George Woodbury MD 5/12/23
Seborrheic Dermatitis or Scalp Eczema is a common sometimes aggravatingly itchy scalp rash that can present with dandruff, lesions in the scalp, and itching. If also often affects the face areas, the ears, the chest, and the back. Let’s take a look at new management strategies, from my perspective as a Memphis Dermatologist, practicing since 1993 with Rheumatology and Dermatology Associates, Cordova TN 38018 (www.Rheumderm.com: 1-901-753-0168).
Scalp itching and rash can be caused by many different underlieing causes, including Psoriasis, Lupus, and Contact Dermatitis. Sometimes a Cordova Dermatologist like myself with take a skin test called a Scalp Excision to look into the possibility of autoimmune triggers for scalp itching, which can even include a condition called Dermatomyositis. We sometimes take a special type of scalp biopsy called an Immunofluorescent Biopsy to further evaluate for autoimmune causes. And Sometimes we take a scraping for a test called a Fungal Culture, or a KOH test, to check whether a yeast or a fungus could be to blame.
But Seborrheic Dermatitis tends to be the most common cause of scalp itching and rash. Dermatologic research has pointed to the possibility that a normal skin yeast – called Pityrosporon – is implicated in the rash of Seborrheic Dermatitis. Everyone worldwide is felt to have a certain amount of this yeast in their scalp – so the condition is generally not considered to be contagious. This Pityrosporon theory helps to explain why treatment plans often incorporate Antifungal Shampoos and Antifungal Creams.
Sometimes allergies to certain fragrances, dyes, preservatives, or components within latex or certain metals can cause attacks of itching in patients with Eczema. As a member of the American Contact Dermatitis Society, at Rheumatology and Dermatology I offer extended Allergy Patch Testing to help search for trigger chemicals. This type of Skin Allergy Testing can lead to a “cure” from the itching of Eczema, by identifying trigger factors, which could be a metal like nickel, or a preservative, fragrance, dye, or component of latex.
In 2021, the good news is that Dermatologists have a growing arsenal of medications to put the itching and/or dandruff of Seborrheic Dermatits and other scalp rashes to rest. We have the topical steroids, of which there are over 30 available, most of which are by prescription only. Topical steroids must be used carefully, to minimize thinning of the skin, and stretch marks. Dermatologists also sometimes use oral agents like prednisone or injectable steroids like methylprednisolone to help calm severe flares of Seborrheic Dermatitis.
Dermatologists use a growing array of over-the-counter shampoos to help to alleviate the itching of Seborrheic Dermatitis:
Tar Shampoos – including MG217, Ionil T Plus, T Sal and T Gel.
Selenium sulfide Shampoo – Selsun Blue.
We also have increasingly effective prescription shampoos to help alleviate the itching and/or dandruff of Seborrheic dermatitis:
Ketoconazole Shampoo – which comes in both prescription strength and over-the-counter strength.
Ciclopirox Shampoo – which is prescription.
And Clobex Shampoo.
We now also have a number of promising steroid-free prescription medications that can be considered for severe scalp rashes:
Pimecrolimus ointment; and
Crisaborole Ointment (Eucrisa®), a new steroid-free medication based upon boron research.
Opzelura® Cream (Ruxolitinib), a new topical Janus kinase inhibitor that works on the Interleukin system involved in itching,
and several new systemic steroid-free treatments for severe eczema:
Dupixent® (Dupilumab) subcutaneous injections, a type of monoclonal antibody;
Upadacitinib (Rinvoq®) and abrocitinib (Cibinqo®) and two promising new non-steroid JAK-1 inhibitor medicines newly approved by the FDA for management of stubborn Atopic Dermatitis.
And in 2016, I became President of Big River Silk Skincare Inc., to manufacture and distribute three lines of helpful lubricating agents (moisturizers) containing an Alpha-Hydroxy chemical (AHA)called Glycolic Acid: GLYCOSHEA® Hand&Body Cream/Standard Strength (1 oz: $19.95; 2 oz: $29.95; 8 oz: $89.95); GLYCOSHEA® Hand&Body Cream/High Strength (1 oz: $29.95; 2 oz: $44.95; 8 oz: $139.95); and GLYCOSHEA® Facial&Neck Cream (1 oz: $39.95/2 oz; $59.95; 8 oz: $179.95). GLYCOSHEA is helpful in both moisturizing the skin and decreasing the appearance of fine lines in the skin, promoting skin smoothness, making it into an Anti-Wrinkle Cream.
Big River Silk also manufactures a special gentle moisturizer for babies, senior, and those with especially sensitive skin, a hypoallergic moisturizer: HypoShea™ Moisturizer Cream (1 oz: $12.95; 2 oz: $18.95; 8 oz: $39.94).
So if you or family members are suffering from itching and rash, consider getting your condition properly diagnosed. My own Dermatology practice – with Rheumatology and Dermatology – is with Rheumatology and Dermatology Associates, at 8143 Walnut Grove Road, Cordova TN, a suburb of Memphis TN. Or you can find a Dermatologist close to you by going to the American Academy of Dermatology web site, to the “Find a Dermatologist” tab: just plug in your zip code, and you’ll get a list of Board-certified Dermatologists closer to you.
George Woodbury Jr. M.D. (12/30/2022)