Alternative Treatment for Seborrheic Dermatitis

Natural therapies for seborrheic dermatitis, such as tea tree oil, essential fatty acids, nutritional supplements and homeopathic and holistic treatments, are becoming more and more popular with patients as they may not be satisfied with traditional remedies. Now that a significant percentage of patients are using some form of complementary and alternative medicine — known as CAM — it behooves their physicians to inform themselves about these approaches to better supervise their care. Despite many options offered by conventional medicine to treat seborrheic dermatitis, many patients do not have much success with this annoying flaking and itching of the scalp, ears, face and sometimes chest and groin. Because of this, your patients may turn to alternative treatments found in health food stores or the Internet in search of relief. Curious myself, I searched on the Internet for treatments that I could either buy over the counter or make myself and my simple Google search turned up 235,000 hits! Below is an “itchy scalp” recipe I found on the Internet.1 It says to combine the following in a 20-oz. spray bottle, store in the refrigerator, and use twice daily to “kill yeast and reduce itching”: • 15 oz aloe vera juice • 4 oz calendula juice or tea • 15 drops lavender essential oil • 5 to 10 drops tea tree oil • 5 to 10 drops rosemary essential oil. Would something like this work? Would it do any harm? We will explore alternative treatments for seborrheic dermatitis in this article and see if any of them have any scientific evidence behind them. Conventional Treatment Options Treatment options are generally aimed at the presumed causative agent of seborrheic dermatitis, the yeast Malassezia species (formerly known as Pityrosporum) naturally found on the skin of many animals including humans,2-10 and its bothersome scaling, redness and itchiness that are part of this condition. Multiple studies have demonstrated the efficacy of conventional topical treatments such as antifungals (ketoconazole, selenium sulfide), keratolytic agents (zinc pyrithione, salicylic acid, tar), and anti-inflammatory/immunomodulatory preparations (corticosteroids and calcineurin inhibitors).8-20 Natural Treatment Options Natural therapies for seborrheic dermatitis are becoming more and more popular with patients, as they may not be satisfied with traditional remedies. Tea tree oil is one of the most popular because it is readily available; it also has some evidence, albeit limited, demonstrating its efficacy. Nutritional supplements have gained a lot of mention on the Internet, but have scant scientific data to back up any anecdotal reports of efficacy. And then there are some remedies floating out there on the Internet that are just plain silly, such as massaging mayonnaise and onions into the scalp (suggestion given on someone’s blog). Below, we will look at various reported alternative treatments for seborrheic dermatitis and the data that exists to back up their reported efficacy. Tea Tree Oil Tea tree oil (Melaleuca oil) is an essential oil extracted by steam distillation from the leaves of a shrub-like tree in Australia (Melaleuca alternifolia) and has shown antimicrobial activity against numerous organisms, including Malassezia.21-23 The primary component conferring the antimicrobial activity is terpinen-4-ol.23 While numerous laboratory studies have demonstrated its antimicrobial properties, only one well-designed clinical trial can be found on PubMed. This particular study is from an Australian group (Satchell et al) and is a randomized, single-blind, parallel-group study of 126 patients with seborrheic dermatitis. One group received a placebo shampoo while the other received a 5% tea tree oil shampoo. This study showed a 41% improvement in severity in the group that received 5% tea tree oil shampoo as compared to 11% improvement in the placebo group (P<0.001).24 Overall, the tea tree oil shampoo was well-tolerated by study participants, with mild burning being the most common adverse event. Bottom Line: Although more studies need to be done, 5% tea tree oil shampoo may be an effective natural treatment for reducing seborrheic dermatitis and may be worth a try for a patient looking for an alternative and natural treatment, or as an adjunct to his/her current conventional regimen. Make sure to remind patients to never use tea tree oil orally as there are reports of toxicity when used in this way.25 Also counsel patients that some people may find it mildly irritating and to stop using it if an irritant dermatitis develops. Essential Fatty Acids (GLA) GLA (gamma-linolenic acid) is an essential fatty acid in the omega-6 family that is associated with growth of the skin, hair and nails.26 Sources rich in GLA are evening primrose oil, black currant and borage oils.26 There are no reports of any kind in the medical literature regarding evening primrose or black currant oil. There are two studies, however, related to borage oil, both involving topical treatment of infants only and the diaper area. An altered essential fatty acid pattern has been suggested in the pathogenesis of infantile seborrheic dermatitis.27,28 Serum essential fatty acid patterns from 30 children with the condition suggested a transient impaired function of the delta-6 desaturase enzyme.27,28 There is one pilot study from Sweden involving 48 children with seborrheic dermatitis, all treated