Seborrheic dermatitis is a common inflammatory disease that affects the sebaceous glands. Symptoms include erythema, scaling, itching, and oily skin. In this disease, the scalp, face, and trunk are mainly affected. The prevalence of seborrheic dermatitis in the United States in the general population is 1–3 percent and in young people it is between 3 and 5 percent. The prevalence of this disease occurs mainly in the age group of 18 to 40 years and its prevalence in all age groups is higher in men than women, but its prevalence is not related to race.
Seborrheic dermatitis imposes high economic costs on patients and reduces their quality of life. Seborrheic dermatitis has a seasonal pattern, so that it intensifies in winter and exposure to sunlight in summer causes a relative improvement of symptoms.
Sebaceous gland activity varies according to anatomical location, sex, and age. Sebaceous glands are present at birth and sebum secretion is relatively high at this time; But then it decreases until puberty and their activity increases again during puberty. Although the etiology of this disease has not yet been determined; However, it may be associated with excessive secretion of sebum and the yeast Malassezia furfur. This microorganism needs fat to grow; hence it is found mainly in the cells of areas of the body that are rich in fat (sebum). It should be noted that sebum is secreted by lipase and hydrolyzed from Malassezia to glycerin and fatty acid.
Two important drug groups in the treatment of seborrheic dermatitis are topical corticosteroids and antifungal agents. Today, due to the side effects of topical corticosteroids, therapeutic measures are more inclined towards antifungal agents. Topical antifungal drugs or topical corticosteroids are usually the first line of treatment for seborrheic dermatitis, which is sometimes used in combination.[9-11]
Triamcinolone is a corticosteroid that blocks the release of substances that cause inflammation in the body. It is used to treat various diseases such as eczema, allergies, lupus, psoriasis, alopecia, asthma, and autoimmune arthritis. The drug binds to its receptors in the cytoplasm by passing through the cell membrane, and the drug-receptor complex enters the cell nucleus. By binding to specific regions of DNA, this complex stimulates the mRNA transcription process, followed by the production of enzymes that are ultimately responsible for the systemic effects of corticosteroids. Corticosteroids exert their anti-inflammatory effects by preventing the accumulation of inflammatory cells in the area of inflammation, inhibiting phagocytosis and the release of enzymes responsible for inflammation, and inhibiting the production and release of chemical mediators of inflammation.
Due to the high prevalence of seborrheic dermatitis and the economic burden and its negative effects that affect the quality of life of patients in terms of psychological and social status, the treatment of these patients is very important. The main purpose of this study was to evaluate the effectiveness of 80-mg Triamcinolone solution diluted with 0.1% normal saline for the treatment of seborrheic dermatitis in adults.
Material and Methods
To conduct this study, 120 adult patients with clinical diagnosis of seborrheic dermatitis with symptoms of pruritus, erythema, burning, and scaling were selected from patients referred to a skin, hair, and beauty clinic. After obtaining written and informed consent, patients were treated with 80 mg of Triamcinolone diluted with 0.1% normal saline. At the beginning of the study, each patient was examined by a dermatologist. The type of lesion including generalized (involvement of more than one area) and localized (involvement of one area), number of lesions, erythema, scaling, itching, burning, as well as demographic characteristics of patients were recorded in the questionnaire. To determine the severity of seborrheic dermatitis by Scoring Index (SI) method by Koca et al. (2003) was used. For this purpose, the criteria of erythema, scaling, itching, and burning in each area were assigned a score from “0” to “3” (no sign: 0, mild: 1, moderate: 2, and severe: 3). Finally, the sum of these values was recorded as the patient’s SI score.
The treatment was injected once every 3 days for 4 weeks. Patients were re-evaluated in the second week of treatment to evaluate the improvement of the disease in terms of clinical symptoms and side effects of the drug. Then, the clinical findings of the patients were recorded and their SI was determined. At the end of treatment and four weeks after treatment, patients were re-examined for recurrence of the disease. Patients’ level of satisfaction was assessed four weeks after the end of treatment. In addition, to determine satisfaction, the patient was asked and the patient’s response was classified as “dissatisfaction,” “mild satisfaction,” “moderate satisfaction,” “good satisfaction” and “very good satisfaction.”
Inclusion criteria were seborrheic dermatitis of the scalp and face with clinical diagnosis, no treatment with topical or systemic corticosteroids for 4 weeks, no treatment with methyldopa, chlorpromazine, topical or systemic acne medications for 1 month, and no Systemic diseases such as Parkinson’s, AIDS, and mood disorders. History of any drug allergy, dissatisfaction to participate in the study, failure to refer for follow-up, very severe disease (itching score greater than 7), pregnancy, and lactation were also considered as exclusion criteria. Finally, the data were statistically analyzed using SPSS software. Ver. 21.
In this study, out of 120 patients, 45% (54 patients) were male and 55% (66 patients) were female. The mean age of patients was 12.3 ± 34.5 years. In terms of the extent of lesions, 57.5% (69 patients) of the lesions were generalized and 42.5% (51 patients) were localized [Table 1]. Table 2 and Figure 1 present the mean SI of patients treated at the beginning of treatment, 2 weeks later and 4 weeks after the end of treatment. Patient satisfaction with Triamcinolone treatment is shown in Table 3. The frequency of disease recurrence during 4 weeks after the start of treatment and 4 weeks after its completion was 8 (6.7%) and 15 (12.5%), respectively. Complications included irritative dermatitis (one case) and dry skin (three cases).
