Simplifying Treatment Regimens for Patients With SD


Experts explore the challenges of multi-product topical treatment algorithms for seborrheic dermatitis (SD) and the value of once-a-day solutions in fostering adherence, improved quality of life, and overall better outcomes.


Linda Stein Gold, MD: When we go back and look at the clinical trial data and look at the areas that were treated, for the majority of patients, they were treating the scalp, but a lot of patients were treating the face and even the eyelids. So, James, when somebody has seborrheic dermatitis and it’s kind of creeping down on the face and it’s the glabella area and it’s the eyebrows and it’s kind of the whole central face [that] starts to get involved, in the past, what have you done if it’s in that periocular area?

James Song, MD: It’s a challenge, Linda, because we like to use topical cortical steroids as kind of a quick treatment, but we also know using steroids around the eyes can be getting to tiger territory, right? So glaucoma, cataracts, increased absorption, and so we have to be very judicious with using steroids in those areas. Topical calcineurin inhibitors has already been set. It burns, it stings, especially in those areas, and I found that topical azoles just don’t work quite that well either, so it’s great that we have a foam that’s highly efficacious and extremely well tolerated, even in these sensitive areas.

Neal Bhatia, MD: What’s funny, because you’re talking about the azoles, patients just get into the mode of thinking, well, this is a fungal infection, this is ringworm, and you have to eventually try to break that cycle. It’s like, look, all these azoles shampoos and over-the-counter antifungals, let’s get rid of this, because it doesn’t have the mechanism that’s directed at the pathogenesis of the disease.

Linda Stein Gold, MD: And what’s interesting here is when we talk about the areas of involvement, as you mentioned earlier, and look at the patients who are in the clinical trials, the majority of patients had multiple areas of involvement. So [it’s about] simplifying the treatment regimen. We all have those patients who come into our office, they’ve seen a number of our colleagues, and they have the bag. I mean, do you all see the bag?

Neal Bhatia, MD: The suitcase. The bag usually has some demon eggs in it too.

Linda Stein Gold, MD: And you know what happens is that we make treatments so complicated. I say we give patients so many things to do, and in this case, if it’s the scalp, it’s the face, it’s the body, and then they go home, and you give them several things, I say they end up incapacitated by fear, because you gave me so many things to do, I just don’t even know what to do, but say I have a little clobetasol, I know that that worked OK, my scalp was a little bit better, so maybe my face is a little bit better…. I had a patient this week who came in with very significant rosacea, and [the treatment] came from somebody, he’s like, “Well, I have something on it, I don’t know what it begins with, maybe it’s a B or something like that.” Turns out this patient was using a very potent steroid that he had gotten for somewhere else, but he started to notice that if he used it on his face, things went away faster. But then it becomes this vicious cycle, and you can get a steroid-induced rosacea. So I think the idea of simplifying and giving patients one thing to do once a day really helps with this whole process.

Neal Bhatia, MD: That goes back to what we were talking about before with what else is concomitant, right? The acne patient who’s still got seborrheic dermatitis up here, but a lot of forehead involvement with comedones; the rosacea patient who’s got seborrheic dermatitis; even the tinea versicolor patient; we’ve seen overlap with those. So you’re right about trying to be a minimalist, but at the same time, we have to spell it out for them on what each step means to the process. We’re talking about the disease they’re not going to cure, right? This is something that they’re going to be treating, but maybe they can at least wind down to the number of things they’re using.

Linda Stein Gold, MD: Absolutely. So any other thoughts on the clinical trial? Anything that struck you in terms of the design? How important is it? And I want to know, we have lots of different treatments, and we have potentially once-a-day treatments versus twice a day treatments. Does that really matter? Shawn, I’m going to start with you. Do you care if something’s a once a day or a twice a day, or do you feel like you’re setting your patients up for better success if it’s a once a day?

Shawn Kwatra, MD: The once a day gives me a lot of ease, because I think it’s much easier to follow for patients. When we were talking about the different therapeutics, I was thinking about how we break particular topical steroids, for example, and then from our perspective, the provider perspective, we write, “Do not apply longer than 7 days to this area” in all caps, then we get a little bit worried. And how simple is it to just have a once daily preparation for patients? So I think that’s great for patients, it’s great for us too.

Linda Stein Gold, MD: Yeah, and Adelaide, we go back to the mechanism of action, and we have the other topical PDE4, but there’s a difference here, right? That one [is] twice a day versus once a day, ointment versus a foam, which is also available on a cream. What about for a kid? Does it matter once a day versus twice a day?

Adelaide Hebert, MD: I think it’s huge. I think every parent is very grateful if we have a product that they can just use once a day. Now many 9-year-olds are mature enough to take over some of their own skin care. It varies with the child in the household, but I think anything that simplifies the regimen is a value added. I also think that, we haven’t mentioned it, going to the pharmacy and having just 1 co-pay instead of the 3 co-pays for 3 products, which patients could confuse, is another value added. That wasn’t part of the study, but that’s the reality that our patients face when they have to buy medicines in multiples, and we want to simplify that part of their life as well.

Transcript was AI-generated and edited for clarity.

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