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Relationship between diet and seborrheic dermatitis

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Funda Tamer
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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 Dermatology Online
© 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
under the terms of the Creative Commons Attribution License, which
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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Full-text available
  • Nov 2023
Introduction Seborrheic dermatitis (SD) is a chronic, inflammatory papulosquamous skin disease. The symptoms and signs of SD are typically managed by topical ketoconazole and topical corticosteroids. However, they don't provide a cure for SD, which explains the disease's chronic nature. With this study, we aimed to identify specific dietary modifications that can be implemented as an adjunctive to traditional treatment of SD. Methods A case-control retrospective study. Data was obtained from medical records of patients diagnosed with SD. Patients were invited to participate in an online self-reported questionnaire, and dietary intake was assessed using a validated food frequency questionnaire. The controls were collected by distributing the same questionnaire to healthy adult residents living in Jeddah via social media. Results Two hundred sixty-seven participants were included in the study, 59 of whom were SD patients. Participants who reported consuming the following food types once daily had a higher percentage of SD compared to those without SD: a slice of white bread (p=0.002), a cup of rice or pasta (p<0.001), non-acidic fruits (p=0.014), leafy green vegetables (p=0.007), other types of vegetables (p=0.001), roasted or fried nuts (p=0.047), raw nuts (p=0.022) and a cup of coffee (p=0.041). When asked about their impression of what food types triggered or relieved their disease, 29 (49.2%) of the diseased participants reported no flare-ups with any kind of food. On the other hand, the following food types were commonly reported to be associated with SD exacerbation: spicy food (16.9%), sweets (16.9%), fried food (13.5%), dairy products (11.9%), and citrus fruits (10.2%). In contrast, citrus fruits, leafy green vegetables (8.5% for each), and the other types of vegetables (6.8%) were frequently observed with SD improvement. Conclusion Several dietary factors have been associated with SD in our cohort. Thus, our findings could offer new insights into the application of adjuvant dietary measures that might play a role in the improvement of SD symptoms and potentially enhance therapeutic outcomes.
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An overview on seborrheic dermatitis and its treatment (allopathy and homeopathy)
Article
Full-text available
  • Aug 2020
Seborrheic dermatitis is a common, chronic inflammation of the skin, characterized by the appearance of red, flaking, greasy areas of skin, most commonly on the scalp, nasolabial folds, ears, eyebrows and chest. The incidence of the disease has two peaks: one in newborn infants up to three months of age, and the other in adults of around 30-60years of age. The exact causes of seborrheic dermatitis are not completely understood, multiple factors appears to be involved in the pathophysiology of the disease. The principle three factors involved are: sebum secreted from sebaceous gland, presence of Malassezia yeast, and the immune response of the host. Currently allopathic treatment and prophylaxis regimens usually include antifungal agents, most often azoles, mild topical steroids, immunomodulatory activity of topical calcineurin inhibitors such as tacrolimus and pimecrolimus and other agents such as selenium sulfide, sulfur, metronidazole and coal tar. Homeopathy offers an excellent treatment for seborrheic dermatitis during all stages. Various homeopathic medicine used to treat seborrheic dermatitis are kali sulphuricum, thuja occidentalis, natrum muriaticum and more. The objective of this review is to discuss and provide information about seborrheic dermatitis and its epidemiology, etiology, pathogenesis, symptoms, diagnosis and its treatment in allopathy and homeopathy.
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New Insights into the Etiopathogenesis of Seborrheic Dermatitis
Article
Full-text available
  • Feb 2017
Seborrheic dermatitis represents a chronic, widespread skin disease that is considered a multifactorial disorder influenced, in part, by Malassezia spp.opportunistic activities as well as by various endogenous and exogenous factors. This review systematizes the recent scientific achievements in the field of insufficiently elucidated etiology and pathogenesis of seborrheic dermatitis.
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Seborrheic Dermatitis and Dandruff: A Comprehensive Review
Article
Full-text available
  • Dec 2015
Seborrheic Dermatitis (SD) and dandruff are of a continuous spectrum of the same disease that affects the seborrheic areas of the body. Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD can affect the scalp as well as other seborrheic areas, and involves itchy and flaking or scaling skin, inflammation and pruritus. Various intrinsic and environmental factors, such as sebaceous secretions, skin surface fungal colonization, individual susceptibility, and interactions between these factors, all contribute to the pathogenesis of SD and dandruff. In this review, we summarize the current knowledge on SD and dandruff, including epidemiology, burden of disease, clinical presentations and diagnosis, treatment, genetic studies in humans and animal models, and predisposing factors. Genetic and biochemical studies and investigations in animal models provide further insight on the pathophysiology and strategies for better treatment.
