in European countries, so clear skin at this age is the exception rather than the rule. The presence of inflamed pimples, pustules and ulcers, blackheads (comedones), spots and scars, a greasy, untidy appearance of the skin in the most visible places causes difficulties in communication, professional organization, reduces self-esteem, and often leads to the formation of significant psycho-emotional disorders, even the desire for complete isolation. Some young people stop leaving home, give up school and work, become isolated, and eventually a minor and completely banal skin problem develops into a personal tragedy. A patient who consults a dermatologist about acne has serious psychological problems. Shyness, guilt, a sense of social unacceptability, anger, depression, and disbelief in the possibility of a cure are expressed to varying degrees. Intense experiences aggravate the course of the disease. In stressful situations, patients, especially women, pick at the skin and squeeze out acne, which further worsens the appearance of the skin due to associated inflammation. In such injured areas, scars and spots remain that do not go away for a long time.

Acne

– a long-term disease, often exacerbating (in girls, usually monthly) and often resistant to treatment. Currently, we know much more about acne than ten years ago, and a competent specialist can always help a patient. In this regard, the opinion that existed in the past that acne will go away on its own with age, and therefore there is no need to waste effort on treating it, now sounds simply absurd. It is not always possible to immediately find the right individual approach, but the efforts made and perseverance shown are always rewarded with a good result. Specialists have a number of effective medications from different groups in their arsenal. The choice of drug depends on the form of the disease, the predominance of certain symptoms, the gender of the patient, and the presence of contraindications.

Acne is most often divided into:

acne with a predominance of comedones (white and blackheads with mild inflammation);
papulopustular acne (there are comedones, inflamed nodules - what are usually called pimples, pustules, sometimes single large painful lumps, gradually turning into ulcers such as boils);
conglobate acne (along with all of the above, there are long-term painful lumps that leave pronounced scars after healing).

Over time, most patients develop the habit of squeezing out comedones and pustules, constantly touching the inflamed skin, which is why bloody crusts, spots, and superficial scars are added to everything described.

Many factors take part in the development of acne, the action of which is ultimately realized in the pilosebaceous follicles. Not all follicles are affected, but only those with a special structure, located on the face and in the upper part of the body, with large sebaceous glands, wide (up to 2.5 mm) ducts and thin, almost invisible hairs. The sebaceous glands are the target organ for sex hormones, especially testosterone. Under the influence of testosterone, produced by the gonads especially actively in adolescence, the size and number of sebaceous glands increase significantly, the production of sebum increases, and its composition changes. In addition, in the development of acne, disruption of the keratinization of the sebaceous gland ducts, difficulty in the outflow of sebum to the surface of the skin, increased proliferation of microbes in accumulated sebum and subsequent inflammation are essential. With the help of modern medicines it is possible to influence almost all factors involved in the development of the disease.

At the initial manifestations of acne (usually at the age of 8–13 years), when the clinical picture is dominated by increased oily skin and comedones (whitish nodules and blackheads), and there are not many inflammatory elements, preparations of retinoic and salicylic acids are used externally. Both acids have the property of dissolving comedones, and salicylic acid has a much weaker effect in this regard. For papulopustular acne, it is advisable to use antibiotics, retinoids, benzoyl peroxide (benzoyl peroxide), traditional external agents (salicylic, chloramphenicol, resorcinol alcohols). Severe forms of acne, including conglobate acne, should be treated with retinoids prescribed orally, and only if there are contraindications, other treatment methods (antibiotics, immunomodulators) should be used. As with papulopustular acne, it is preferable to use a combination of different drugs.

Problems solved during the treatment process and ways to solve them:

reduction in sebum production (retinoids, especially retinoic acid, hormonal drugs - estrogens, progestins or antiandrogens, spironolactones);
reduction of inflammation - antibiotics (tetracyclines, erythromycin, lincomycin, clindamycin) and local anti-inflammatory and microcirculation-improving agents, including zinc oxide, sulfur, tar, ichthyol, resorcinol;
prevention of the appearance and elimination of comedones (retinoids, especially retinoic acid, salicylic alcohol);
preventing the appearance of scars (early initiation of treatment, retinoids, curiosin, contractubex, avoiding trauma to rashes).

