How to treat seborrheic dermatitis?
The main attention in the treatment of each patient who suffers from seborrheic dermatitis should be given to the identification of individually significant factors in the pathogenesis of seborrheic dermatitis and, if possible, their correction.
Etiotropic treatment of seborrheic dermatitis consists in the systematic use of external antimycotic agents acting on P. Ovale. These include ketoconazole (Nizoral) and other azole derivatives - clotrimazole (Clotrimazole, Kanesten, Candide, etc.), miconazole (Dactarin), bifonazole (Mycospor), econazole (Pevaril, etc.), isoconazole (Travogen), etc., terbinafines (Lamizil, etc.), olamines (Batrafen), amorolfine derivatives, zinc preparations (Kuriozin, Regecin, etc.), sulfur and its derivatives (selenium disulphide, selenium disulphide, etc.), tar, ihtiol. For the treatment of seborrheic dermatitis of smooth skin and skin folds, these fungicides are used in the form of a cream, ointment, gel and aerosol. When attaching pyogenic infection, antibacterial drugs are prescribed - creams with antibiotics (Baneocin, Fucidine, Bactroban, etc.), 1-2% aqueous solutions of aniline dyes (brilliant green, eosin, etc.).
When the scalp is affected, these funds are used more often in the form of therapeutic shampoos, which should be applied several times a week. The course of medical shampoos is usually 8-9 weeks. It should be remembered that these shampoos need to be applied with the mandatory application of foam for 3-5 minutes, and then - to wash off.
In the "dry" type of lesions of the scalp, it is inappropriate to use alkaline soaps and shampoos, as well as alcohol-containing products, as they degrease and dry the skin, enhance its peeling. Most preferably shampoos containing azoles (Nizoral, Sebozol) or zinc preparations (Friederm-zinc, Kerium-Cream), sulfur and its derivatives (Selezhel, Derkos dandruff for dry scalp ).
With hypersecretion of the sebaceous glands, antiseboric agents are effective, since removing from the skin of the lipid film means the elimination of a favorable environment for the life of P. Ovale. Rational is the use of detergents containing anionic and nonionic detergent acids (for example, lemon) and normalizing the pH of the skin surface. In the case of a fatty type, shampoos containing azoles ("Nizoral", "Sebozol", "NodeD. C "," Node. ("Friederm-tar"), ichthyol ("Curtiol", "Curtiol S"), sulfur and its derivatives (shampoo "Derkos for dandruff for oily scalp") and other products with antifungal activity ( "Saliker", "Kelyual D.S.", "Kerium-intensive", "Kerium gel", etc.).
In the inflammatory type of seborrheic dermatitis, a quick therapeutic effect is provided by solutions, emulsions, creams, ointments, aerosols containing glucocorticosteroid hormones (Elokom, Advantan, Lokoid, etc. Or combined agents (Pimafucort, Triderm, Travocort) with timely prescription of external antifungal agents. , that these drugs are prescribed for a short time within 7-10 days, and fluorinated glucocorticosteroids are not preferred.
Traditionally, keratolytic agents are used in the treatment of seborrheic dermatitis in low concentrations: salicylic acid (for the scalp - shampoos "Phytosilic", "Phyto-saret", "Salicher", "Kerium-Intensive", "Kerium-Cream", "Kerium-gel" , "Squafan") and resorcinol. Rational is the use of combined external drugs containing antimycotics, glucocorticoids and exfoliating agents.
After the onset of remission, careful care of the skin and scalp is shown. For washing recommend "soft" shampoos that do not change the pH of the skin surface ("Ecoderm", "Elijon", "pH balance", etc.). Also recommend a preventive head wash with detergents, including antifungal agents, once every 1-2 weeks.
Critical to the treatment of severe forms of seborrheic dermatitis has individual pathogenetic therapy. However, it is far from always possible to identify and eliminate factors that play a pathogenetic role in the onset of seborrheic dermatitis. Assign inside or intramuscular calcium preparations in combination with vitamin B6. In severe, generalized and resistant to external treatment of seborrheic dermatitis, systemic administration of azole agents (Ketoconazole - Nizoral 240 mg / day for 3 weeks or itraconazole - Orungal 200 mg / day for 7-14 days) is shown. In acute cases of generalized seborrheic dermatitis, in extreme cases, systemic steroids are prescribed (a rapid clinical effect is usually achieved with taking 30 mg prednisalone per day) concomitantly with active external or general therapy with antimycotics. In cases of secondary infection and the development of complications (lymphangitis, lymphadenitis, fever, etc.) antibacterial agents of a wide spectrum of action are shown. Sometimes patients who have seborrheic dermatitis are prescribed isotretinoin and selective phototherapy (UV-B).