Managing Seborrheic Dermatitis Across All Skin Types


Dermatologists discuss clinical considerations when treating seborrheic dermatitis across diverse skin types, addressing common symptoms, concerns, and overall efficacy.


Linda Stein Gold, MD: So let’s go back again, James. You talked about skin of color patients. Is this something that you would be comfortable giving across all different Fitzpatrick skin types, or do you feel like it targets one area or one patient type better than another?

James Song, MD: That’s a great question. We know that one of the issues with our topical cortical steroids it can cause hypopigmentation, so we have to be very careful about how we’re using it. With this study being studied across all different Fitzpatrick skin types and even the patients with darker skin types you saw that it repigmented the skin. I think that gives me a lot of confidence that you can use it across the entire spectrum without having to worry that it’s going to cost them a hypopigmentation.

Linda Stein Gold, MD: Is that something that’s real? We talk about hypopigmentation with topical steroids, and, Shawn, I know we all have a practice that has patients of all different skin types. Do you see this or is it just something that’s reported that’s not true?

Shawn Kwatra, MD: I actually see it all the time, and I see a lot of areas that folks have been just applying topical steroids [become] hypopigmented, and sometimes it doesn’t ever reverse.

Neal Bhatia, MD: Part of the problem too in the darker skin types, that dusky violaceous erythema…could still be active disease. So you get patients who keep thinking that they should be treating, especially when they’re using steroids, and then they overdo it. Whereas you know it’s something safer…for example, roflumilast, that’s 0.3% foam, has enough of the ingredient that we’re not dealing with that potential for overdoing it. But you still want patients to recognize it. If they’re still itching, [if] they still have a little bit of redness, and if they’re skin types 4 to 6, they may still have a little more activity than if they were more fair.

Linda Stein Gold, MD: Now, we use this on up to 20% body surface area. For seborrheic dermatitis, that’s a lot. I don’t know if you guys see more than that. Maybe in a child, you might see it a little more extensive. I think in patients who have concomitant diseases, neurologic diseases, HIV, it tends to be more severe, maybe a little bit more extensive. But I think that really encapsulates pretty much all of our seborrheic dermatitis patients, right? So I don’t think that’s a limitation in that it was studied up to 20%.

Adelaide Hebert, MD: No, I think 20% is very generous. I think we were very fortunate that we had that ability during the clinical trial. I also think one of the things my patients really valued was the rapid onset of action. They could tell. They came back, and at least some of them were happy because of their response. Not everybody was on the active portion of the trial. Some got the vehicle only. But there really was a rapid onset in several of the patients that I can think of even today that were very pleased.

Neal Bhatia, MD: Adelaide, you’ve brought up maximum use before. I mean, the maximum use studies and the [pharmacokinetics] studies give us that reassurance that 20% is not going to cluster up.

Linda Stein Gold, MD: And we talk about the vehicle. When we talk about topical therapy, we know that that is a marriage between the active drug and the vehicle. I expect the vehicle to help in terms of barrier repair and things like that. So I do want to see a little bit of a vehicle effect in terms of getting that skin at least somewhat better. And we did see that in the clinical trials. We had a nice, healthy delta, or difference, between the active and the vehicle. It was highly statistically significant. We also know that that vehicle is a nice vehicle in terms of contributing to the barrier repair overall.

Transcript was AI-generated and edited for clarity.

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