Features of acne treatment with drugs of different groups

Currently, retinoids are the most effective group of drugs for the treatment of acne. Their use solves several problems at once - reducing sebum production and inflammation, preventing the appearance and elimination of comedones and scars. Two isomers of retinoic acid (tretinoin and isotretinoin) are used for external treatment of acne. Roaccutane and Retinol palmitate are used for internal treatment of conglobate acne and common papulopustular acne resistant to other external agents.

Roaccutane (isotretinoin) (Hoffmann-La Roche, Switzerland) is available in capsules for oral use of 10 and 20 mg (30 pieces per package). Prescribed at the rate of 0.5–1.0 mg/kg body weight per day, taken in equal parts 2 times a day after meals for 12–16 weeks. If repeated courses are necessary, the break should be at least 8 weeks. Roaccutane is a highly effective drug, however, its use is limited by high cost and many side effects. Treatment is always carried out under the supervision of a specialist.

Retinol palmitate

(vitamin A) is a domestic drug, it is produced in capsules for oral use at 33,000 and 100,000 IU, as well as in an oil solution at 100,000 IU/ml. Effective doses for acne are at least 300,000 IU per day. The course of treatment is 12–16 weeks. The intervals between courses are 4–8 weeks. Retinol palmitate is inferior in effectiveness to Roaccutane, however, it is better tolerated and the cost is much lower.

For external treatment of acne, preparations containing all-trans retinoic acid (tretinoin) and 13-cis-retinoic acid (isotretinoin) are used. All-trans retinoic acid is contained in the following foreign preparations: Retin-A – 0.05% cream in tubes of 30 g (Silag, Switzerland), Lokatsid – 0.05% cream in tubes of 30 g and 0.1% solution in 15 ml bottles (“Pierre Fabre”, France). External preparations with 13-cis-retinoic acid, which has higher bioavailability, are produced only in Russia - Retinoic ointment 0.1% and 0.05% and Retasol® (FNPP "Retinoids"). It is recommended to apply ointments and solution to previously cleansed skin 1-2 times a day. Once the effect is achieved, it is recommended to reduce the concentration or reduce the frequency of application of the drug. Duration of treatment is 12–16 weeks.

Drugs from the retinoid group have a number of side effects. The most serious of them are teratogenicity and embryotoxicity. In this regard, women of childbearing age are prescribed retinoids with reliable contraception and a negative pregnancy test. In the outpatient card, when prescribing systemic treatment, a note is usually made about the woman’s awareness of possible side effects, and abroad dermatologists offer women to fill out and sign a special form in order to avoid further prosecution in the event of side effects. External treatment with drugs of this group is stopped when pregnancy occurs. Retinoids do not have a negative effect on the reproductive function of men.

In the first or second week of treatment, most patients experience an exacerbation reaction, expressed in redness, moderate itching, and peeling of the skin. The patient should be warned about the reaction, and if he is facing important life events at this time, then it is better to postpone the start of treatment. Typically, these phenomena go away on their own within a few days, after which a lasting improvement occurs. Dry lips, cracks in the corners of the mouth, peeling of the skin are common during the treatment process; they are eliminated by using a neutral moisturizing cream for the face and body, hygienic lipstick or lip gel, and limiting the use of detergents when washing and washing. With systemic administration of retinoids, dry nasal mucosa, nosebleeds, conjunctivitis, urethritis, increased levels of transaminases and lipids in the blood, and increased sensitivity of the skin to sunlight are sometimes observed. Taking this into account, before the start of treatment and monthly during treatment, a biochemical blood test is performed, it is recommended to use sun protective creams, and avoid direct sunlight.

Contraindications

pregnancy and lactation, abnormalities in biochemical blood tests (hyperlipidemia, increased activity of ALT, AST and alkaline phosphatase), renal and liver failure, hypervitaminosis A, drug intolerance. Retinoids cannot be prescribed simultaneously internally and externally, ultraviolet irradiation, drugs with keratolytic and exfoliating effects, exfoliating cosmetic procedures and products (scrubs, peeling). The effect of retinoids is weakened by the simultaneous use of glucocorticosteroid drugs and alcohol intake.

Antibiotics

Of the wide range of antibiotics used to treat acne, only tetracyclines, erythromycin, lincomycin, josamycin and clindamycin are used. Prescription of antibiotics orally is indicated when a large area of skin is affected, with a predominance of pustules. During pregnancy, only erythromycin can be used among these drugs.

