Author Topic: Seborrhea: My treatment algorhitm  (Read 8376 times)

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Offline Looper

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Seborrhea: My treatment algorhitm
« on: Wednesday November 24, 2004, 12:49:42 AM »

Four month ago I joined this great community looking for answers for my skin condition. At the time I was recovering from the steroid rebound that hydrocortisone gave me. Now my SD hasn’t been an issue for quite some time (knock on wood) . The least I can do in return to this group, is to share my experience. Here goes:

Facial areas:

1) Elidel(pimecrolimus) 1% crиme. This effective crиme with low side-effect profile can suppress SD in couple of applications.
 2)(Loprox or Batrafen)Ciclopiroxolamine 1% crиme. This is a new antifungal which is effective against SD. The best thing about it is that along with its antifungal activity(targeting P.Ovale) it exhibits anti-inflammatory activity similar to hydrocortisone 2,5%, but without the side-effects of topical steroids. I use a local version of it.
3)Frequent cleansing of the skin(twice a day) with the proper cleanser. I found that the Garnier Synergy Pure line(washing gel+toner+mousturiser) is very effective. This is the first cosmetic product I have found useful. It is especially designed for oily/acne-prone skin. It is not recommended for sensitive skin, so if you have rosacea in addition of your SD, you may want to find an alternative to this like Dove exfoliating cream bar.
4)Recently I have found a honey/propolis/other herbals lotion that is useful for keeping the skin free of SD.This is a local product (I’m from Macedonia), so most of you should find a similar lotion with the same ingredients.
5) Dietary changes may be helpful, but don’t do anything extreme. I am a college student on a very demanding college, so my diet relies mostly on fast-foods. You should try cutting down the processed foods, and see if you get any results.

The algorithm:

Because Elidel is an expensive crиme, and the ciclopiroxolamine (Loprox in the US, Batrafen in the EU), is 10-times cheaper then 15g Elidel tube, I recommend using the Elidel for flare-ups, and the do a maintenance therapy with ciclopiroxolamine or the propolis product and use Elidel only on the weekends. I use these products only at night before I go to bed, and during the day I use the Garnier Synergie Pure line.

Of course, “feeding” the skin all the time with synthetic drugs, no matter how low their side-effect profile is, is not good for the skin. So I recommend after you put things in control, use a “vacation” from the synthetic drugs, and rely on the cosmetic/natural product. You can always restart treatment if needed.

From my experience, this treatment has fast action (two-three days until you clear things) and then keeping it in that state with the maintenance therapy.

The scalp:
I do not have much problems with the scalp. Head&Shoulders regular usage is taming it. You should try Nizoral if you have problems. At this point I must say that Nizoral crиme did nothing for my facial areas.

That’s what I have to share. I really hope this works for you. SD isn’t such a bad thing, but keeping it down, really makes difference although not a big one. After all we are what we are with or without SD, but keeping your skin free from SD can make things easier.

Here is some scientific data on these products(although my sincere experience should be your main argument):



Ciclopirox is a hydroxylated pyridone, a unique substance in our topical treatment armamentarium. It first came to market in Europe and has been in use for a number of years (1). Worldwide it is or has been available as a spray, vaginal cream, powder, solution, cream, lotion, gel, and nail lacquer. The latter four are available in the United States at the time of this article. Ciclopirox gel differs from other formulations. It contains ciclopirox as a free acid, as opposed to an olamine salt. Superficial fungal infections and seborrheic dermatitis are two of the most common disorders seen in dermatology and indeed in medicine in general; ciclopirox is active against both, and literally may be used head to foot.


Ciclopirox differs structurally from other available anti-fungals and works differently. It has a unique and complex mode of action which mainly affects iron dependent enzyme systems (e.g. cytochromes, catalase, peroxidase) and cytoplasmic membranes (e.g. transport mechanisms) (2). It penetrates well into the stratum corneum (3). Ciclopirox may affect Malassezia furfur via damage to the cell membranes and disorganization of internal structures (2). Furthermore, with Candida albicans and Saccharomyces cerevisiae, ciclopirox may block the transmembrane transport of radiolabeled leucine (2). The other main classes of topical antifungals are the imidazoles, polyenes, allylamines, and benzylamines.

1) Imidazoles. Ciclopirox does not affect sterol biosynthesis, as do the azoles. The later are primarily fungistatic and work by inhibiting, ergosterol synthesis primarily affecting the cell wall.

2) Polyenes. These also work by binding to ergosterol, therefore disrupting the fungal cell membranes primarily in Candida.

