Author:
Dr Ivana Minić
Specialist in dermatology and venereology
Seborrheic eczema is no longer classified only as a disease of the scalp and skin. An increasing number of dermatologists are communicating to patients that this is a condition they must fully understand in order to completely change the existing “rules of the game”. The focus is no longer on treating consequences or merely addressing symptoms; instead, more and more attention is being placed on the beginning of the story of seborrhea, which starts in the very first days of life.
Let’s uncover the truth. Immediately after birth, our skin becomes colonized by microorganisms with which, over the following days, months and years, we build a healthy microbiome that will create the formula for a future strong and healthy skin immunity. Don’t forget, we are talking about the body’s largest organ; this is a slow process, but a deeply rooted and powerful one.
What does genetics say?
On the other hand, genetics determines and codes how each part of our body will be built and develop functionally. If we look at our organism, it is clear that it is predetermined in what way and in what proportion certain fatty acids, cholesterol and other elements will form the composition of each person’s sebum. We now know that, on the one hand, we have colonization, and on the other, the process of sebum secretion, with the emphasis that the composition of sebum is not the same in every individual. The most important link in the microbiome is Malassezia, a fungus that plays the role of “guardian of the skin’s acid mantle” and of maintaining the skin’s pH value. It achieves this by breaking down sebum, which is its primary food, and this process is in balance in the majority of people. In 4% of the world’s population, however, the composition of sebum is such that for this fungus it becomes SUPER FOOD, allowing it to freely and rapidly increase the number of its colonies. More Malassezia leads to increased breakdown of sebum, which in turn leads to a greater need for its production, because our body reacts according to the principle “everything that is consumed rapidly must be created rapidly”. And there we have the first symptom of seborrhea – OILY SKIN.
How does the process continue to develop? The multiplication of this fungus disrupts the ideal relationship within the microbiome and with other participants, making it more dominant, and through its acidic by products it further lowers the skin’s pH, damages the skin barrier and opens the way directly to deeper layers of the skin. The alarm is triggered; the body does not support this “unruly population” and begins to reject the superficial layer of the skin by scaling. This is how we reach the second symptom of seborrhea – flaking or “DANDRUFF”. In the deeper “living layer” of the skin, it encounters the most notorious guardian of general health – our IMMUNE SYSTEM. The battle begins: different mediators are released, the process easily spreads to neighboring areas – inflammation occurs and finally the full clinical manifestation of seborrheic dermatitis develops, with REDNESS and ITCHING. If we then add to this story the elements that directly or indirectly influence the immune system and the acidity of the skin, through diet and skincare, we get a clearer picture of the possible triggers of this process, which opens the door to another topic.
Now that we have the full picture, you will agree that the old approach of treating consequences does not solve the essence of the problem. And that essence is always at the beginning of the process. We cannot influence genetics, that is clear, but we can regulate the presence of Malassezia.
Medications with antifungal action are effective in this battle
2% ketoconazole (Mycoseb) stands out with the highest efficacy. However, a powerful weapon in your hands can also become your greatest enemy, and that is why we bring you new rules – here is why. With inadequately managed therapy, you put yourself at risk of relapse. The rules of the game are not one way and are not limited to the so called “eliminate the enemy” strategy. In the case of Malassezia, that is impossible anyway, because once the antifungal effect of the medication ceases, relapses are possible.
A new approach to controlling seborrhea would aim to return Malassezia to the framework of its natural presence. This strategy can be divided into several phases.
• The first is the ATTACK PHASE, which involves uncompromising reduction of the number of Malassezia colonies. Depending on the clinical picture, 2% ketoconazole is the drug of choice and should be applied adequately to the affected areas of the body once daily until the first satisfactory therapeutic response is achieved.
• The second phase is the CONSOLIDATION PHASE: restoring harmony to the microbiome and regulating an optimal environment for its recovery. The number of colonies continues to be controlled, but with a different approach that influences the composition of sebum and creates unfavorable conditions for its further proliferation.
• The third phase, or REDUCTION PHASE, often overlaps with the previous phase in cases where the clinical presentation is highly advanced and the clinical picture is more severe. This is a phase managed by a dermatologist and often involves the use of medications with immunosuppressive or immunomodulatory effects.
Where do you fit into this?
Trust the process. If your seborrheic dermatitis is not in a severe form and is localized only to the scalp region, then you are the captain – so control it and manage it like a professional. It is important that you understand the essence of the process and act uncompromisingly and in time.
The solution is simpler than it seems. What does it look like in two simple steps? Let 2% ketoconazole (Mycoseb) shampoo be your ally in the first phase; when you notice improvement, the continuation of the battle moves into the second phase. From 2% ketoconazole, switch to preparations such as Mycosens. Mycosens supports the skin microbiome and is perfect for the consolidation phase. Its formulation is designed to support everyday use without drying out the skin and to control pH values. With continuous use, subjective symptoms subside, and you achieve complete control.
Understanding, education and action are your new formula for fighting seborrheic eczema.
