Seborrheic Dermatitis

By | 2011-07-18

Definition and cause

Seborrheic dermatitis is characterized by excessive dry or oily sebum, commonly caused by a combination of Staph pyoderma and Malassezia dermatitis. It is fairly common in dogs and rare in cats.

Medical therapy rationale, drug(s) of choice, and nutritional recommendations

The recommended treatments are topical shampoos such as selenium sulfide in combination with ketaconizole when secondary yeast infections are involved. Antibacterial shampoos may also be indicated based upon the status of the skin and secondary bacterial infection. The potential of hepatopathies with ketaconizole is a precaution that should be discussed.

Anticipated prognosis

Regular antifungal or antibacterial shampoos can be used to control seborrheic dermatitis, although recurrences are common.

Integrative veterinary therapies

Proper diagnostic evaluation is required to properly diagnose and treat these cases. Obtaining a full medical history and conducting a physical exam, skin scraping, and blood evaluation with thyroid levels are recommended in most cases. Impression smears and cytology may yield yeast overgrowth and secondary bacterial infections as microorganisms congregate around the exudative process in an attempt to ingest and process homotoxins being excreted or stored in affected tissues. Many chronic dermatitis cases undergo regressive vicariation and produce severe oily material (see Homotoxicology).

Gently cleansing the oily material away on a regular basis decreases retoxification from rancid, oxidized fatty acids, and reduces nutritional support of pathogens such as yeast and bacteria. Avoid topical agents that suppress the secretion of material (such as coal tar, corticosteroids, and antihistamines) unless their use is absolutely necessary, because these inhibit the body’s natural ability to remove fat-soluble homotoxins through the skin and can be absorbed, causing further injury to the cutaneous defenses. Antihistamines are the least harmful of the aforementioned group.

The addition of therapeutic nutrition and biological therapies helps to boost immune function and improve the elimination of toxins via the skin. These improvements often minimize exacerbation and recurrences.

Nutrition

General considerations / rationale

While medical therapy is focused locally upon the skin (inflammation, pruritus, sebum), the nutritional approach adds gland support for the organs of the immune system and nutrients to help decrease local inflammation and enhance toxin elimination, especially via the skin.

Appropriate nutrients

Nutritional / gland therapy: Glandular adrenal and lymph provide intrinsic nutrients for the glands of the immune system and the skin. These nutrients help enhance the elimination of toxins via the skin (see Gland Therapy and the Enhancement of Elimination, site).

Lecithin / phosphatidyl choline: Phosphatidyl choline is a phospholipid that is integral to cellular membranes. It helps to move fats into the cells and is important for cellular integrity. Lecithin is an essential nutrient required by the skin and all of the body’s cells of the body for general health and wellness. Studies with lecithin have shown that it can emulsify fats which are important for the skin’s health.

Evening primrose oil: evening primrose oil has been proven to have both antiinflammatory and antipruritic effects and, as part of a balanced nutritional program, can exert a positive effect on animals with skin disease. Studies suggest that evening primrose oil is beneficial in people with atopic dermatitis and eczema.

Chinese herbal medicine / acupuncture

General considerations / rationale

Seborrheic dermatitis is due to Heat and Wind invading the Liver and Lungs. This leads to Yin and Blood deficiency. The Lungs control the skin, so Lung pathology can cause dermatitis. The Liver is the organ most likely to suffer from Wind. When the Liver is invaded by Wind, the result is pruritis.

Blood and Yin are fluids. If they are deficient in the Skin it causes dryness because the skin cannot remain healthy when it is not nourished.

Treatment is aimed at reversing the fluid deficiency, or normalizing the skin and soothing the itch. It is also necessary to control secondary infections.

Appropriate Chinese herbs

Angelica (Bai zi): Has antiinflammatory properties. It may decrease inflammation of the skin.

Atractylodes (Cang zhu): Has activity against Staphylococcus auerus and dermatophytes. It may help prevent secondary infections.

Bupleurum (Chai hu): Decreases the effect of histamine release and has antibiotic effects against streptococci. It may help decrease pruritis and prevent secondary skin infections.

Cicada slough (Chan tui): Has been used successfully in humans to treat chronic urticaria, which indicates that it has a beneficial effect on the skin. It may be of use in seborrheic dermatitis to help protect the skin or prevent itching due to secondary bacterial infections.

Honeysuckle (Jin yin hua): Has antibiotic effects against Staphylococcus aureus, E. coli, and Pseudomonas aeruginosa.

Licorice (Gan cao): Inhibits the growth of Staphylococcus aureus. It contains glycyrrhizine and glycyrrhentinic acid, which have corticosteroid activity. This may help prevent secondary infections and decrease pruritis.

Mint (Bo he): Relieves itching and has antiinflammatory effects.

Moutan (Mu dan pi): Demonstrates antiinflammatory actions via inhibition of prostaglandin synthesis and decreases vascular permeability. It inhibits the growth of Staphylococcus aureus, streptococci, and dermatophytes.