3) Allylamines / benzylamines. These are closely related substances that suppress ergosterol at an earlier point than the azoles by inhibiting squalene epoxidase.

Spectrum of Activity

Antimicrobial Activity

Its uniformity of antimycotic activity distinguishes ciclopirox from most other topical antifungals (4). It has fungicidal and sporicidal activity in vitro (5). It can also be fungistatic at times (2). It is active against dermatophytes, yeasts and non-dermatophyte molds MIC range 0/9-3/9 g/ml (6,7). It has in vitro activity against many grain positive and gram negative bacteria including Proteus species, Psuedomonas species, Proprionibacteria aches, and Corynebacterium minutissimum (6).

Antiinflammatory Activity

Ciclopirox olamine may exhibit better antiinflammatory activity than 2.5% hydrocortisone (8). It may inhibit prostaglandin and leukotriene synthesis in human polymorphonuclear cells (2).

Clinical Uses

Seborrheic Dermatitis

About 3-4% of the population has or has had seborrheic dermatitis. Sebum-rich areas promote growth of lipophilic yeast like Pityrosporum ovale and Malassezia. It is effective against seborrheic dermatitis of the face and the scalp (9). It has been used in a shampoo form outside of the USA. Although there are no good studies to prove this, ciclopirox shampoo could be used empirically to decrease the chance of relapse and reinfection after tinea capitis is treated orally, as has been done empirically by clinicians with ketoconazole shampoo.

Tinea Versicolor

Clinical and mycologic cure rates have been recorded as high as 77% after two weeks of treatment (11).

Tinea Corporis/Cruris

At the end of 28 days with twice a day treatment, 2/3 of patients were clinically and mycologically cured (4).


Cutaneous candidosis was 83% clinically cured and 82% to 90% mycologically cured in one study (12). Vaginal candidosis was treated as an inserted cream, which cleared the condition 72% in one study (13) and as high as 91% in another (12).

Tinea Pedis

The drug is active against the common mycological causes of tinea pedis, Trichophyton rubrum and Trichophyton mentagrophytes. It also has antibacterial and anti-inflammatory properties that make it especially helpful in inflammatory conditions such as inflamed tinea pedis. One may experience mild transient burning after application. Ciclopirox powder may be used for drying as well as for its antimicrobial effect.


Lacquer is applied nightly to toenails. It has been shown to penetrate the nail plate. Cure is less than 10% (17). Other studies have been done with different formulations with varying results (15,16). Theoretically, especially in the lacquer form, it may be used to decrease relapse and reinfection of onychomycosis (18,19).


Ciclopirox olamine is pregnancy Category B (5). Safety and efficacy are unproven in lactating women (5). Ciclopirox olamine 1% cream is not associated with delayed hypersensitivity type contact sensitization, contact sensitizers, phototoxicity, or photo contact sensitization (2).


The pedal complex (foot and nails) often acts as the reservoir for fungus to spread elsewhere. The author feels strongly that when seeing tinea on the body other than on the scalp, the pedal complex needs to be examined.

Some of the drawbacks of ciclopirox:

1) occasional contact burning

2) twice-a-day application

An ideal topical agent is broad spectrum, efficacious in low concentration, keratinophilic, and lipophilic, with a convenient dosing schedule, fungicidal activity, a reservoir effect in the stratum corneum, high mycologic and clinical cure rates, a lack of microbial resistance, low relapse rate, low incidence of adverse effects, and low cost (19). Cosmetic acceptability is another important criterion.


Ciclopirox olamine in its various forms is safe and effective. It appears to fulfill the criteria mentioned above as well as any other product on the market.


(1.) Dittmar W, Lohan G. HOE 296, a New Antifungal compound with a broad antimicrobial spectrum. Laboratory Results. Arzneim--Forsch Drug Res 1973; 23:670-676.

(2.) Gupta AK. Ciclopirox: An Overview. Intern J Dermatol 40:1-7, 2001.

(3.) Ceschin-Roques CG, Hanel H, Pruja-Bougaret SM, et al. Ciclopirox olamine cream 1%: In vitro and in vivo Penetration into the Stratum corneum. Skin Pharmacology 1991; 4:95-99.

(4.) Bogaert H, Cordero C, Ollague W, Sayin RC, et al. Multicentre Double-Blind Clinical Trials of Ciclopirox Olamine Cream 1% in the Treatment of Tinea Corporis and Tinea Cruris. J Int Med Res 1986; 14:210-216.

(5.) Loprox Cream package insert, 2002.

