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Seborrheic Dermatitis

Also indexed as: Cradle Cap

Seborrheic dermatitis is a common inflammatory condition of the skin. Cradle cap is a type of seborrheic dermatitis found in infants; it is usually self-limiting and subsides by the age of six months. A qualified physician should diagnose these conditions. Much of the research on this condition has been performed on infants and its applicability to the adult population is unclear.

Checklist for Seborrheic Dermatitis

Rating Nutritional Supplements Herbs
2Stars   Aloe vera (topical)
1Star Biotin (cradle cap)
Borage oil, topical (cradle cap)
Folic acid (seborrheic dermatitis)
Vitamin B12, injection (seborrheic dermatitis)
Vitamin B6, topical (seborrheic dermatitis)		  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of seborrheic dermatitis? A dry, flaky scalp is typical of mild cases of seborrheic dermatitis. More severe cases have itching, burning, greasy scales overlying red patches on the scalp. Seborrheic dermatitis may be confused with severe dandruff. However, seborrheic dermatitis may also be found on the eyebrows, eyelids, forehead, ears, chest, armpits, groin, and the skin folds beneath the breasts or between the buttocks.

How is it treated? Conventional treatment includes the use of topical cortisone-like drugs (e.g., betamethasone and fluocinonide) to control symptoms. For scalp treatment, doctors may also recommend using an over-the-counter or prescription antidandruff shampoo containing selenium sulfide, coal tar, or salicylic acid.

Dietary changes that may be helpful: An early study reported that nursing infants with cradle cap improved when high-biotin foods, such as liver and egg yolk, were added to the mother’s diet.1

A preliminary report suggested that an allergy elimination diet for an infant may be useful in the treatment of cradle cap. The most common offending foods identified were milk, wheat, and eggs.2 More research is needed to confirm the value of this approach in the treatment of cradle cap.

Nutritional supplements that may be helpful: A group of researchers found that infants with cradle cap appeared to have an imbalance of essential fatty acids in their blood that returned to normal when their skin rashes eventually went away.3 In a preliminary trial, these researchers later found that application of 0.5 ml of borage oil twice daily to the affected skin resulted in clinical improvement of cradle cap within two weeks.4

Preliminary studies have found that injecting either the infant or the nursing mother with biotin may be an effective treatment for cradle cap.5 6 Studies of oral biotin have yielded mixed results in infants. Older preliminary studies and case reports suggest that 4 mg per day of oral biotin might be sufficient for mild cases of cradle cap, but 10 mg per day was required for more severe cases.7 Two more recent, controlled trials found that oral biotin (4 or 5 mg per day) produced no benefit.8 9 Thus, the scientific support for using oral biotin to treat cradle cap is weak. The role of biotin in adult seborrheic dermatitis has not been studied.

One physician reported that injections of B-complex vitamins were useful in the treatment of seborrheic dermatitis in infants.10 A preliminary trial found that 10 mg per day of folic acid was helpful in 17 of 20 cases of adult seborrheic dermatitis.11 However, this study also found that oral folic acid did not benefit infants with cradle cap. A preliminary study found that topical application of vitamin B6 ointment (containing 10 mg B6 per gram of ointment) to affected areas improved adult seborrheic dermatitis.12 However, oral vitamin B6 (up to 300 mg per day) was ineffective. Injections of vitamin B12 were reported to improve in 86% of adults with seborrheic dermatitis in a preliminary trial.13 Oral administration of vitamin B12 for seborrheic dermatitis has not been studied.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful : A crude extract of aloe vera (Aloe barbadensis) may help seborrheic dermatitis when applied topically. In a double-blind trial, people with seborrheic dermatitis applied either a 30% crude aloe emulsion or a similar placebo cream twice a day for four to six weeks.14 Significantly more people responded to topical aloe vera than to placebo: 62% of those using the aloe vera reported improvements in scaling and itching, compared to only 25% in the placebo group.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Gyorgy P. Dietary treatment of scaly desquamative dermatoses of the seborrheic type. Arch Derm Syph 1941;43:230–47.

2. Eppig JJ. Seborrhea capitis in infants: a clinical experience in allergy therapy. Ann Allergy 1971;29:323–4.

3. Tollesson A, Frithz A, Berg A, Karlman G. Essential fatty acids in infantile seborrheic dermatitis. J Am Acad Dermatol 1993;28:957–61.

4. Tollesson A, Frithz A. Borage oil, an effective new treatment for infantile seborrheic dermatitis. Br J Dermatol 1993;129:95 [letter].

5. Nisenson A. Seborrheic dermatitis of infants: treatment with biotin injections for the nursing mother. Pediatrics 1969;44:1014–6.

6. Messaritakis J, Kattamis C, Karabula C, Matsaniotis N. Generalized seborrheic dermatitis: clinical and therapeutic data of 25 patients. Arch Dis Child 1975;50:871–4.

7. Nisenson A. Seborrheic dermatits of infants and Leiner’s disease: a biotin deficiency. J Pediatr 1957;51:537–48.

8. Keipert JA. Oral use of biotin in seborrheic dermatitis of infancy: a controlled trial. Med J Aust 1976;1:584–5.

9. Erlichman M, Goldstein R, Levi E, et al. Infantile flexural seborrheic dermatitis. Neither biotin nor essential fatty acid deficiency. Arch Dis Child 1981;56:560–2.

10. Nisenson A. Treatment of seborrheic dermatitis with biotin and vitamin B complex. J Pediatr 1972;81:630–1 [letter].

11. Callaghan TJ. The effect of folic acid on seborrheic dermatitis. Cutis 1967;3:583–8.

12. Schreiner AW, Rockwell E, Vilter RW. A local defect in the metabolism of pyridoxine in the skin of persons with seborrheic dermatitis of the “sicca” type. J Invest Derm 1952;19:95–6.

13. Andrews GC, Post CF, Domnkos AN. Seborrheic dermatitis: supplemental treatment with vitamin B12. NY State Med J 1950;50:1921–5.

14. Vardy DA, Cohen AD, Tchetov T, et al. A double-blind, placebo-controlled trial of an Aloe vera (A. barbadensis) emulsion in the treatment of seborrheic dermatitis. J Dermatol Treat 1999;10:7–11.