Seb Derm, Elidel and Protopic : a Warning

Written by on January 27, 2006 in seborrheic dermatitis with 0 Comments

The author is warning that as seborrheic dermatitis is not well understood and although some studies are showing that pimecrolimus and tacrolimus can be effective, some caution is still advised until large studies are completed.

Pharmacotherapy Update: Treating Seborrheic Dermatitis, James Q. Del Rosso, D.O., F.A.O.C.D.

Journal: Skin & Aging, Issue Number: 2, 2005

Seborrheic dermatitis is a common inflammatory chronic-recurrent disorder characterized by erythema and fine scaling, with or without symptoms such as pruritus. The scalp is affected in up to 90% of cases and the face in up to 75% of patients; other sites of predilection include the periauricular region, central chest, axillae and groin regions.

A variety of effective therapeutic agents are available, including topical corticosteroids, topical antifungal agents, sulfur-sulfacetamide combinations, sulfacetamide, zinc pyrithione and selenium sulfide; multiple vehicle formulations (for example shampoo, foam, cream, gel, lotion, solution, etc.), allow for usage applicable to specific body locations. Although the etiology of seborrheic dermatitis has not been fully elucidated, the commensal yeast, Malassezia furfur (Pityrosporum spp), appears to play a pivotal role in the pathogenesis.

The topical calcineurin inhibitors, pimecrolimus (Elidel) and tacrolimus (Protopic), are FDA-approved in the United States for treatment of atopic dermatitis and have also been shown to be effective in the treatment of other inflammatory dermatoses, including seborrheic dermatitis. Effective reduction in signs and symptoms coupled with favorable safety with chronic administration supports their consideration as viable treatment options for managing seborrheic dermatitis.

This article reviews office-based observational experience with pimecrolimus and tacrolimus in the treatment of seborrheic dermatitis. A perspective on overall treatment recommendations is also reviewed based on available literature and clinical experience.

Looking Ahead: The pathogenesis of seborrheic dermatitis is poorly understood; however, multiple studies indicate that certain Malassezia organisms play a role in the pathogenesis of seborrheic dermatitis. Presently, a variety of treatments are available for seborrheic dermatitis, and the most effective agents are those that directly reduce inflammation associated with the disease or those that decrease the number of M. furfur organisms.

Recently, topical calcineurin inhibitors (pimecrolimus and tacrolimus) have been suggested for treatment of seborrheic dermatitis. At this point, additional studies, including larger controlled trials, are needed to further define efficacy parameters and treatment regimens for initial therapy and maintenance treatment.

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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