The results of the study showed that 61.67% (74 patients) of patients with “good” to “very good” satisfaction with the effectiveness of treatment of seborrheic dermatitis with Triamcinolone. Based on the findings of the study, it was found that the SI before treatment was 2.45 ± 7.45 which after 2 weeks and 4 after treatment, this index decreased by 61.6% (SI: 2.86 ± 1.94). In addition, the SI decreased to 88.6% (SI: 0.85 ± 1.02) after 4 weeks. In addition, the frequency of recurrence of the disease during 4 weeks after the start of treatment and 4 weeks after its completion was 8 (6.7%) and 15 (12.5%), respectively. The above results indicate the appropriate effectiveness of the treatment method used in the present study (Triamcinolone eighty mg diluted with 0.1% normal saline) for the treatment of seborrheic dermatitis.
Based on our knowledge, no study has been performed using Triamcinolone to treat seborrheic dermatitis. However, various other treatments for this disease have been evaluated, some of which are consistent with the present study and some of which are inconsistent. Goldust et al. (2013a) compared the efficacy of 2% Sertaconazole and 1% Clotrimazole ointment in relation to the treatment of 128 patients with seborrheic dermatitis in terms of recovery rate, patient satisfaction, and side effects. The results of the study showed that the level of satisfaction of patients receiving Sertaconazole was higher than patients receiving Clotrimazole and after 1 month of stopping treatment, no recurrence was observed in any of the patients. In addition, the results of that study showed that Sertaconazole 2% is a tolerable drug by patients and effective for moderate to severe seborrheic dermatitis. Study Alirezaei et al. (2019) showed that the SI in two groups of patients with seborrheic dermatitis before receiving Clotrimazole and Sertaconazole was 7.16 ± 2.20 and 6.45 ± 2.10, respectively, for 2 weeks after starting treatment was 4.08 ± 1.82 and 2.78 ± 2.14, respectively, and for 4 weeks after treatment, 2.62 ± 2.13 and 0.89 ± 1.09 were obtained. Also, based on the results of that study, the recurrence rate of disease in the Clotrimazole and Sertaconazole groups was 32% and 21.7%, respectively, and the rate of good satisfaction in these two groups was 38% and 71.1%, respectively. Finally, based on the findings of that study, it was found that the rate of complications and recurrence of seborrheic dermatitis symptoms with the two drugs Clotrimazole and Sertaconazole are similar to each other, but the effectiveness of Sertaconazole is higher and therefore more satisfied in patients.
In another study by Lotti et al. (2013) evaluated the efficacy of 2% Sertaconazole and 2% ketoconazole for the treatment of seborrheic dermatitis in 132 patients. The results of this study showed that 85.1% of patients who received 2% Sertaconazole were satisfied with their treatment. Attarzadeh et al. (2013) evaluated the effectiveness of Emu oil (ostrich oil), Clotrimazole ointment and hydrocortisone for the treatment of seborrheic dermatitis in 124 patients. In the study, 62 patients received Clotrimazole and ostrich oil and another 62 patients received ostrich oil and hydrocortisone. The results of the above study showed that the treatment method improved in both groups. However, the effectiveness of hydrocortisone and Clotrimazole in preventing scaling was better than ostrich oil. Hydrocortisone was also more effective than ostrich oil in relieving pruritus, but ostrich oil was better than Clotrimazole in relieving erythema. Based on the results of that study, it can be said that although ostrich oil is useful in the treatment of seborrheic dermatitis; But compared to Clotrimazole and hydrocortisone, it was less effective.
Goldust et al. (2013b) evaluated the efficacy of two topical Sertaconazole drugs with topical hydrocortisone for the treatment of patients with seborrheic dermatitis. The results of that study showed that the satisfaction of patients receiving Sertaconazole was higher than the satisfaction of patients receiving hydrocortisone (85.1% vs. 76.9%). Saki et al. (2013) reported that Sertaconazole 2% significantly reduced the score of patients with atopic dermatitis compared to hydrocortisone and based on patients’ opinions, Sertaconazole was significantly preferred to hydrocortisone. In addition, a clinical trial study by Balighi et al. (2017) was performed for 60 patients with seborrheic dermatitis (30 patients receiving hydrocortisone and 30 patients receiving Sertaconazole). The results of the study showed that seborrheic dermatitis lesions were significantly reduced in both groups and were similar in recovery and frequency of complications in both groups.
Results of a review study conducted by Okokon et al. (2015) showed that the most effective drugs in the treatment of seborrheic dermatitis are the antifungal drugs Ketoconazole and Cyclopirox. This review study had very limited clinical trials that followed the outcome of treatment for more than four weeks. In this study, the effect of Ketoconazole was similar to that of steroids, but with fewer side effects. The results of the study also showed that the effect of treatment on patients’ quality of life was unclear. Comparing the results of the present study with the results of previous and similar studies, it was found that the injection of Triamcinolone 80 mg diluted with 0.1% normal saline can be similar to other similar drugs for the treatment of seborrheic dermatitis. Although the use of any drug can have its own side effects, the side effects of using Triamcinolone should also be considered.
Based on the results of the present study, it can be concluded that topical injection of triamcinolone can be effective and efficient for the treatment of seborrheic dermatitis. Because the obtained results showed that this treatment method reduces the high SI, increases patient satisfaction and also observed low number of cases with recurrence of the disease.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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