Using Accutane to Treat Seborrheic Dermatitis

May 7, 2024

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Seborrheic dermatitis, also known as seborrheic eczema, is a common skin condition that causes red, itchy, flaky skin. The most common areas affected are the scalp, face, upper chest, and back. Accutane (isotretinoin) is a medication often used to treat severe acne. Some research has looked into using low doses of Accutane to treat seborrheic dermatitis as well.

What is Seborrheic Dermatitis?

Seborrheic dermatitis occurs when the sebaceous glands produce too much oil (sebum). This excess oil builds up on the skin’s surface, causing inflammation and flaking. It can occur in infants (cradle cap) and adults. Seborrheic dermatitis is not contagious.

Some key facts about seborrheic dermatitis:

  • Affects 3-5% of the general population
  • Onset often during puberty and middle age
  • Chronic, relapsing condition
  • Potential triggers include stress, weather extremes, oily skin

Symptoms typically involve red, greasy skin covered with flaky white or yellow scales. Itching is common. The most commonly affected areas include:

  • Scalp
  • Eyebrows
  • Face (nasolabial folds, cheeks, creases by ears)
  • Upper chest
  • Back

While not dangerous, seborrheic dermatitis can cause social stress and discomfort due to its visibility. Severe cases that don’t respond to self-care may require prescription medication.

Overview of Treatment Options

Since seborrheic dermatitis is tied to sebum production and skin cell growth, treatment focuses on:

Reducing inflammation

Topical corticosteroids reduce swelling and redness. Common examples for the scalp include betamethasone, clobetasol, and fluocinonide.

Controlling fungal growth

Antifungal shampoos containing ketoconazole, zinc pyrithione, or selenium sulfide help prevent Malassezia fungal overgrowth.

Removing excess skin cells

Keratolytic ingredients like salicylic acid and sulfur remove psoriasis scales.

For mild seborrheic dermatitis, medicated shampoos plus over-the-counter hydrocortisone cream often suffice. Moderate to severe cases may need prescription topical or oral medication.

Accutane is normally prescribed for severe, scarring acne unresponsive to other therapies. Research over the past decade has explored whether low doses of Accutane could also treat seborrheic dermatitis by reducing sebum production.

How Accutane May Help Treat Seborrheic Dermatitis

Accutane (isotretinoin) is a retinoid, meaning a compound related to vitamin A. It impacts several processes involved in seborrheic dermatitis:

Sebum Production

Accutane dramatically lowers the skin’s oil (sebum) output by shrinking the sebaceous glands. Less excess oil means less inflammation.

Keratinization

This medication helps normalize the growth and shedding of skin cells. This may help resolve the flaky, scaly skin patches caused by seborrheic dermatitis.

Inflammation

In addition to lowering sebum levels, Accutane is thought to have anti-inflammatory effects. Reducing overall skin inflammation likely aids clearing.

Early case reports described seborrheic dermatitis improvement in acne patients taking Accutane. This prompted research into using isotretinoin as an intentional treatment for this condition.

Overview of Research on Oral Isotretinoin for Seborrheic Dermatitis

Most studies on using isotretinoin for seborrheic dermatitis are small, but results are overall very promising. Even low doses may equal or outperform standard antifungal treatments. Larger trials are still needed.

Below is a brief overview of some key studies in date order:

  • 2003 case series – 11 patients took 10 mg isotretinoin daily for 6 months. 90% saw complete clearing or marked improvement of seborrheic dermatitis, especially on the face and scalp. No relapses were seen in the 3 months after stopping treatment.
  • 2016 randomized trial – 46 patients took either 20 mg isotretinoin or 200 mg itraconazole daily for 6 weeks. The isotretinoin group saw significantly greater improvement in erythema, scaling, itching and burning. No important side effects occurred.
  • 2017 randomized trial – 137 patients received either 10 mg isotretinoin, antifungal shampoo, or 200 mg itraconazole daily for 6 weeks. Again, those taking isotretinoin had the greatest reduction in symptoms. Low dose isotretinoin was also better tolerated compared to itraconazole.
  • 2023 review – After examining the current research, the study authors concluded oral isotretinoin shows promise for treating moderate to severe seborrheic dermatitis unresponsive to standard topical therapy. They call for larger, longer-term trials to confirm initial positive results.

While quite promising, using isotretinoin for seborrheic dermatitis is still considered experimental pending further study. Dermatologists may prescribe it off-label for severe, recalcitrant cases. Low doses can minimize risk of side effects.

Considerations Before Using Isotretinoin for Seborrheic Dermatitis

Accutane (isotretinoin) offers a different mechanism of action compared to traditional antifungal and anti-inflammatory agents. However, this strong acne medication has notable safety concerns requiring careful consideration.

Effectiveness

  • May significantly improve moderate to severe seborrheic dermatitis symptoms when other treatments fail
  • Helps normalize keratinization, sebum production, inflammation
  • Allows lower steroid use
  • Prevents Malassezia yeast overgrowth

Side Effects

  • Very teratogenic – strict birth control mandatory
  • Can cause severe drying and cracking of skin and lips
  • Headaches, joint pain, nausea possible
  • Depression risk controversial

Other Factors

  • Not FDA approved for seborrheic dermatitis
  • Optimal dose and duration undefined
  • Risk of relapse after stopping medication
  • Requires monthly blood testing

Careful patient selection is critical. Those with very extensive disease or who experience isotretinoin side effects may do better with topical therapy plus systemic antifungals.

What to Expect When Taking Isotretinoin for Seborrheic Dermatitis

Patients considering isotretinoin for seborrheic dermatitis should understand required testing, risks, and monitoring involved with this therapy.