(6.) Gupta A. The Spectrum of Utility of Ciclopirox for the Treatment of Superficial Fungal &. Bacterial infection. Ann Dermatol Venereol 2002; 129:IS607-IS842.

(7.) Gupta A. Antifungal Susceptibility Testing of Dermatophytes, Yeasts and Non-Dermatophyte to Ciclopirox and other Antifungal agents. Ann Dermatol Venereol 2001; 129:IS607IS84201.

(8.) Rosen T, Schell BJ, Orengo I. Anti-inflammatory Activity of Antifungal Preparations. Internat J Dermatol 1997; 36:788-792.

(9.) Dupuy R, Maurette C, Amoric JC, et al. Randomized placebo-controlled, double-blind study on clinical efficacy of ciclopirox olamine 1% cream in facial seborrheic dermatitis. BR J Dermatol 2001; 144:1033-1036.

(10.) Wu YC, Chuan Mt, Lu YC. Efficacy of ciclopirox 1% cream in onychomycosis and tinea pedis. Mycoses 1991; 34:93-95.

(11.) Cailen SI, Frost P, Jacobson C. Treatment of Tinea Versicolor with a new antifungal agent, Ciclopirox Olamine Cream 1%. Clin Therapeutics 1985; 7:574-583.

(12.) Bagatell, FK, Bogaert, H, Cullen SL, et al. Evaluation of a New Antifungal Cream, Ciclopirox Olamine 1% in the Treatment of Cutaneous Candidosis. Clin Therapeutics 1985; 8:41-48.

(13.) Quciorz JL and Cymbalista NB. Estudo clinico com ciclopirox creme vaginal na candidiase vulvovaginal. Revista Brasileira Clinica e Terapuetica 1980; 37:479-483.

(14.) Peil HG. Offene Studie zur Wirksam Keit and vertragilich Keit cicloprox olamine bei vulvovaginaler candidose. Arzeimittel--Forshung 1981; 31: 1366-1372.

(15.) Jue SG. Dawson GW, Brogden RN. Ciclopirox Olamine 1% cream: A Preliminary Review of its antimicrobial activity and Therapeutic Use. Drugs 1985; 330-341.

(16.) Quadipur SA, Horn G, Hoehler T. Zur Lokalvirksamkeit von cicloproxolamin bei Naglemy Kosen. Arzneimittel--Forsch 1981; 31:1369-1372.

(17.) Penlac lacquer package insert, 2002.

(18.) Gupta AK, Daniel CR. Factors that may affect the response of onychomycosis to oral antifungal therapy. Australasian J Dermatol 1998; 59:222-224.

(19). Gupta AK, Daniel CR. Onychomycosis: Strategies to reduce treatment failure and recurrence. Curtis 1998; 62:189-101.


C. Ralph Daniel, MD

971 Lakeland Dr #659

Jackson, MS 39216




COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2003 Gale Group

Elidel crиme:

Topical pimecrolimus in the treatment of seborrheic dermatitis.
Brownell I, Quan LT, Hsu S.
Department of Dermatology, Baylor College of Medicine, Houston, TX, USA.
Seborrheic dermatitis is a chronic inflammatory disease that mainly affects seborrheic areas of skin. An inflammatory response to the yeast Pityrosporum ovale has been thought to be important in the etiology of the condition. Therefore, topical antifungals and corticosteroids have been the mainstay of treatment. The recent development of topical macrolactam immunomodulators has offered a useful, safe alternative to corticosteroids in the treatment of various inflammatory skin disorders. We report successful treatment of seborrheic dermatitis with pimecrolimus.
PMID: 12952760 [PubMed - indexed for MEDLINE]

An open pilot study using tacrolimus ointment in the treatment of seborrheic dermatitis.
Meshkinpour A, Sun J, Weinstein G.
University of California, Irvine, USA.
Seborrheic dermatitis is generally treated with topical steroids, antifungals, or both. This pilot study was undertaken to examine the possibility of tacrolimus as a useful therapy for seborrheic dermatitis. In a single-center, open-label study, 18 consecutive patients with seborrheic dermatitis were treated with 0.1% tacrolimus for a total of 28 days or until complete clearance occurred, if sooner. Of the patients, 11 (61%) showed 100% clearance of their seborrheic dermatitis; the remaining 7 patients showed 70% to 99% clearance. The most common side effects were mild local burning and irritation.
PMID: 12833030 [PubMed - indexed for MEDLINE]