Antibiotics of the tetracycline group have an advantage over other groups, since they are lipophilic and easily reach the main object of their action - the sebaceous glands. They can be prescribed for a long time - 2-3 months in a small dose. In this case, they block the production of bacterial lipases, the main link in the development of inflammation. A significant advantage of this method is the possibility of long-term treatment without disturbing the composition of the intestinal flora. The daily dose of tetracycline is 1000 mg (10 tablets of 0.1 g or 4 tablets of 0.25 g), doxycycline hydrochloride is 50 mg (1 capsule of 0.05 g once a day), Unidox Solutab is 50 mg ( 1/2 tablet of 0.1 g), metacycline - 600 mg (2 times a day, 0.3 g). Antibiotics of the tetracycline group in the indicated doses are always well tolerated, and side effects characteristic of long-term use at a bacteriostatic dose do not develop. Tetracyclines are contraindicated in concomitant fungal diseases, pregnancy (last trimester), liver dysfunction, leukopenia, children under 8 years of age, and kidney disease. During treatment, insolation is not recommended, ultraviolet irradiation, retinoids for internal use, hormonal contraceptives, psychotropic, anticonvulsant and antidiabetic drugs are not prescribed. Absorption of tetracycline is weakened in the presence of food, especially milk and fermented milk products, as well as trace elements - aluminum, calcium, magnesium, iron. Their use should be avoided during treatment. Tablets are taken separately from meals.

Doxycycline, Metacycline and Unidox Solutab are better absorbed and can be taken with or after meals with plenty of water. Unfortunately, microorganisms quickly develop resistance to drugs in this group, and when re-prescribed they are rarely effective.

Erythromycin belongs to the group of macrolides, the daily dose is 500-1000 mg divided into 3-4 doses 1-1.5 hours before meals. The drug is available in tablets or capsules of 0.1, 0.25 and 0.5 g. Possible side effects include nausea, vomiting, diarrhea, and liver dysfunction. The drug is contraindicated in case of individual intolerance, liver diseases with impaired liver function. It should be borne in mind that erythromycin is inactivated by dairy products and acidic drinks, and also increases blood levels and enhances the toxic effect of carbamazepine (tegretol, finlepsin) and theophylline.

Clindamycin (lincomycin group) is prescribed in a daily dose of 0.6 g, divided into 2 doses, available in capsules of 0.15 g and under the name Dalacin C - 0.15 and 0.3 g. The course of treatment is 7–10 days. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with erythromycin and B vitamins. Lincomycin is prescribed in a daily dose of 1500–2000 mg (2 tablets 3–4 times a day), available in capsules of 0.25 g. The duration of treatment and side effects are similar to clindamycin.

Josamycin or vilprafen in a daily dose of 1000 mg (1 tablet 2 times a day between meals) is used for 2–4 weeks, then 1 tablet. within 8 weeks. Possible side effects include dyspepsia (nausea, vomiting, diarrhea), liver dysfunction. The drug is incompatible with lincomycin and weakens the effect of hormonal contraceptives.

If antibiotics are intolerant, they resort to sulfonamide drugs, usually co-trimoxazole (Biseptol, Septrin, Groseptol, Cotripharm 480). The drug is prescribed 480-960 mg (1-2 tablets) 2 times a day during or after meals with an interval of 12 hours. During treatment, it is recommended to drink plenty of fluids, monitor the condition of the blood and urine, avoid solar and ultraviolet irradiation, and do not prescribe ascorbic acid.

It is logical to assume that local use of the above antibiotics may be much more effective and safer than internal use. However, research shows that topical application of erythromycin, clindamycin and tetracycline is effective only for mild acne, especially in combination with zinc, retinoids or benzoyl peroxide. External use of 1% erythromycin ointment (Ung. Erythromycini 1%) has a positive effect only in combination with other external and internal agents; gel with clindamycin Dalacin T (Pharmacia, USA) is more effective. Easy to use Eryderm (Abbott Labor, USA) – 2% solution of erythromycin. Levomycetinic, boric, and resorcinol alcohols are also used to dry and cauterize individual rashes. Combination preparations that are effective are Zinerit (Yamanouchi, Netherlands) - a solution of erythromycin and zinc acetate and Benzamycin, gel for external use, in 20 g tubes (Rhone-Poulenc Rorer, USA), containing 3% erythromycin and 5% benzoyl peroxide. All of the above drugs are prescribed 2 times a day. Like antibiotics prescribed orally, external medications tend to cause the development of antibiotic-resistant strains of microorganisms, so their repeated prescription is often ineffective. Resistance of Propionibacterium acnes strains (the main microorganism that multiplies in the sebaceous glands of patients) to commonly used antibiotics was found in 60% of patients. Increased resistance depends on the duration of therapy; resistance to erythromycin develops more often.