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Seborrheic dermatitis
Article
Full-text available
  • Nov 2011
Seborrheic dermatitis is a chronic relapsing erythematous scaly skin disease, the prevalence of which is around 1 to 3% of the general population in the United States. It has two incidence peaks, the first in the first three months of life and the second beginning at puberty and reaching its apex at 40 to 60 years of age. The prevalence of seborrheic dermatitis is higher in HIV-positive individuals and the condition tends to be more intense and refractory to treatment in these patients. Neurological disorders and other chronic diseases are also associated with the onset of seborrheic dermatitis. The currently accepted theory on the pathogenesis of this disease advocates that yeast of Malassezia spp., present on the skin surface of susceptible individuals, leads to a non-immunogenic irritation due to the production of unsaturated fatty acids deposited on the skin surface. This article provides a review of the literature on seborrheic dermatitis, focusing on immunogenetics, the clinical forms of the disease and its treatment.
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Seborrheic dermatitis: Etiology, risk factors, and treatments: Facts and controversies
Article
  • Jul 2013
Seborrheic dermatitis (SD) is a common skin condition seen frequently in clinical practice. The use of varying terms such as sebopsoriasis, seborrheic dermatitis, seborrheic eczema, dandruff, and pityriasis capitis reflects the complex nature of this condition. Despite its frequency, much controversy remains regarding the pathogenesis of SD. This controversy extends to its classification in the spectrum of cutaneous diseases, having being classified as a form of dermatitis, a fungal disease, or an inflammatory disease, closely related with psoriasis. Some have postulated that SD is caused by Malassezia yeasts, based on the observation of their presence in affected skin and the therapeutic response to antifungal agents. Others have proposed that Malassezia is incidental to a primary inflammatory dermatosis that resulted in increased cell turnover, scaling, and inflammation in the epidermis, similar to psoriasis. The presence of host susceptibility factors, permitting the transition of M furfur to its pathogenic form, may be associated with immune response and inflammation. Metabolites produced by Malassezia species, including oleic acid, malssezin, and indole-3-carbaldehyde, have been implicated. SD also has been traditionally considered to be a form of dermatitis based on the presence of Malassezia in healthy skin, the absence the pathogenic mycelial form of Malassezia yeasts in SD, and its chronic course. As a result, proposed treatments vary, ranging from topical corticosteroids to topical antifungals and antimicrobial peptides.
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Seborrheic Dermatitis: An Update
Article
  • Jun 2012
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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Oily Skin: An Overview
Article
  • Jun 2012
  • SKIN PHARMACOL PHYS
Oily skin (seborrhea) is a common cosmetic problem that occurs when oversized sebaceous glands produce excessive amounts of sebum giving the appearance of shiny and greasy skin. This paper overviews the main concepts of sebaceous gland anatomy and physiology, including the biosynthesis, storage and release of sebum, as well as its relationship to skin hydration and water barrier function. We also address how skin oiliness may vary according to diet, age, gender, ethnicity and hot humid climates. The deeper understanding of this skin type provides the opportunity to better guide patients regarding skin care and also assist in the development of sebosuppressive agents.
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Diet in Dermatology: Present perspectives.
Article
  • Mar 2010
Many nutrients are essential for life, and an adequate amount of nutrients in the diet is necessary for providing energy, building and maintaining body organs, and for various metabolic processes. The role of food in the induction of various skin disorders and skin diseases leading to nutritional deficiencies is well known. The photo-protective potential of antioxidants, the effects of micronutrient supplementation on the skin immune system, and the modulating effects of fatty acids on skin disorders are well documented. Skin diseases due to nutritional deficiencies, the dietary role in skin immunity and various skin diseases, and the role of antioxidants and other supplements in skin health have been reviewed.
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Sebaceous Gland Response in Man to Prolonged Total Caloric Deprivation
Article
  • Nov 1970
The response of the sebaceous gland to total caloric deprivation was studied in 18 obese patients undergoing fasts for periods of four to eight weeks. Sebum production was measured in 11 of the patients and was found to decrease in each individual, with an average reduction of 40%. Diminished secretion usually occurred by the fourth week but was sometimes seen as early as one or two weeks. The composition of the sebum, analyzed in 14 patients, was also altered, and this could be detected as early as five days after the onset of fast. The qualitative changes in surface lipid consisted of a reduction in the amount of triglyceride fatty acids, wax esters, cholesterol and cholesterol esters but with no significant alteration in the amount of squalene.
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