with topical GLA in the form of borage oil (24% GLA) twice daily for about 2 weeks; however, treatment was limited to the diaper area only.27 After 10 to 12 days, all children in the study were free from skin lesions. This same group (Tollesson et al)27 also studied the presence of M. furfur in 21 infants with the clinical diagnosis of infantile seborrheic dermatitis. Culture specimens for M. furfur were taken from the foreheads and chests of the infants by means of contact plates at the time of diagnosis, directly after treatment to complete healing, and 1 year following clinical diagnosis. Contact plates were then dispersed with 0.5 mL of borage oil. Additionally, all patients were treated topically with borage oil containing 25% gammalinolenic acid (GLA) twice daily in the diaper area only. Interestingly, the in vitro and in vivo effects were discordant: no reduced growth of M. furfur was seen on contact plates prepared with borage oil, but all patients showed resolution of skin lesions. In both of these studies, no skin irritation was demonstrated. Bottom Line: There are not enough quality studies to show that GLA in any of its forms, oral or topical, are effective in treating seborrheic dermatitis. Although it will likely not cause any harm, there is no conclusive evidence to show that it will help significantly in any area of the body except the diaper area (not too helpful for adults with this problem!). Other Nutritional Supplements and Topicals Seborrheic dermatitis has been associated with nutritional deficiencies, however, no firm association has been established.29-31 Although nutritional deficiencies (selenium, zinc, B vitamins and biotin) have been associated with the occurrence of seborrheic dermatitis (studied most in infants), there are no well-designed studies examining this association in the adult population. Other oral therapies your patients may find on the Internet without any evidence to support them include Milk of Magnesia, ginger root juice, fish oil and acidophilus capsules. Topical treatments without any evidence whatsoever demonstrating efficacy include lavender oil, rosemary oil, aloe vera gel and calendula (field marigold) juice or cream. Bottom Line: There is no reason to recommend any of these treatment options for your patients with seborrheic dermatitis, although use of them is not likely to be harmful. Additionally, limited research has shown that lavender essential oil may cause an irritant or allergic dermatitis in some individuals,32,33 so caution patients about this possibility. Homeopathic Treatments There is one study in the literature demonstrating improvement in seborrheic dermatitis using an oral preparation of a low-dose homeopathic mineral solution containing potassium bromide, sodium bromide, nickel sulfate and sodium chloride.34 This study was a placebo-controlled, randomly selected, double-blinded study involving 41 adult participants with scalp, face or scalp/face involvement. For the first 10 weeks, patients were split between the medication group and the placebo group and then all participants received the medication for another 10 weeks. After the first 10 weeks of treatment, those in the medication group showed significant improvement in their seborrheic dermatitis over the placebo group (P<0.04). Additionally, the placebo patients’ conditions before and after crossover to active treatment was also evaluated and showed significant improvement 10 weeks after crossing over to the medication (P<0.01). The most frequent adverse events were mild GI distress (10.4% of the medication group). There were also no significant abnormalities in laboratory measurements (CMP, CBC and UA) during the course of the study in any of the participants. Bottom Line: Although this single study showed improvement in clinical severity of seborrheic dermatitis with minimal side effects, more quality studies are needed before recommending this oral remedy to patients. For patients who like to use homeopathic regimens and would like to try this, remind them to have their primary care physician monitor their electrolytes in particular. Other Holistic Treatments Although there is a lot of information on the Internet and anecdotal reports about the merit of acupuncture, hypnotherapy or biofeedback in the treatment of seborrheic dermatitis, there are no studies available in the medical literature regarding any of these. Bottom Line: Acupuncture, hypnotherapy or biofeedback are virtually harmless procedures for patients willing to spend the time and money without any guarantee of improvement of their seborrheic dermatitis. Conclusion While there are many purported natural remedies for seborrheic dermatitis, the one therapy that seems to be effective is using a shampoo containing tea tree oil; it seems to be fairly well-tolerated and can be found in an increasing number of inexpensive shampoos that are available over the counter, such as Jason Naturals, Nature’s Gate, and Beauty Without Cruelty. If your patients are not happy with their current conventional regimen, you may suggest adding such a shampoo to their plan. It definitely wouldn’t hurt anything and may even help. As for the other alternative remedies discussed in this article, more studies are needed to show any sort of substantial efficacy in treating seborrheic dermatitis. Dr. Taylor is a dermatology clinical research fellow at Wake Forest University School of Medicine, Winston-Salem, N.C.