Thinking back to medical school basics, we learned of several “-rrheas”: Rhinorrhea (mucous), diarrhea (gastrointestinal waste), galactorrhea (milk). All relate to an abnormal corporeal discharge—certainly uninvited, undesired. So along comes “seborrhea,” our dermatologic term for an excess of sebum, a word often used synonymously with seborrheic dermatitis, but in fact not quite capturing the extent of the latter’s pathophysiology. We would be hard-pressed to convince our patients with red, flaky patches—those who complain of chronically dry skin that emollients do not seem to help—that really, their problem is oiliness. Instead, we expand upon that definition to include Malassezia yeast, and an inflammatory reaction to its presence on the skin.
While many conventional therapies are available (-azole antifungals, low potency steroid creams, topical non-steroidal anti-inflammatories) patients are increasingly distressed by the idea of a chronic condition, and are looking for a “root-cause” approach to its elimination. Others are hoping for more natural treatment options, with less risk for long-term side effects—hence, the growing interest in integrative solutions.
Tea tree and borage are two topical essential oils which have both historic use and study data around seborrheic dermatitis. Satchell and colleagues linked the antimicrobial action of tea tree oil to the terpinen-4-ol molecule, and further demonstrated in a randomized controlled trial that daily use of a 5% shampoo yielded a 41% improvement in symptoms, as opposed to 11% in the placebo arm.1 Borage seed oil is high in gamma-linolenic acid (GLA), purported to have anti-inflammatory benefits. The data is mixed on this, however; one study of infantile seborrheic dermatitis demonstrated 100% resolution within two weeks of topical borage oil application,2 but a follow-up study by the same group failed to demonstrate clinical benefit.3
Of similar interest: