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Relationship between diet and seborrheic dermatitis

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Abstract

Background: Seborrheic dermatitis is a chronic inflammatory skin disease that affects 1-10% of the general population. Malassezia yeasts, immune response and emotional stress have been implicated in the etiology of seborrheic dermatitis. However, the effect of diet on development of seborrheic dermatitis is still controversial. This study investigates the differences in the frequency of consumption of foods and food groups between patients with seborrheic dermatitis and healthy individuals. Material and Methods: Fifty-one patients with seborrheic dermatitis of the scalp (28 female, 23 male) and 50 healthy individuals within the control group (30 female, 20 male) have been included in this study. The mean age of the patients and control group were 30.6±11.4 years and 32.7±10.7 years, respectively (p=0.35). Dietary habits were evaluated by a questionnaire which includes frequency of intake of meat, processed meat, chicken, fish, egg, legume, milk, dairy products, fruit, vegetable, bread, tea, coffee, coke, fast food, sugar, pasta, rice, chocolate, cake, cookie and pie. The questionnaire included options like every day, 3-5 times a week, 1-2 times a week, twice a month, once a month and none. Results: The frequency of intake of foods in the questionnaire was simlar between patients and healthy individuals except for vegetables. Vegetable consumption was significantly more common among patients than healthy individuals (p=0.04). Conclusions: The results showed that dietary habits were not associated with increased risk of seborrheic dermatitis.
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© Our Dermatol Online 3.2018 261
How to cite this article: Tamer F. Relationship between diet and seborrheic dermatitis. Our Dermatol Online. 2018;9(3):261-264.
Submission: 27.11.2017; Acceptance: 13.01.2018
DOI: 10.7241/ourd.20183.6
Relationship between diet and seborrheic dermatitis
Relationship between diet and seborrheic dermatitis
Funda Tamer
Ufuk University School of Medicine, Department of Dermatology, Ankara, Turkey
Corresponding author: Dr. Funda Tamer, E-mail: fundatmr@yahoo.com
INTRODUCTION
Seborrheic dermatitis is a chronic inflammatory skin
disease which is characterised by erythematous scaly
plaques on the sebaceous areas like forehead, eyebrows,
glabella, nasolabial folds, scalp, chest, and back. The
prevalence of seborrheic dermatitis among adults in
the general population is 1-10%. It is more common
in men than in women. The disease usually presents
between the ages of 30 and 40 years [1]. The incidence
of seborrheic dermatitis is similar between ethnic
groups [2]. The exact cause of this condition remains
unknown. However, numerous factros including
Malassezia yeasts, sex hormones like androgens, sebum
levels, immune response, neurogenic factors and
stress have been implicated in the etiopathogenesis of
seborrheic dermatitis [3].
Sebaceous glands are distributed all over the skin
surface except palms and soles. However, the secretion
of sebum from sebaceous glands is highest on the scalp,
face, chest, and back [4]. Sebum has an important
role in the pathogenesis of seborrheic dermatitis [5].
It maintainces epidermal barrier function, carries
anti-oxidants to the skin surface and protects skin
from microbial colonization. Sebum is composed
of triglycerides, fatty acids, wax esters, sterol esters,
cholesterol, cholesterol esters, and squalene. Lipids
are used by Malassezia species for proliferation.
They degrade sebum, free fatty acids and leave the
unsaturates which cause inflammation, irritation and
scaling in seborrheic dermatitis [4].
Insulin and insulin-like growth factor-1 (IGF-1)
stimulate the lipogenesis of sebaceous glands by a
transcription factor named sterol regulatory element-
binding protein 1. It has been suggested that high
carbohydrate intake leads to reactive hyperinsulinemia
and increased IGF-1 production [6]. Zinc, riboflavin,
pyridoxine and niacin deficiency can lead to seborrheic
dermatitis-like lesions. Therefore, nutrition has
been associated with an increased risk of seborrheic
ABSTRACT
Background: Seborrheic dermatitis is a chronic inflammatory skin disease that affects 1-10% of the general population.
Malassezia yeasts, immune response and emotional stress have been implicated in the etiology of seborrheic dermatitis.
However, the effect of diet on development of seborrheic dermatitis is still controversial. This study investigates the
differences in the frequency of consumption of foods and food groups between patients with seborrheic dermatitis and
healthy individuals. Material and Methods: Fifty-one patients with seborrheic dermatitis of the scalp (28 female, 23 male)
and 50 healthy individuals within the control group (30 female, 20 male) have been included in this study. The mean age
of the patients and control group were 30.6±11.4 years and 32.7±10.7 years, respectively (p=0.35). Dietary habits were
evaluated by a questionnaire which includes frequency of intake of meat, processed meat, chicken, fish, egg, legume, milk,
dairy products, fruit, vegetable, bread, tea, coffee, coke, fast food, sugar, pasta, rice, chocolate, cake, cookie and pie. The
questionnaire included options like every day, 3-5 times a week, 1-2 times a week, twice a month, once a month and none.
Results: The frequency of intake of foods in the questionnaire was simlar between patients and healthy individuals except
for vegetables. Vegetable consumption was significantly more common among patients than healthy individuals (p=0.04).
Conclusions: The results showed that dietary habits were not associated with increased risk of seborrheic dermatitis.
Key words: Dandruff; Diet; Seborrhea; Seborrheic dermatitis
Brief Report
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© Our Dermatol Online 3.2018 262
dermatitis [2]. However, no exact relation has been
established yet [7].
The purpose of this study was to examine the frequency
of consumption of foods in patients with seborrheic
dermatitis and healthy subjects and determine the
relationship between dietary habits and seborrheic
dermatitis.
MATERIALS AND METHODS
This study included 51 patients with seborrheic
dermatitis of the scalp and 50 healthy individuals
within the control group. The exclusion criteria were
having an inflammatory skin disease like psoriasis,
lichen planus, having a chronic condition like diabetes,
hypertension, renal insufficiency, hypothyroidism,
hyperthyroidism, obesity, cancer, eating disorder, and
requiring a special diet.
Dietary intake was evaluated by a food frequency
questionnaire which consisted of frequency of intake of
meat, processed meat, chicken, fish, egg, legume, milk,
dairy products, fruit, vegetable, bread, tea, coffee, coke,
fast food, sugar, pasta, rice, chocolate, cake, cookie and
pie. The questionnaire included options such as every
day, 3-5 times a week, 1-2 times a week, twice a month,
once a month and none. All participants answered the
questionnaire based on their eating habit for the last
five years.
Statistical analysis was performed using SPSS 22.0
(SPSS Inc., Chicago, IL). Continuous variables were
defined as the means (±) standard deviations and
categorical variables as percentages. Differences
between groups were analysed by independent-samples
t-test for numerical variables and chi-square test for
categorical variables. A p-value <0.05 was considered
statistically significant.
RESULTS
Fifty-one patients with seborrheic dermatitis
(28 female, 23 male) and 50 healthy individuals within
Table 1: Information about the frequency of consumption of some foods among patients and control group
Patient (n=51) Groups Control (n=50) P-value
Meat None
Once a month
Twice a month
1-2 times a week
3-5 times a week
Everyday
1
4
4
25
14
3
2%
7.8%
7.8%
49%
27.5%
5.9%
0
4
4
16
21
5
0%
8%
8%
32%
42%
10%
0.43
Milk None
Once a month
Twice a month
1-2 times a week
3-5 times a week
Everyday
8
6
8
13
10
6
15.7%
11.8%
15.7%
25.5%
19.6%
11.8%
5
7
9
14
5
10
10%
14%
18%
28%
10%
20%
0.62
Fruit None
Once a month
Twice a month
1-2 times a week
3-5 times a week
Everyday
0
2
3
3
17
26
0%
3.9%
5.9%
5.9%
33.3%
51%
1
1
1
5
19
23
2%
2%
2%
10%
38%
46%
0.68
Bread None
Once a month
Twice a month
1-2 times a week
3-5 times a week
Everyday
2
0
1
5
8
35
3.9%
0%
2%
9.8%
15.7%
68.6%
1
0
1
4
6
38
2%
0%
2%
8%
12%
76%
0.93
Sugar None
Once a month
Twice a month
1-2 times a week
3-5 times a week
Everyday
7
2
5
7
15
15
13.7%
3.9%
9.8%
13.7%
29.4%
29.4%
10
4
4
5
5
22
20%
8%
8%
10%
10%
44%
0.16
Vegetable None
Once a month
Twice a month
1-2 times a week
3-5 times a week
Everyday
0
0
2
14
21
14
0%
0%
3.9%
27.5%
41.2%
27.5%
0
2
2
3
26
17
0%
4%
4%
6%
52%
34%
0.04
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the control group (30 female, 20 male) were included
in the study. The mean age of the patients and control
group were 30.6 ±11.4 years and 32.7±10.7 years,
respectively (p=0.35). The mean disease duration was
7.3±8.5 years. Dietary habits were similar between
the two groups except for vegetable intake (Table 1).
Consumption frequency of vegetable was everyday in
14 (27.5%) patients; 3-5 times a week in 21 (41.2%)
patients; 1-2 times a week in 14 (27.5%) patients;
twice a month in 2 (3.9%) patients. However, vegetable
consumption frequency was everyday in 17 (34%)
controls; 3-5 times a week in 26 (52%) controls;
1-2 times a week in 3 (6%) controls; twice a month in
2 (4%) controls and once a month in 2 (4%) controls.
Vegetable consumption was significantly more frequent
among patients than controls (p=0.04). There were no
statistically significant differences between patients and
healthy individuals in the frequency of intake of meat
(p=0.43), processed meat (p=0.94), chicken (p=0.33),
fish (p=0.70), egg (p=0.14), legume (p=0.53), milk
(p=0.62), dairy products; yogurt (p=0.28), cheese
(p=0.88), fruit (p=0.68), bread (p=0.93), tea, coffee
(p=0.20), coke (p=0.13), fast food (p=0.79), sugar
(p=0.16), pasta, rice (p=0.66), chocolate (p=0.34),
cake, cookie and pie (p=0.98).
DISCUSSION
Seborrheic dermatitis is characterized byhyperkeratosis,
parakeratosis, excess intercellular and intracellular
lipids. Epidermal keratinocytes consist of lipid
granules which play role in the skin permeability.
However, sebaceous glands are the main source
of lipids of skin surface [6]. Therefore, sebaceous
secretions are considered to play a pathogenetic
role in seborrheic dermatitis [8]. Sebaceous glands
provide lipid substrates for the Malassezia growth.
Sebum consists of 57.5% triglycerides, 26.0% wax
esters, 12.0% squalene, 3.0% cholesterol esters and
1.5% cholesterol [6]. Sebaceous gland secretions
metabolise to irritating unsaturated fatty acids by
Malassezia [4]. The prevelance of the disease is
directly correlated with increased sebaceous gland
activity [8]. Predilection sites are sebaceous gland rich
areas like face, ears, scalp and the upper trunk [6].
Patients with oily skin are prone to develop seborrheic
dermatitis [9]. When hygiene is poor as occurs in
neuropathic patients, the residual sebum on the
skin results in growth of Malassezia and seborrheic
dermatitis [10].
The effect of diet on increased sebum production
has been reported previously. It has been suggested
that dietary lipids like fatty acids, acetat and glucose
may be the source for sebum synthesis [6]. Frequent
consumption of carbohydrates with a high glycemic
index can lead to hyperinsulinemia. It istimulates
sebum secretion by increasing androgen levels [11].
Boelsma et al. investigated the effect of diet on the
skin conditions including hydration, sebum content,
and surface pH of the skin in 302 healthy subject.
They assessed dietary intake with food frequency
questionnaires and sebum content of the forehead with
the sebumeter. No association between the nutrients
in diet and sebum content of the skin have been
found. However, increased serum vitamin A levels were
related with decreased sebum content [12]. It has been
suggested that caloric restriction can reduce sebum
release. Pochi et al. evaluated sebaceous gland activity
in obese patients following a four to eight week-long
caloric deprivation. The study showed decrease in
sebaceous gland secretion in all patients [13].
Dietary changes shown to be benefical in the treatment
of skin diseases like psoriasis, scleroderma, acne,
rosacea, herpes, pemphigus, and Refsum’s disease [14].
Moreover, dietary recommendations have been reported
in the treatment of dandruff which is regarded as a mild
form of seborrheic dermatitis with scalp scaling [15,16].
Patients with dandruff were adviced to eat foods rich
in vitamin B, shellfish, red meat, sunflower seeds,
sardines, salmon, water based fruits and vegetables.
In addition to this, the patients were adviced to avoid
oily and greasy food products, sugar, junk foods, animal
fats, flour, and seafood [16]. Faulty eating habits
have also been reported to be related with seborrheic
dermatitis [9]. In 1967, Bett et al. measured the sugar
intake of 16 patients with seborrheic dermatitis and
two groups of control subjects with a questionary.
A control group included 16 healthy individuals and
the other included 16 patients suffering from warts.
The consumption of sugar by patients with seborrheic
dermatitis was found to be significantly higher than
two groups of control subjects [17].
However, the association between diet and seborrheic
dermatitis has not been clearly established yet. There
are no adequate number of studies in the literature.
Therefore, frequency of food consumption of patients
with seborrheic dermatitis and healthy individuals have
been compared in this study. No significant differences
have been observed between two groups except for
frequency of vegetable intake. Vegetable consumption
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© Our Dermatol Online 3.2018 264
was significantly more frequent among patients than
controls. This study indicates that diet doesn’t play
role in production of sebum in patients with seborrheic
dermatitis.
CONCLUSION
In conclusion, the results showed that dietary habits
were not associated with increased risk of seborrheic
dermatitis.
STATEMENT OF HUMAN AND ANIMAL
RIGHTS
All procedures followed were in accordance with the
ethical standards of the responsible committee on
human experimentation (institutional and national)
and with the Helsinki Declaration of 1975, as revised
in 2008.
STATEMENT OF INFORMED CONSENT
Informed consent was obtained from all patients for
being included in the study.
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Copyright by Funda Tamer. This is an open-access article distributed
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permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited.
Source of Support: Nil, Confl ict of Interest: None declared.
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Seborrheic dermatitis is a chronic relapsing inflammatory skin disorder clinically characterized by scaling and poorly defined erythematous patches. The prevalence of adult seborrheic dermatitis is estimated at 5%. Although the exact cause of seborrheic dermatitis has yet to be understood, Malassezia yeasts, hormones (androgens), sebum levels and immune response are known to play important roles in its development. Additional factors including drugs, winter temperatures and stress may exacerbate seborrheic dermatitis. A variety of treatment modalities are available, including antifungal agents, topical low-potency steroids and calcineurin inhibitors (immunomodulators). This review summarizes current knowledge on the etiopathogenesis and therapy of adult seborrheic dermatitis.
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