Platycodon (Jie geng): Decreases allergic reactions, and may help with skin inflammation.

Poria (Fu ling): Has inhibitory effects on Staphylococcus aureus.

Rehmannia (Sheng di huang): Has shown antiinflammatory activity in mice.

Siegesbeckia (Xi xian cao): Inhibits the growth of Staphylococcus aureus.

White peony (Bai shao): Contains paeoniflorin, which is a strong antiinflammatory. It also has antibiotic effects against Staphylococcus aureus, some streptococci, E. coli, Pseudomonas aeruginosa, and some dermatophytes.

Acupuncture has been used to treat skin allergies. By stimulating specific acupuncture points, it is possible to stimulate the pet’s immune system and reduce the itching and inflammation associated with dermatitis. This may be applicable to the skin inflammation seen in seborrheic dermatitis or help with itching secondary to bacterial invasion of the abnormal skin.

The authors have used GV14, SP9, and SP10 to control inflammation (clear Heat in traditional Chinese medicine terms). LI11 can be used to stop any itching and HT7 can be used to calm the animal so it does not lick or scratch and irritate the skin further. Local points can be used; these include LI4 for the front legs, GB34 for the back legs, and GB20 for the neck.

Homotoxicology

General considerations / rationale

Seborrhea means “to run oil,” and represents Excretion Phase or Inflammation Phase homotoxicoses. Seborrhea often occurs in chronic cases of dermatitis, and this condition can represent genetic or breed-related issues. In those cases, it represents the Degeneration Phase on the Six-Phase Table.

An important sign of healing is represented by an oily secretion, which begins as thick waxy material and slowly becomes progressively more liquid and lighter in viscosity. If the clinician observes such changes, especially when hair regrowth and depigmentation of hyperpigmented areas are noted, the client should be properly advised and therapy should be continued in earnest.

Appropriate homotoxicology formulas

(See also the protocols for Hypothyroidism, Cushing’s disease, Addison’s disease, allergic dermatitis, and otitis externa.)

Abropernol: Hyperhydrosis, hyperkeratosis, and eczema are all indications. The ingredient Pulsatilla pratensis is classically used for urticarial eczema, which may occur following the ingestion of rich food (diarrhea may be present). This is a useful remedy in many conditions where response to treatment (case change) is not apparently forthcoming. Ocular discharge may be present, as may be heavy, bland ear discharges. Calcium fluoratum is useful for stony swelling of glands, calcified ear canals, chronic suppurative otitis media, anal itching, fissures and cracks on the anus and foot pads, and excessive scar tissue.

BHI-Hair and -Skin: The ingredient Thuja occidentalis treats dry hair, hair loss, dandruff (due to Selenium), urticarial reactions, eczema located around the mouth and face, and epitherliomas. Petroleum rectifacatum is included for eczema that is worse in the winter and excessive sweating from the axillae and feet. Acidum nitricum treats jagged warts that bleed easily, foul skin secretions, and poorly healing granulomas. The presence of Hamamelis virginiana is useful for traumatic inflammations and venous disturbances. This remedy also treats blistery eruptions and dry skin.

BHI-Skin: Used for eczema; rashes and hives; skin eruptions; red rash all over the body; pustules; acute and chronic skin lesions; moist, suppurating lesions; and herpetic ulcers. This is a very useful remedy that contains Berberis vulgaris for itchy blisters, anal eczema, and pigmenting eczema. Berberis is supportive of cutaneous, hepatobiliary, renal, and adrenal systems, and greatly assists in excretion of homotoxins via these routes. Rhus tox is useful for red rashes, itching, and contact hypersensitivity reactions. Arsenicum album is a classic remedy for dry skin, eruptions, and boils / carbuncles. Sulfur is a useful agent in chronic dermatitis because it activates blocked enzyme systems. It is useful in eczema with intense itching and vesicular eruptions, and for patients that frequently have a bad smell. Sepia, Petroleum, and Kreosotum all assist in eczema. Hydrofluoricum acidum is useful for brittle nails. Graphites (see Graphites homaccord) is also included.

Coenzyme compositum: Provides metabolic support and reversal of iatrogenic factors. Hepeel and Coenzyme compositum may be used in conditions to reduce pruritus.

Cutis compositum: A broad remedy that is indicated in all cutaneous diseases to establish drainage and stimulate healing of the skin. It is a wide-reaching formula that stimulates nonspecific defenses in a variety of cutaneous conditions. Cutis compositum can be used in any phase homotoxicosis; it opens skin to drainage and repair. It supports regeneration and repair of organs involved in skin health (Cutis suis, Hepar suis, Splen suis, Placenta suis, Glandula suprarenalis suis, Funiculus ubilicalis suis). It contains Sulfur to repair blocked enzyme systems and Cortisonum aceticum to repair damage from prior corticosteroid exposure. It supports circulation and drainage (Aesculus hipposcastanum).

Engystol N: Provides support to the immune system. Sulfur assists in allergic dermatitis and eczema, as well as in viral infections and in cases associated with vaccinosis.