Other antiseptics and disinfectants. One of the successful modern approaches to treatment is the use of benzoyl peroxide, a lipophilic compound due to the presence of a benzoic acid residue in its composition. Benzoyl peroxide applied to the skin breaks down under the influence of air into peroxide and inactive benzoic acid, which remains on the surface of the skin. Active oxygen compounds damage the walls of bacteria, destroying them, and the content of fatty acids decreases, which prevents inflammation. At the same time, the same compounds also have a damaging effect on the horny scales, which is clinically expressed by peeling of the skin that accompanies the therapeutic effect. Benzoyl peroxide preparations have no effect on comedones, so they are not used if they predominate. Various companies offer this drug under the names Benzacne (Polfa, Poland), Desquam (Bristol-Myers, USA), Oxy 5 and Oxy 10 (SmithKline Beecham, UK), Baziron (Galderma, France). Benzoyl peroxide is available in the form of 2%, 5%, and 10% gel, 5% and 10% lotion. Treatment begins with applying a lower concentration of the drug to the face, then it is increased. A higher concentration is immediately applied to the back and chest. Benzoyl peroxide is applied to previously cleansed skin once a day. Side effects include an exacerbation reaction in the first days of use, dryness and flaking of the skin, discoloration of hair and linen when the drug comes into contact with them. Intolerance is common, so before starting treatment it is recommended to conduct a skin test - the drug is applied to a small area of skin on the flexor surface of the forearm for 48 hours. If there is no itching or redness, you can apply the drug to your face.

A combination of topical application of benzoyl peroxide in the morning and Retinoic ointment in the evening has a good effect, especially in the presence of comedones.

Azelaic acid inhibits the growth of microorganisms and reduces the content of free fatty acids on the skin surface. Skinoren cream or gel (“Schering”, Germany), containing 20% and 15% azelaic acid, respectively, is applied to the facial skin (both affected and rash-free areas) 2 times a day. When used, local skin irritation is possible. Skinoren is used in the complex treatment of acne; using it as an independent remedy usually does not bring success.

Zinc hyaluronate is part of the Curiosin gel (Gedeon Richter, Hungary), has a healing and antimicrobial effect. It can be used for a small number of rashes, since the effectiveness of the drug is low. The gel is applied to cleansed skin twice a day; a burning sensation and redness of the skin at the application sites are possible.

Povidone-iodine (Betadine) is used to lubricate pustules in a concentrated (10%) or diluted 1:1 solution with water 1-2 times a day. It is undesirable to use in fair-skinned and red-haired patients due to increased sensitivity to iodine. The diluted solution cannot be stored.

For a small number of comedones in the initial stage of the disease, salicylic alcohol 2–3% is effective. It is used 2 times a day, being careful not to apply to the entire affected area to avoid drying it out, but only to individual areas.

Sulfur is an anti-inflammatory agent; it is included as one of the components in most external agents (ointments and mash) traditionally used in the treatment of acne. However, in recent years, its comedogenic effect has been discovered, i.e. it can cause the formation of comedones.

Hormone therapy

Sex hormone therapy is only possible for women. Estrogens (ethinyl estradiol) and antiandrogens (cyproterone acetate, spironolactone) can be used for treatment. Estrogens reduce the secretion of the sebaceous glands, although not as significantly as retinoids. They can be used simultaneously with topical retinoic acid, antibiotics or benzoyl peroxide, which increases the therapeutic effect. To achieve a good result, estrogens must be given for a long time - at least 5 cycles. The first signs of improvement are noticeable only towards the end of the second or third cycle. Estrogen has many side effects - nausea, fluid retention in the body, swelling of the legs, weight gain, breast tenderness, skin pigmentation, increased risk of vascular thrombosis. Risk factors for side effects include smoking, alcohol consumption, obesity, and vascular diseases. Cyproterone acetate for the treatment of acne is used only in combination with estrogens. Of the combination drugs, Diane-35 and Janine (Schering, Germany) are used. The drug is prescribed 1 tablet per day, starting from the first day of the cycle, for 21 days with a break of 7 days. The antiandrogenic drug Cyproterone or Androcur (“Schering”, Germany) is prescribed 1 tablet (10 mg) per day, starting from the first day of the cycle for 15 days, a new course begins 4 weeks after the start of the first. Glucocorticosteroid drugs are prescribed orally or parenterally only for abscess and fulminant acne, which is extremely rare. External use of corticosteroid ointments is not indicated.

