Себорейный дерматит: как помочь пациенту

Панюкова С.В., Пирузян А.Л., Корсунская И.М. Себорейный дерматит: как помочь пациенту. Consilium Medicum. 2020; 22 (7): 46–48.
DOI: 10.26442/20751753.2020.7.200314

________________________________________________

Paniukova S.V., Piruzyan A.L., Korsunskaya I.M. Seborrheic dermatitis: how to help the patient. Consilium Medicum. 2020; 22 (7): 46–48.
DOI: 10.26442/20751753.2020.7.200314

Читать PDF

Аннотация

Себорейный дерматит (СД) представляет собой часто встречаемое заболевание, локализующееся на участках кожи, богатых сальными железами. Патогенез заболевания до конца не изучен, но предполагается, что определенную роль в его развитии играет колонизация условно-патогенными дрожжами Malassezia. Распространенность СД в разных странах колеблется примерно около 3%. Чаще всего наблюдается у мужчин, и риск развития заболевания повышается с возрастом. Клинически СД проявляется воспалительными ограниченными бляшками с выраженным шелушением и зудом. Течение заболевания помимо физического дискомфорта вызывает и ухудшение психоэмоционального состояния пациента. Важно предупредить его, что заболевание зачастую носит хронический характер, и стойкого клинического эффекта можно добиться преимущественно при длительной терапии, например препаратами цинка пиритиона. В своей практике мы отмечаем, что у пациентов с СД имеются нарушения корнеометрических показателей кожи: повышенная жирность и сниженная увлажненность. Терапия препаратами цинка пиритиона в сочетании с увлажняющими шампунями демонстрирует значимые результаты уже через 3 нед применения и позволяет добиться стойкой ремиссии и улучшить качество жизни пациентов при длительном лечении.

Ключевые слова: себорейный дерматит, цинк пиритион, корнеометрические показатели кожи, длительная ремиссия.

________________________________________________

Seborrheic dermatitis (SD) is a common disease affecting skin areas rich in sebaceous glands. The disease pathogenesis is not fully understood, but is believed that colonization by the opportunistic Malassezia yeasts plays a certain role in its development. The prevalence of SD in different countries is around 3%. SD most commonly occurs in men, and the risk for the disease increases with age. SD manifests by inflammatory localized plaques with marked desquamation and itching. Apart from physical discomfort, the disease causes an impairment of the patient's psycho-emotional status. It is important to warn the patient that the disease is often chronic, and a stable clinical effect can be achieved mainly with prolonged therapy, for example, with zinc pyrithione. In our practice, we note that patients with SD have alterations in corneometry parameters: increased skin fat content and decreased skin hydration. Therapy with zinc pyrithione combined with moisturizing shampoos shows significant results already after 3 weeks of use and allows you to achieve stable remission and improve the quality of life of patients with long-term treatment.

Key words: seborrheic dermatitis, zinc pyrithione, corneometry parameters of the skin, long-term remission.

Полный текст

Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.