Graphites homaccord: Contains Graphites, which is indicated for loss of hair, oozing cutaneous discharges, and sticky eczema behind the ear pinnae. Treats dry, chronic dermatitis and eczema; obese patients; constipation; honey-yellow crusts on dermatitis; dermatitis of the ear’s meatus; moist and cold feet with poorly healing wounds; and easily ulcerating skin. Patients that require Graphites frequently have a tendency to obesity and constipation. Tiny abrasions may be more susceptible to infection and oozing. The patients may have dry ear canals in which otoscopic examination may show white concretions on the tympanum. Calcium carbonicum Hahnemanni complements Graphites; this assists in cases showing exudative dermatitis and facial rashes / eczema, poor-healing wounds, petechial eruption, and boils.

Hepar compositum: Used for liver drainage and support during detoxification (see Hepatitis protocols).

Hormeel S: Has a normalizing effect on the endocrine system.

Lymphomyosot: Promotes lymphatic drainage and contains homeopathically diluted thyroid hormone and iodine to activate suppressed thyroid and immune functions.

Psorinoheel: A deep-acting remedy with Psorinum and sulfur that is indicated in constitutional cases as well as the Excretion Phase.

Schwef-Heel: Contains sulfur, which is indicated in seborrhea activates many blocked enzymes systems. Oily skin, red skin, foul odors are all indications for sulfur, which may need to be given intermittently while recovery is progressing.

Solidago compositum: Provides renal support and drainage during detoxification. It is a phase remedy for the Deposition Phase. There is a connection in Traditional Chinese Medicine between skin disease and the Kidney (Zang Fu organ). Many forms of dermatitis improve when the kidney is treated and supported.

Thyroidea compositum: Provides matrix drainage and neuroendocrine support. It contains a wide variety of glandular support agents such as Glandula thyroidea suis and Thymus suis, as well as Corpus pineale suis, Splen suis, Medulla ossis suis, Funiculus umbilicalis suis, and Hepar suis. Other ingredients support metabolism and drainage. Cortisonum aceticum assists in cases of iatrogenic damage from corticosteroids and chronic stress.

Traumeel S: An antiinflammatory that repairs blocked enzyme systems to stimulate healing.

Ubichinon compositum: Provides metabolic support.

Authors’ suggested protocols

Nutrition

Immune and skin support formulas: 1 tablet for every 25 pounds of body weight BID.

Lecithin / phosphatidyl choline: One-fourth teaspoon for every 25 pounds of body weight BID.

Oil of evening primrose: 1 capsule for every 25 pounds of body weight SID.

Chinese herbal medicine / acupuncture

The author recommends Formula H52 ImmunoDerm and H67 DermGuard at a dose of 1 capsule each for every 10 to 20 pounds. It may be necessary to initially use antibiotics or shampoos to control secondary infections. In addition to the herbs discussed above, these preparations contain scutellaria (Huang Qin), fleece flower root (He shou wu), siler (Fang feng), tokoro (Bi xie), schizonepeta (Jing jie), dandelion (Pu gong ying), oldenlandia (Bai hua she cao), kochia (Di fu zi), xanthium fruit(Cang Er zi), bitter orange (Zhi ke), angelica radix (Dang gui), buffalo horn shavings (Sui Niu jiao), earthworm (Di long), silkworm (Jiang can) and cnidium (Chuan xiong).

The recommended acupuncture points are LI4, LI11, ST36, SP6, GB34, and SP10 (Handbook of traditional Chinese medicine Practitioners).

Homotoxicology

(Dose: 10 drops PO for 50-pound dog; 5 drops PO small dog or cat)

Symptom formula: Schwef-Heel and / or Graphites homac-cord, Psorinoheel, and Abropernol used for 2 to 4 weeks BID.

Detoxification formula (Excretion and Inflammation phase cases): Lymphomyosot, Nux vomica homaccord, and Berberis homaccord BID for 30 days; then re-evaluate case.

Detoxification formula (Deposition, Impregnation, Degeneration, and Dedifferentiation phase cases): Galium-Heel, Lymphomyosot, Hepar compositum, Solidago com-positum, and Thyroidea compositum every 3 days for 30 to 120 days or until case change ceases. Then shift to Detox Kit for 30 days. Further use of Deep Detoxification is indicated in chronic cases.

Product sources

Nutrition

Immune and skin support formulas: Animal Nutrition Technologies. Alternatives: Immune System Support — Standard Process Veterinary Formulas; Immuno Support — Rx Vitamins for Pets; Immugen — Thorne Veterinary Products; Derma Strength — Vetri Science Laboratories; Canine Dermal Support — Standard Process Veterinary Formulas.

Lecithin / phosphatidyl choline: Designs for Health.

Oil of evening primrose: Jarrow Formulas.

Chinese herbal medicine

Formula H52 ImmunoDerm and H67 DermGuard:

Natural Solutions, Inc.

Homotoxicology

BHI / Heel Corporation