Drugs of other groups

Zincteral (Polfa, Poland) contains zinc sulfate, a deficiency of which is often found in patients with acne. Tablets of 0.124 g are prescribed 1-2 times a day during or immediately after meals for 1-2 months. There may be nausea in the first week of use. The drug enhances the effect of retinoids, but weakens the effect of tetracyclines. Homeopathic treatments include injections of Cutis compositum or Traumeel (Heel, Germany). Herbal medicine is still widely used as an auxiliary means - applications of badyagi pulp for resorption of individual large nodes, lotions with green tea, calamus rhizome, raspberry shoots. Infusions of plants with estrogenic effects (hop cones, sage leaves) are prescribed internally.

Skin care

Many patients, feeling the increased sebum secretion characteristic of acne, try to wash their face as often as possible using soap and a sponge. At the same time, the skin dries out, but sebum secretion does not become significantly lower, since fat is washed out only from the surface of the skin, without affecting the sebaceous glands themselves, located in its depths. In this regard, frequent washing of the skin (no more than once a day), or the use of sponges and washcloths is not recommended to avoid irritation and injury. Many people now use antimicrobial soap. But it changes the state of the microbial flora only on the surface of the skin and does not have a significant effect on the course of the disease. At the same time, antimicrobial additives contained in soap can cause irritation or allergic reactions. To cleanse the skin, it is better to use soft neutral soap for sensitive skin or special cosmetics intended for this purpose (cleansing with milk, then tonic), and to eliminate the shine of the face associated with the release of sebum to the surface, use cosmetic wipes or special mattifying wipes facilities. The widely held belief that decorative cosmetics should not be used for acne has also now been revised. Modern high-quality cosmetics that do not irritate the skin, mask existing defects well, do not significantly disturb sweating, and are not applied to the skin in a thick layer and can be used during the day. It should be removed at home. Some medications require the use of sunscreen. It is better to prefer gels and milk, and also be sure to quickly remove them from the skin indoors. Scrubs and peels may be recommended to smooth the surface of the skin and give it freshness, but are contraindicated during treatment with retinoids, benzoyl peroxide and tetracyclines.

The use of therapeutic masks with a drying effect and detergents is limited during treatment with retinoids and alcohol solutions. If there are pustules on the skin and severe inflammation, massage and cosmetic cleansing of the skin are contraindicated.

Diet

Both in the past and now, most dermatologists always recommend following a fairly strict diet. Our long-term observations have shown that the benefit of such restrictions is small, and only in a few patients there is a clear connection between eating certain foods (mainly chocolate) and increasing rashes. We usually recommend that patients adhere to a reasonable diet, without excesses, and include more fermented milk products and greens in their diet. However, 2-3 days of fasting during an exacerbation always gives a positive result. In general, when prescribing modern therapeutic agents, there is no need to follow any diet to achieve a good result. If the patient is to take part in a festive feast, it is better to stop taking oral medications for 2-3 days and prescribe enterosorbents (Polyphepan, Enterosgel, etc.).

Our recommendations for treating acne

Initial stage - a few small black dots appear on the nose and forehead (usually in children) - Salicylic alcohol, Retinoic ointment, Skinoren, medicinal cosmetics.
The same, but for significantly oily skin - Retinoic ointment, Salicylic alcohol.
Numerous black spots and individual inflammatory nodules and pustules - Retinoic ointment, Salicylic alcohol, on pustules - alcohols with antibiotics, Dalatsin T, Povidone-iodine.
The predominance of inflammation with a small number of comedones - Retinoids (Retinoic ointment, Retasol®), benzoyl peroxide (Benzacne, Desquam, Oxy 5 and Oxy 10, Baziron), external preparations with antibiotics (Dalacin T, Zinerit, Eriderm, Benzamycin).
The predominance of pustules in a common process (face, back, chest) - antibiotics, in some cases - retinoids internally (Roaccutane, Retinol palmitate), externally - benzoyl peroxide, disinfectants.
Individual large painful ulcers on the face - antibiotics, externally - antibiotic ointments and benzoyl peroxide.