Список литературы

1. Zander N, Sommer R, Schäfer I et al. Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population-based study in 161 269 employees. Br J Dermatol 2019; 181 (4): 743–8.
2. Sanders MGH, Pardo LM, Franco OH et al. Prevalence and determinants of seborrhoeic dermatitis in a middle-aged and elderly population: the Rotterdam Study. Br J Dermatol 2018; 178 (1): 148–53.
3. Lifson AR, Hessol NA, Buchbinder SP, Holmberg SD. The association of clinical conditions and serologic tests with CD4+ lymphocyte counts in HIV-infected subjects without AIDS. AIDS 1991; 5 (10): 1209–15.
4. Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Dis Clin Pract 2017; 4 (1): 21–31.
5. Han ZA, Choi JY, Ko YJ. Dermatological problems following spinal cord injury in Korean patients. J Spinal Cord Med 2015; 38 (1): 63–7.
6. Burton J, Pye R. Seborrhoea is not a feature of seborrhoeic dermatitis. Br Med J (Clin Res Ed) 1983; 286 (6372): 1169–70.
7. Pechère M, Krischer J, Remondat C et al. Malassezia spp carriage in patients with seborrheic dermatitis. J Dermatol 1999; 26 (9): 558–61.
8. Falk MHS, Linder MT, Johansson C et al. The prevalence of Malassezia yeasts in patients with atopic dermatitis, seborrhoeic dermatitis and healthy controls. Acta Derm Venereol 2005; 85 (1): 17–23. DOI: 10.1080/00015550410022276
9. Watanabe S, Kano R, Sato H et al. The effects of Malassezia yeasts on cytokine production by human keratinocytes. J Invest dermatol 2001; 116 (5): 769–73. DOI: 10.1046/j.1523-1747.2001.01321.x
10. Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol 2013; 31 (4): 343–51. DOI: 10.1016/j.clindermatol.2013.01.001
11. Gary G. Optimizing treatment approaches in seborrheic dermatitis. J Clin Aesthet Dermatol 2013;
6 (2): 44.
12. Gupta A, Bluhm R. Seborrheic dermatitis. J Eur Acad Dermatol Venereol 2004; 18 (1): 13–26. DOI: 10.1111/jdv.2004.18.issue-1
13. Soeprono FF, Schinella RA, Cockerell CJ, Comite SL. Seborrheic-like dermatitis of acquired immunodeficiency syndrome: a clinicopathologic study. J Am Acad Dermatol 1986; 14 (2): 242–8.
14. Gupta AK, Versteeg SG. Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review. Am J Clin Dermatol 2017; 18 (2): 193–213.
15. Purnamawati S, Indrastuti N, Danarti R, Saefudin T The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review. Clin Med Res 2017; 15 (3–4): 75–87.
16. Mayser P, Schulz S. Precipitation of free fatty acids generated by Malassezia – a possible explanation for the positive effects of lithium succinate in seborrhoeic dermatitis. J Eur Acad Dermatol Venereol 2016; 30 (8): 1384–9.
17. Gupta AK, Richardson M, Paquet M Systematic review of oral treatments for seborrheic dermatitis.
J Eur Acad Dermatol Venereol 2014; 28 (1): 16–26.
18. Augustin M, Kirsten N, Körber A et al. Prevalence, predictors and comorbidity of dry skin in the general population. J Eur Acad Dermatol Venereol 2019; 33 (1): 147–50.
19. Brocard A, Knol AC, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology 2007; 214: 325–7.
20. Brocard A, Dréno B. Innate immunity: a crucial target for zinc in the treatment of inflammatory dermatosis. J Eur Acad Dermatol Venereol 2011; 25: 1146–52.
21. Bukvic Mokos Z, Kralj M, Basta-Juzbasic A, Lakos Jukic I. Seborrheic dermatitis: an update. Acta Dermatovenerologica Croatica 2012; 20: 98–104.
22. Valia RG. Etiopathogenesis of seborrheic dermatitis. Ind J Dermatol, Venereol Leprol 2006; 72: 253–5.
23. Ozuguz P, Dogruk Kacar S et al. Evaluation of serum vitamins A and E and zinc levels according the severity of acne vulgaris. Cutaneous Ocular Toxicol 2014; 33: 99–102.
24. Azzouni F, Godoy A, Li Y, Mohler J. The 5 alpha-reductase isozyme family: a review of basic biology and their role in human diseases. Advanc Urol 2012; 2012: 530121.
25. Chow SC. Immunomodulation by statins: mechanisms and potential impact on autoimmune diseases. Arch Immunol Ther Exper 2009; 57: 243–51.
26. Gupta M Mahajan VK Mehta KS Chauhan PS. Zinc therapy in dermatology: a review. Dermatol Res Practice 2014; 2014: 709152.
27. Kitamura H, Morikawa H, Kamon H et al. Toll-like receptor-mediated regulation of zinc homeostasis influences dendritic cell function. Nature Immunol 2006; 7: 971–7.
28. Sardana K, Chug S, Garg VK. The role of zinc in acne and prevention of resistance: have we missed the "base" effect? Int J Dermatol 2014; 53: 125–7.
29. Sugimoto Y, Lopez-Solache I, Labrie F, Luu-The V. Cations inhibit specifically type I 5 alpha-reductase found in human skin. J Invest Dermatol 1995; 104: 775–8.
30. Hay RJ. Malassezia, dandruff and seborrhoeic dermatitis: an overview. Br J Dermatol 2011; 165: 2–8.
31. Dawson TL Jr. Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis. J Invest Dermatol Symp Proc 2007; 12: 15–9.
32. De Angelis YM, Saunders CW, Johnstone KR et al. Isolation and expression of a Malassezia globosa lipase gene, LIP1. J Invest Dermatol 2007; 127: 2138–46.
33. Warner RR, Schwartz JR, Boissy Y, Dawson TL Jr. Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo. J Am Acad Dermatol 2001; 45: 897–903.
34. Pierard GE, Pierard-Franchimont C. Effect of a topical erythromycin-zinc formulation on sebum delivery. Evaluation by combined photometric-multi-step samplings with Sebutape. Clin Exper Dermatol 1993; 18: 410–3.
35. Barak-Shinar D, Green LJ. Scalp Seborrheic Dermatitis and Dandruff Therapy Using a Herbal and Zinc Pyrithione-based Therapy of Shampoo and Scalp Lotion. J Clin Aesthet Dermatol 2018; 11 (1): 26–31.
36. Панюкова С.В., Соркина И.Л., Лысенко В.В., Корсунская И.М. Рациональная терапия себорейного дерматита. Клин. дерматология и венерология. 2012; 10 (4): 61–5.
[Paniukova S.V., Sorkina I.L., Lysenko V.V., Korsunskaia I.M. Ratsional'naia terapiia seboreinogo dermatita. Klin. dermatologiia i venerologiia. 2012; 10 (4): 61–5 (in Russian).]