Pre-Treatment

  • Negative pregnancy test for females
  • Baseline blood count, liver enzyme, cholesterol panels
  • Signed consent and waiver forms
  • Acne may worsen initially

During Treatment

  • Start at 10-20 mg daily
  • Dose increases if needed
  • Taper at end avoided if possible
  • Monthly blood tests

Ongoing Monitoring

  • Teratogenicity prevention in women
  • Depression/mood changes
  • Headaches, joint/muscle pain
  • Severe dryness requiring moisturizers
  • Sunlight sensitivity protection

Improvement often starts around 4 weeks as sebum production decreases. Maximum results may take 3-6 months. Maintenance low dose therapy may follow to prevent relapse.

isotretinoin Seborrheic Dermatitis Treatment Protocol

A typical isotretinoin treatment protocol for seborrheic dermatitis may involve:

Baseline Evaluation

Perform a full skin exam looking for signs of seborrheic dermatitis (scaling, redness, etc.). Assess disease severity and determine if isotretinoin is appropriate.

Testing & Consent

Conduct baseline blood count, liver enzyme, lipid panels. Female patients require pregnancy testing. Review risks, required monitoring, contraception, etc. and obtain signed consent.

Initiate Low Dose Isotretinoin

Prescribe 10-20 mg oral isotretinoin once daily to start. Instruct on sunlight avoidance, skin/lip moisturization, etc.

Ongoing Monitoring

See patient monthly to assess side effects, compliance, and response to treatment. Repeat blood tests. Adjust dose up if indicated.

Maintenance Therapy

After maximal improvement (usually 3-6 months), continue low dose isotretinoin as needed to prevent relapse. Perform periodic blood tests.

Cease Treatment

When ready to stop, taper isotretinoin over 4 weeks rather than abruptly halting. Check blood count/liver tests one month after final dose.

Some dermatologists repeat treatment courses as necessary if seborrheic dermatitis returns after cessation.

Combination Treatments

While isotretinoin can greatly improve seborrheic dermatitis on its own, some dermatologists use it as part of a multi-pronged treatment plan including:

  • Isotretinoin – reduces sebum production, keratinization, inflammation
  • Antifungals – treat Malassezia overgrowth
  • Steroids – relieve itching, redness
  • Moisturizers – combat severe isotretinoin dryness

This combination allows shorter, lower dose isotretinoin treatment plus quicker relief from anti-inflammatory steroids if needed. It may also prevent seborrheic dermatitis relapse after isotretinoin cessation.

Some common combination treatment regimens include:

  • Isotretinoin + ketoconazole shampoo
  • Isotretinoin + mild topical steroid like hydrocortisone
  • Isotretinoin + antifungal shampoo + moisturizer

Using isotretinoin with other agents provides synergy. The isotretinoin addresses the root pathologic cause while additional therapies quickly reduce symptoms.

Home Remedies & Lifestyle Changes

While oral medication plays a key role in treating seborrheic dermatitis, certain at-home strategies can also help control symptoms:

  • Tea tree oil – Applying diluted tea tree oil reduces scaling and inflammation. It has both antifungal and anti-inflammatory properties.
  • Apple cider vinegar – The acidity helps destroy fungus and balances pH. Mix with water and apply topically.
  • Aloe vera gel – Soothes inflamed skin and may inhibit yeast growth thanks to its antifungal properties.
  • Probiotics – Ingesting probiotic supplements restores balance between healthy and harmful skin bacteria.
  • Diet – Avoiding high glycemic index foods like white bread, rice, and pasta may reduce flare ups.

In conjunction with medical therapy, lifestyle measures like gentle skin care, stress reduction, and a balanced diet can help minimize seborrheic dermatitis symptoms.

Conclusion: Key Takeaways

  • Seborrheic dermatitis causes red, greasy, scaly skin patches due to excess sebum and inflammation. Mild cases often respond to medicated shampoos, but more severe disease may need oral medication.
  • Studies show the acne drug Accutane (isotretinoin) improves moderate to severe seborrheic dermatitis by reducing sebum output, keratinization, and inflammation.
  • Low dose isotretinoin (10-20 mg daily) appears effective and well tolerated but lacks FDA approval for seborrheic dermatitis. Larger trials are still needed.
  • Combination therapy with antifungals, topical steroids, and moisturizers may allow quicker symptom relief and prevent relapse.
  • Careful patient selection and monthly monitoring are mandatory given isotretinoin’s potential side effects like severe dryness and birth defects.
  • In addition to medical treatment, lifestyle measures like probiotics, diet, and stress reduction help control seborrheic dermatitis.

In suitable candidates, isotretinoin shows great promise for treating recalcitrant, extensive seborrheic dermatitis. Ongoing research aims to solidify its role as a second-line systemic therapy for this condition.

Frequently Asked Questions about Using Isotretinoin for Seborrheic Dermatitis

Why consider isotretinoin for seborrheic dermatitis?

Isotretinoin (Accutane) addresses root causes like high sebum production instead of just suppressing symptoms. It may succeed when other treatments fail.

What dose of isotretinoin is used for seborrheic dermatitis?

Studies show doses as low as 10 mg per day significantly improve moderate to severe seborrheic dermatitis with good tolerability.

How long until isotretinoin starts working for seborrheic dermatitis?

Patients often notice less oiliness around 1 month. Maximum improvement occurs by 3-6 months. Maintenance treatment may follow initial clearing.

Does isotretinoin cure seborrheic dermatitis permanently?

Isotretinoin cannot cure seborrheic dermatitis. Once stopped, symptoms often recur eventually. Some doctors do repeated courses or low dose daily maintenance therapy.

What blood tests are needed when taking isotretinoin?

Baseline and monthly blood count, liver enzymes and lipid panels are required. Pregnancy tests for women. Extra tests if side effects develop.

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