Seborrhea and seborrheic dermatitis

In recent years, what was previously united by one term “seborrhea” has begun to be divided into 2 concepts – seborrhea of the head and seborrheic dermatitis (damage to smooth skin).

Seborrheic dermatitis

– chronic inflammatory skin disease. It affects 1-3% of adults (mostly men). Seborrheic dermatitis, along with acne, is a disorder of sebum secretion. Indeed, both diseases are often combined in the same person and affect the same areas of the skin - the so-called “seborrheic zones” - the face, chest (décolleté area) and the middle part of the back along the spine (interscapular region), where the largest sebaceous glands with wide ducts that secrete large amounts of sebum. Sebaceous glands of this type actively develop and increase in size during puberty. The composition of sebum also changes, it becomes more viscous, the components it contains contribute to increased keratinization, which corresponds to peeling visible to the eye. Smaller glands, but also secreting large amounts of sebum, are located on the scalp. Their purpose is to provide fat lubrication to the hair and make it invulnerable to external influences. These glands also become more active during puberty. In adolescents and adults, the mildest form of seborrheic dermatitis is characterized by flaking of the skin and its excess oiliness without inflammation - on the scalp it is dandruff, and on the face and chest - accumulations of fatty scales in the skin folds - near the wings of the nose, in the nasolabial fold, on the bridge of the nose , less often - on the chest and back. Fatty scales soaked in sebum serve as a good breeding ground for the development of lipophilic fungi Malassezia furfur or Pityrosporum ovale. In turn, the immune system reacts to them with the development of allergic dermatitis, the disease enters its second, more unpleasant phase, and is no longer limited to mild manifestations. Itching, burning, at first mild, then more intense redness of the skin, severe peeling, and hair loss appear. The manifestations of the disease are aggravated by the patients themselves - constant scratching, attempts to remove crusts, remove accumulations of scales from the hair, the use of “folk” remedies, and the most powerful ones, inevitably lead to increased redness, the appearance of scratches and wounds, the proliferation of other microbes, and the development of complications of the pustular process. It is usually in this condition that patients turn to a dermatologist, although everything could have been corrected much earlier.

For any manifestation of the disease, you should pay attention to your diet. Sometimes its correction is enough to prevent further development of the disease. Alcohol, sweets and starchy foods should be limited, regardless of the type of food. For itching and inflammation, smoked, salted, pickled foods, spicy seasonings, strong broths, instant coffee, citrus fruits, kiwi, pineapples and juices from them are also temporarily limited.

Treatment depends on the stage of development and clinical picture of the disease. If dandruff appears without inflammation, you can limit yourself to only external treatment; in more serious cases, internal treatment is also necessary. External treatment includes keratolytic, glucocorticosteroid, antiseptic, disinfectant and antifungal agents. Antifungal drugs are usually the starting point for treatment and can be used long-term without the risk of side effects. Various dosage forms are used - creams, gels, shampoos. Shampoos with antifungal substances - Nizoral, Keto-plus, Perhotal, Mycozoral, Sebozol contain 1-2% ketoconazole. Ti/Jel anti-dandruff shampoo contains 0.75% piroctone olamine and 2% salicylic acid. Creams and gels are applied 2 times a day, shampoos - 3 times a week. Various other medicinal substances that also have antifungal properties include zinc pyrithioneate, tar, sulfur, resorcinol and selenium disulfide. Medicines containing these compounds are available in the form of shampoos for the treatment of dandruff (Friderm-tar, Ti/Jel-Newtar, Friderm-zinc) and ointments for the treatment of smooth skin lesions (Skin-cap, birch tar, tar and sulfur-tar ointments ). Prescription forms are also used: Vidal milk, alcohol solutions with sulfur, boric acid, tar. After hair treatment, it is necessary to change combs, hair brushes, and hats.