________________________________________________

1. Zander N, Sommer R, Schäfer I et al. Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population-based study in 161 269 employees. Br J Dermatol 2019; 181 (4): 743–8.
2. Sanders MGH, Pardo LM, Franco OH et al. Prevalence and determinants of seborrhoeic dermatitis in a middle-aged and elderly population: the Rotterdam Study. Br J Dermatol 2018; 178 (1): 148–53.
3. Lifson AR, Hessol NA, Buchbinder SP, Holmberg SD. The association of clinical conditions and serologic tests with CD4+ lymphocyte counts in HIV-infected subjects without AIDS. AIDS 1991; 5 (10): 1209–15.
4. Skorvanek M, Bhatia KP. The Skin and Parkinson's Disease: Review of Clinical, Diagnostic, and Therapeutic Issues. Mov Dis Clin Pract 2017; 4 (1): 21–31.
5. Han ZA, Choi JY, Ko YJ. Dermatological problems following spinal cord injury in Korean patients. J Spinal Cord Med 2015; 38 (1): 63–7.
6. Burton J, Pye R. Seborrhoea is not a feature of seborrhoeic dermatitis. Br Med J (Clin Res Ed) 1983; 286 (6372): 1169–70.
7. Pechère M, Krischer J, Remondat C et al. Malassezia spp carriage in patients with seborrheic dermatitis. J Dermatol 1999; 26 (9): 558–61.
8. Falk MHS, Linder MT, Johansson C et al. The prevalence of Malassezia yeasts in patients with atopic dermatitis, seborrhoeic dermatitis and healthy controls. Acta Derm Venereol 2005; 85 (1): 17–23. DOI: 10.1080/00015550410022276
9. Watanabe S, Kano R, Sato H et al. The effects of Malassezia yeasts on cytokine production by human keratinocytes. J Invest dermatol 2001; 116 (5): 769–73. DOI: 10.1046/j.1523-1747.2001.01321.x
10. Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol 2013; 31 (4): 343–51. DOI: 10.1016/j.clindermatol.2013.01.001
11. Gary G. Optimizing treatment approaches in seborrheic dermatitis. J Clin Aesthet Dermatol 2013;
6 (2): 44.
12. Gupta A, Bluhm R. Seborrheic dermatitis. J Eur Acad Dermatol Venereol 2004; 18 (1): 13–26. DOI: 10.1111/jdv.2004.18.issue-1
13. Soeprono FF, Schinella RA, Cockerell CJ, Comite SL. Seborrheic-like dermatitis of acquired immunodeficiency syndrome: a clinicopathologic study. J Am Acad Dermatol 1986; 14 (2): 242–8.
14. Gupta AK, Versteeg SG. Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review. Am J Clin Dermatol 2017; 18 (2): 193–213.
15. Purnamawati S, Indrastuti N, Danarti R, Saefudin T The Role of Moisturizers in Addressing Various Kinds of Dermatitis: A Review. Clin Med Res 2017; 15 (3–4): 75–87.
16. Mayser P, Schulz S. Precipitation of free fatty acids generated by Malassezia – a possible explanation for the positive effects of lithium succinate in seborrhoeic dermatitis. J Eur Acad Dermatol Venereol 2016; 30 (8): 1384–9.
17. Gupta AK, Richardson M, Paquet M Systematic review of oral treatments for seborrheic dermatitis.
J Eur Acad Dermatol Venereol 2014; 28 (1): 16–26.
18. Augustin M, Kirsten N, Körber A et al. Prevalence, predictors and comorbidity of dry skin in the general population. J Eur Acad Dermatol Venereol 2019; 33 (1): 147–50.
19. Brocard A, Knol AC, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology 2007; 214: 325–7.
20. Brocard A, Dréno B. Innate immunity: a crucial target for zinc in the treatment of inflammatory dermatosis. J Eur Acad Dermatol Venereol 2011; 25: 1146–52.
