Seborrheic dermatitis: Identification of key disease factors and treatment with a topical solution of betamethasone 0.05% + salicylic acid 2%

Abstract

Introduction. Existing gaps occurring in the knowledge of seborrheic dermatitis etiopathogenesis determine the need for a comprehensive approach aiming to identify the cause-and-effect relationships between genetic, morphofunctional, and microbiological factors of SD, as well as to develop evidence-based models to tailor medical decisions for individual patients. Aim. Identify key factors in the development and course of seborrheic dermatitis using Bayesian network analysis and to evaluate the efficacy of topical betamethasone dipropionate 0.05% + salicylic acid 2% solution. Mat erials and methods. The study consisted of two phases. In the first phase, a clinico-pathogenetic model was reconstructed using non-parametric Bayesian network analysis based on data from 90 patients with SD. In the second phase, an open-label prospective study evaluated the efficacy and safety of Akriderm SK solution in 62 patients with scalp SD over 2 weeks of active treatment and 4 weeks of follow-up. Results. The SD model revealed a triad of clusters: “metabolism – epidermis – microbiota”; correlations were established between glucose and cholesterol with keratinization and dysbiosis, associations of the TNF-α AA genotype with Candida albicans colonization (r = 0.88), and hyperbilirubinemia with pruritus (r = 0.91). In the treatment of patients with scalp SD with the solution for external use Akriderm SK, clinical remission (SEDASI ≤ 2) was achieved in 90.3% of patients by the end of the 2nd week of therapy, while the relapse rate after 4 weeks of observation was 1.6%. Conclusions. The proposed Bayesian model elucidates the multifactorial pathogenesis, visualizing the interdependencies and hierarchy of factors and clinical manifestations and supporting a personalized approach. Betamethasone dipropionate 0.05% + salicylic acid 2% solution is an effective and safe treatment for scalp SD.

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