For severe inflammation, anti-inflammatory, antiseptic and disinfectants are used. For weeping and severe swelling of the lesions, lotions with resorcinol 1% and herbal decoctions are used. The crusts are usually lubricated with alcohol solutions (salicylic, resorcinol, boric alcohols). Corticosteroids have a rapid anti-inflammatory effect - they are used on the head in the form of solutions - Elokom, Diprosalik (Schering-Plough USA), Lokoid (Janssen-Cilag Belgium), Belosalik (Belupo, Croatia), on seborrheic areas - in the form of ointments and creams - Elokom, Diprosalik, Belosalik, Hydrocortisone ointment. It should be noted that on the skin of the face, which is much thinner than in other areas, only non-fluorinated glucocorticosteroids can be used in the form of easily absorbed creams and emulsions (Advantan emulsion, Elokom cream, Lokoid cream) or weak (Prednisolone, Hydrocortisone) ointments. Drugs in this group are not suitable for long-term use due to the risk of undesirable effects - thinning of the skin, dilation of blood vessels, appearance or worsening of acne. When it is possible to relieve acute inflammation (usually in 3-5 days), and with residual peeling, they are replaced by drugs containing vitamin A - emulsion-based ointments Videstim®, Radevit® (FNPP “Retinoids”, Russia). It is known that vitamin A (retinol palmitate) reduces sebum secretion by reducing the size of the sebaceous glands and keratinization, and also has the properties of a local immunomodulator. Videstim® contains 0.5% retinol palmitate on an emulsion basis, Radevit® - 1% retinol palmitate, ergocalciferol and tocopherol acetate (vitamins A, D and E). The drugs are used for a long time, including for the purpose of preventing relapses. In recent years, the local immunomodulator pimecrolimus, supplied to Russia under the name Elidel, has also been used in treatment. Keratolytic agents are used for severe peeling and crusting. Apply sulfur-salicylic ointment 2-5% 1.5-2 hours before washing hair under a scarf, on the face - 1 hour before washing, 10% ointment with urea Carboderm (Ukraine). A particularly good effect is brought by combination drugs that combine the keratolytic properties of salicylic acid and anti-inflammatory glucocorticosteroids - Diprosalik, Belosalik. Internal remedies include vitamin A (retinol palmitate) in a daily dose of 100,000–200,000 IU (once at night for 2 months), B vitamins, in particular brewer’s yeast (Merz Germany and domestic companies), brewer’s yeast with the addition of zinc and selenium Nagipol, multivitamin-mineral complexes, preparations with selenium (Selevit, Triovit), zinc (Zincteral). To reduce sebum production in women, hormone therapy (Diane-35, Janine) and antiandrogens (Androcur) are used - see above. Despite successful therapy, the disease often recurs. A rational approach to diet and careful selection of skin and hair care products are necessary to maintain a favorable treatment result for as long as possible.

prof. IN AND. Albanova

Treatment of an advanced case

In severe cases of dry seborrhea (when the shoulders are regularly strewn with white flakes of dead skin), treatment with 10% sulfur ointment is suggested.

Here are the main steps of the procedure:

From the first to the eighth day of treatment, the ointment should be rubbed into the scalp daily. To do this, divide your hair into thin strands and apply the substance along the partings, rubbing it into each part for at least 4 minutes.
On the ninth, give your hair a rest: don’t make masks, don’t go to the shower, don’t use ointment.
On the tenth day of treatment, rinse your hair with clean, freshly boiled water and a specialized shampoo for dry dandruff.
From days 11 to 14 of treatment, treat the scalp with a solution of boric acid (2 teaspoons of acid per 150 grams of hot water). Rub the liquid into the roots of your hair before going to bed, wrap wet hair in a scarf and leave overnight.
Then there is a seven-day rest from the procedure and the entire treatment is repeated. Ideally, you need to do it 3 times.

Psoriasis and dandruff

Dandruff on the head appears not only due to the activity of the sebaceous glands and fungi. Sometimes scales on the hair occur with psoriasis. This is a common disease associated with heredity and the body's immune system. The disease is chronic, its therapy is designed to reduce symptoms.

Signs of psoriasis:

the appearance of pink or red spots (occur not only on the head, but also on the arms, legs, and other parts of the body);
gray scales on plaques;
itching, sometimes pain.

An outbreak of this autoimmune disease can easily be confused with seborrhea. It is important to see a doctor on time, because the treatment of these ailments is very different.

Psoriasis appears between the ages of 15 and 35 years. Outbreaks of the disease can be caused by:

poor nutrition;
cold or dry air;
stress.

The causative agent is not fungi, but the person’s own immunity, which attacks healthy cells, which causes active growth of the epidermis.

Therapy requires close supervision by a dermatologist. Both local and oral medications can be prescribed. Phototherapy, IV courses, and injections help relieve symptoms.