Tacrolimus 0.1% ointment for seborrhoeic dermatitis: an open-label pilot study.
Braza TJ, DiCarlo JB, Soon SL, McCall CO.
Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.
BACKGROUND: As a topical immunosuppressant, tacrolimus ointment may be beneficial in the treatment of seborrhoeic dermatitis, while avoiding adverse effects related to long-term use of topical corticosteroids. OBJECTIVES: To determine the safety and efficacy of topical tacrolimus 0.1% ointment in the treatment of seborrhoeic dermatitis. METHODS: Sixteen subjects (15 men and one woman) were enrolled in a 6-week, open-label, uncontrolled trial of daily topical tacrolimus 0.1% ointment. Following a 2-week washout period for subjects using conventional therapy for seborrhoeic dermatitis, study medication was applied nightly to affected areas until clinical clearance occurred, and then for 7 days thereafter. Lesional extent and severity were assessed at baseline (day 0), at week 2 and at week 6 using the following parameters: (i). clinical assessment of erythema and scaling using a 0-3 scale; (ii). investigator global assessment; (iii). subject global assessment using a 0-6 scale; and (iv). serial photography. RESULTS: Thirteen of 16 (81%) subjects completed the study protocol; three subjects were lost to follow-up at week 6. Relative to the mean baseline value, the mean lesional erythema scores improved by 66.1% and 70.9% at weeks 2 and 6, respectively. Compared with baseline, the mean scaling scores improved by 63.7% at week 2 and 87.8% at week 6. These observations were statistically significant (P < 0.05, Wilcoxon two-sample test). Mean investigator global assessment scores improved by 76.6% at week 2 and 82.7% at week 6, relative to the mean baseline value. Mean subject global assessment scores also improved, by 69.4% at week 2 and 83.5% at week 6, relative to the mean baseline value. Other than transient application site pruritus/burning in two subjects, no serious adverse events were observed. CONCLUSIONS: This pilot study suggests that topical tacrolimus 0.1% ointment is efficacious in the short-term treatment of seborrhoeic dermatitis. Further controlled trials are warranted, to determine its efficacy and safety for this common condition.
PMID: 12828755 [PubMed - indexed for MEDLINE]

Honey products:

Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff.

Al-Waili NS.

Dubai Specialised Medical Centre and Medical Research Labs, P.O.Box 19964, Dubai, United Arab Emirates.

Honey has antibacterial, antifungal and antioxidants activities and has high nutrient value. In this study we investigated the potential use of topical application of crude honey in the management of seborrheic dermatitis and dandruff. Thirty patients with chronic seborrheic dermatitis of scalp, face and front of chest were entered for study. Twenty patients were males and 10 were females, their ages ranged between 15 and 60 years. The patients had scaling, itching and hair loss. The lesions were scaling macules, papules and dry white plaques with crust and fissures. The patients were asked to apply diluted crude honey (90% honey diluted in warm water) every other day on the lesions with gentle rubbing for 2-3 mins. Honey was left for 3 hr before gentle rinsing with warm water. The patients were followed daily for itching, scaling, hair loss and the lesions were examined. Treatment was continued for 4 weeks. The improved patients were included in a prophylactic phase, lasting six months. Half patients were treated with the topical honey once weekly and the other half served as control. All the patients responded markedly with application of honey. Itching was relieved and scaling was disappeared within one week. Skin lesions were healed and disappeared completely within 2 weeks. In addition, patients showed subjective improvement in hair loss. None of the patients ( 15 patients) treated with honey application once weekly for six months showed relapse while the 12/15 patients who had no prophylactic treatment with honey experienced a relapse of the lesions 2-4 months after stopping treatment. It might be concluded that crude honey could markedly improve seborrheic dermatitis and associated hair loss and prevent relapse when applied weekly.

PMID: 11485891 [PubMed - indexed for MEDLINE]

Best wishes,


If one thinks that something is impossible, one should not prevent the other one from doing it.

Celery Peach

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Re: Seborrhea: My treatment algorhitm
« Reply #1 on: Wednesday November 24, 2004, 06:52:24 AM »
 :hi: Looper

Thats a great article ! And thank you for sharing what has worked for you !  :)


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Re: Seborrhea: My treatment algorhitm
« Reply #2 on: Wednesday November 24, 2004, 12:51:57 PM »
Great article Looper!


Offline Andy50

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Re: Seborrhea: My treatment algorhitm
« Reply #3 on: Wednesday November 24, 2004, 07:58:59 PM »
Being a seborrheoic dematitis sufferer i`ve found this a fantastic article,thanks Looper :)
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You were good in your time
And we thank you

Offline chili-o

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Re: Seborrhea: My treatment algorhitm
« Reply #4 on: Friday November 26, 2004, 07:30:07 PM »
Hey there!