21. Bukvic Mokos Z, Kralj M, Basta-Juzbasic A, Lakos Jukic I. Seborrheic dermatitis: an update. Acta Dermatovenerologica Croatica 2012; 20: 98–104.
22. Valia RG. Etiopathogenesis of seborrheic dermatitis. Ind J Dermatol, Venereol Leprol 2006; 72: 253–5.
23. Ozuguz P, Dogruk Kacar S et al. Evaluation of serum vitamins A and E and zinc levels according the severity of acne vulgaris. Cutaneous Ocular Toxicol 2014; 33: 99–102.
24. Azzouni F, Godoy A, Li Y, Mohler J. The 5 alpha-reductase isozyme family: a review of basic biology and their role in human diseases. Advanc Urol 2012; 2012: 530121.
25. Chow SC. Immunomodulation by statins: mechanisms and potential impact on autoimmune diseases. Arch Immunol Ther Exper 2009; 57: 243–51.
26. Gupta M Mahajan VK Mehta KS Chauhan PS. Zinc therapy in dermatology: a review. Dermatol Res Practice 2014; 2014: 709152.
27. Kitamura H, Morikawa H, Kamon H et al. Toll-like receptor-mediated regulation of zinc homeostasis influences dendritic cell function. Nature Immunol 2006; 7: 971–7.
28. Sardana K, Chug S, Garg VK. The role of zinc in acne and prevention of resistance: have we missed the "base" effect? Int J Dermatol 2014; 53: 125–7.
29. Sugimoto Y, Lopez-Solache I, Labrie F, Luu-The V. Cations inhibit specifically type I 5 alpha-reductase found in human skin. J Invest Dermatol 1995; 104: 775–8.
30. Hay RJ. Malassezia, dandruff and seborrhoeic dermatitis: an overview. Br J Dermatol 2011; 165: 2–8.
31. Dawson TL Jr. Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis. J Invest Dermatol Symp Proc 2007; 12: 15–9.
32. De Angelis YM, Saunders CW, Johnstone KR et al. Isolation and expression of a Malassezia globosa lipase gene, LIP1. J Invest Dermatol 2007; 127: 2138–46.
33. Warner RR, Schwartz JR, Boissy Y, Dawson TL Jr. Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo. J Am Acad Dermatol 2001; 45: 897–903.
34. Pierard GE, Pierard-Franchimont C. Effect of a topical erythromycin-zinc formulation on sebum delivery. Evaluation by combined photometric-multi-step samplings with Sebutape. Clin Exper Dermatol 1993; 18: 410–3.
35. Barak-Shinar D, Green LJ. Scalp Seborrheic Dermatitis and Dandruff Therapy Using a Herbal and Zinc Pyrithione-based Therapy of Shampoo and Scalp Lotion. J Clin Aesthet Dermatol 2018; 11 (1): 26–31.
36. Paniukova S.V., Sorkina I.L., Lysenko V.V., Korsunskaia I.M. Ratsional'naia terapiia seboreinogo dermatita. Klin. dermatologiia i venerologiia. 2012; 10 (4): 61–5 (in Russian).

Авторы

С.В. Панюкова1, А.Л. Пирузян2, И.М. Корсунская*2

1 ГБУЗ «Московский научно-практический центр дерматовенерологии и косметологии» Департамента здравоохранения г. Москвы, Москва, Россия;
2 ФГБУН «Центр теоретических проблем физико-химической фармакологии» РАН, Москва, Россия
*marykor@bk.ru

________________________________________________

Svetlana V. Paniukova1, Anastas L. Piruzyan2, Irina M. Korsunskaya*2

1 Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology, Moscow, Russia;
2 Center for Theoretical Problems of Physicochemical Pharmacology, Moscow, Russia
*marykor@bk.ru

Назад к списку

Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.