Boy, am I ever thankful to this forum. I've been battling with SD for such a long time. I feel like I've been robbed of the best years of my life. I don't just mean this from a vanity standpoint either (although everyone is entitled to some) but sometimes my D would be so bad that I couldn't even smile, laugh or make any other significant facial expresion because my skin would be so tight; try going to the dentist when it's this bad.

I have learned not to take my skin or my health for granted and I also learned not to surrender and keep searching for helpful remedies. So far this forum has been my key to better skin. Although a week after I joined the forum and thx to Selsun my skin improved a lot, I started to over wash it and only gave myself the worst flare up ever. It looked like I had a bad sunburn: my skin was very red, some parts were even dark brown and it was so cracked it seemed my nose would fall off. It was evident that along with the Selsun I also needed a good moisterizer. Desperate I ran to the pharmacy to look for a zinc cream. I looked through every aisle for something and finally came to the baby section and found the zinc oinments for diaper rash. Sure it had zinc but zinc oxide not pyrithione but I bought it anyway. For awhile it did feel better but then it started to itch a lot. When I tried washing it off it was so greasy it was difficult get out, the cure was now worse than the problem. Then I thought of olive oil. I warmed some up, massaged it onto my face, let that dissolve the zinc cream then washed it off with Cetaphil and a drop of Selsun. Would you believe the redness was gone? Skin was still very scaly, flaky and cracked in some parts but the less damaged parts were  all better. I put some aloe vera gel and finding some temporaty relief I hit the sack.

I feared that I'd wake up to a break out. Being that for years I had used harsh products to reduce the sebum production (sulfur, coal tar, salicylic acid) and it seems that at night my skin would produce all the grease I washed off and then some. So if my skin felt a little greasy now, what would it be like in the morning? I was so amazed to find it the same; if only I knew what normal oil production was, I would dare say it was normal. The bad parts were still very rough but there was no redness underneath. Itchiness was down to a minimum. I washed only with Cetaphil this time and moisterized with the aloe vera. Still no redness. Some flakes and roughness. At night I put on warm olive oil 20 min. before washing. Continued improvement; some roughness. Then yesterday I tried the honey only left it on for an hour, though. I am amazed by the results. My skin is great! I can hardly believe it. I must look at myself every five minutes. Last night I stayed off the olive oil and the Selsun, washed only with Cetaphil. The last of the flakes are coming off, my skin feels awesome. Finally a reason to smile! And it's great that I can actually do it without cracking my skin. I am crossing my fingers  that this is not just temporary.

Thx a lot for the sweet tip!   ;D
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Offline Looper

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Re: Seborrhea: My treatment algorhitm
« Reply #5 on: Saturday November 27, 2004, 11:03:51 PM »
Hi, there.

Not a problem, guys. I enjoined writing it.

Hey, andy50 "seborrheoic dematitis" ??? ?! What, did they changed the name while I was gone? ;) This is aimed at chili-o to learn to smile a bit often.

chili-o, if you have any problems do not hesitate to ask. There are many treatments for this condition, you just need to find the ones for you. I'm sure you'll find a safe way to control your "problem". Also, avoid steroid sollutions.

Best wishes.
If one thinks that something is impossible, one should not prevent the other one from doing it.

Offline chili-o

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Re: Seborrhea: My treatment algorhitm
« Reply #6 on: Tuesday November 30, 2004, 07:19:23 PM »
It's been a week already of good doses of honey and I've got the smoothest skin ever! It's like a baby's bottom! I love it. I do still have a bit of redness around the nose but then again I've always had that, even before the SD developed so I guess it's ok.

Thx again! ;D
« Last Edit: Tuesday November 30, 2004, 07:21:07 PM by chili-o »
"It is only with the heart that one can see rightly. What is essential is invisible to the eye." - Saint-Exupery

Offline idil

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Re: Seborrhea: My treatment algorhitm
« Reply #7 on: Monday December 06, 2004, 07:26:30 PM »
hey looper.

 Ive tried ointments that had 1%hydrocortisone and 2%nizoral in the past and they didnt do much for me. After reading your post I went to see a doc yesterday and asked him to prescribe Loprox or  BatrafenCiclopiroxolamine 1% creme. I asked him how long i should use it and he told me to use it on my face until it clears up. My question is how long did you use it?

Secondly about the honey, im wondering can i just by plain honey from a health store and use it on my face or does it have to be diluted???

Im wondering about aloe vera, which is better the gel or creme version????
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