Plaque rouge sur le visage

Bonjour,
J'ai 38 ans et depuis de nombreuses années (au moins 20), je souffre de dermite séborrhéïque sur le visage: principalement dans les sourcils, sur les ailes du nez, dans la barbe et sur le torse. Au cours de ces nombreuses années, j'ai vu de nombreux dermatos et essayer de nombreuses pommades dont kétoderm, dermalibour, lithioderm. J'ai des crises après une exposition au soleil, en période de stress intense.
Je ne sais plus quoi essayer. J'ai l'impression que plus rien ne marche; ça me brûle, j'ai la peau extra sèche, des rougeurs difficiles à cacher... Esthétiquement c'est loin d'être joli.
A chaque fois que j'ai essayé quelque chose de nouveau, ça marche un mois ou 2, et puis après j'ai l'impression que la peau s'habitue et c'est reparti.
En lisant les nombreux forums sur la question, je ne suis pas persuadé qu'aujourd'hui il existe le traitement miraculeux.
A ce jour, je ne sais plus quoi faire: dois je consulter un nouveau dermato? Existe-t-il de nouvelles pommades plus efficaces que les précédentes?
Bref, merci de me conseiller sur ce que je peux faire.

Le traitement de la dermite séborrhéïque comporte souvent des dermocorticoides au moins au début (locapred sur le visage, localone sur le cuir chevelu et le torse) et en entretien une ou deux fois par semaine). En cas de résultats insuffisants, certains praticiens recommandent parfois des antifongiques du type fluconazole (hors A.M.M) par voie orale pour endiguer une forte crise, la crème au tacrolimus est parfois aussi utilisée pour des dermite séborrheïques sévères et résistantes, après les dermocorticoides & éviter les récidives (hors A.M.M & non remboursée).


[B]BIBLIOGRAPHIE[/B]

Am J Clin Dermatol. 2007;8(4):235-8.
[B]Efficacy of oral fluconazole in the treatment of seborrheic dermatitis: a placebo-controlled study.[/B]
Cömert A, Bekiroglu N, Gürbüz O, Ergun T.
Source Department of Dermatology, School of Medicine, Maltepe University, Maltepe, Istanbul, Turkey. [EMAIL="asuata@superonline.com"]asuata@superonline.com[/EMAIL]
[B]Abstract[/B]
BACKGROUND: Seborrheic dermatitis (SD) is a common, chronic dermatosis. Although the pathogenetic mechanisms of SD are not clear, Malassezia spp. yeasts are known to cause the disease. Previous studies have shown that topical and systemic antifungals provide clinical benefit.
OBJECTIVE: To evaluate the safety and efficacy of short-term oral fluconazole in patients with SD.
METHODS: Sixty-three patients with mild-to-moderate SD were randomly allocated to receive either oral fluconazole 300 mg in a single dose per week or placebo, for 2 weeks. Twenty-seven patients taking fluconazole and 23 patients taking placebo completed the study and were analyzed. The SD area severity index (SDASI) score and the patient's subjective assessment of pruritus and burning sensation were evaluated before and after treatment. Both the investigator and the patients were blinded to treatment.
RESULTS: A statistically significant improvement in SDASI score after treatment compared with baseline was obtained with fluconazole (p=0.01) but not with placebo. However, the difference between the treatment groups was not statistically significant (p>0.05). Subjective improvements in symptoms, such as pruritus and burning sensation, were observed in both groups but no statistically significant differences versus baseline were seen.
CONCLUSION: The results of this study indicate that fluconazole provides marginal and statistically insignificant benefit for the therapy of SD. However, larger studies using different dosages and/or durations of fluconazole therapy may provide a rationale for systemic use of fluconazole in SD.

Indian J Dermatol. 2011 Sep-Oct;56(5):515-6.
[B]Oral itraconazole for the treatment of severe seborrhoeic dermatitis.[/B]
Das J, Majumdar M, Chakraborty U, Majumdar V, Mazumdar G, Nath J.
Source Department of Dermatology, Calcutta School of Tropical Medicine, Kolkata, West Bengal.
[B]Abstract[/B]
BACKGROUND: Seborrheic dermatitis (SD) is an inflammatory skin disorder in which colonies of Malassezia furfur have been found in affected areas.
AIM: The aim of this study was to evaluate the efficacy of itraconazole in the treatment of severe SD.
MATERIALS AND METHODS: Itraconazole was given to 30 patients of SD in a dose of 100 mg twice daily for 1 week followed by 200 mg/day for first 2 days of the following 2 months. The response was noted on day 15, 30, 60, and 90. The clinical response was graded as markedly effective, effective, or ineffective.
RESULTS: Clinical improvement (evaluated as markedly effective or effective) was observed in 83.3% cases.
CONCLUSION: The anti-inflammatory activity of oral itraconazole suggests that it should be the first-line therapy in severe SD.

[B]Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults.

Papp KA, Papp A, Dahmer B, Clark CS.[/B]
Source Probity Medical Research Inc., Waterloo, Ontario, Canada.
[B]Abstract[/B]
BACKGROUND: Tacrolimus is a topical calcineurin inhibitor with immunomodulatory, anti-inflammatory, and fungicidal properties that may be beneficial in the treatment of facial seborrheic dermatitis.
OBJECTIVES: We sought to compare the efficacy and safety of tacrolimus with standard corticosteroid treatment in adults with facial seborrheic dermatitis in a phase II, single-blind, randomized controlled trial.
METHODS: Adult patients were enrolled in a 12-week study. Subjects were randomized to tacrolimus 0.1% ointment (n = 16) or hydrocortisone 1% ointment (n = 14) applied twice daily to symptomatic regions of the face. The primary efficacy measure was the severity of facial seborrhea at the end of treatment (day 84) as measured by the Seborrhea Area and Severity Index-Face. Secondary efficacy measures included physician and patient assessment of seborrhea, the frequency of medication application, and adverse events.
RESULTS: The severity of facial seborrhea was similarly improved in both treatment groups (P = .86). Tacrolimus 0.1% ointment was used on significantly fewer days than 1% hydrocortisone ointment (mean missed doses per patient at first visit: 15.6 vs 7.6, P < .05; at last visit: 13.5 vs 7.7, P = .08). The majority of doses were missed because of lack of symptoms. The adverse event profile for both agents was similar; however, there was a numerically higher incidence of adverse events in the hydrocortisone group.
LIMITATIONS: This was a small, open-label study.
CONCLUSION: Tacrolimus 0.1% ointment required significantly fewer applications compared with hydrocortisone 1% ointment to achieve a comparable clinical response in adults with facial seborrheic dermatitis. Tacrolimus was generally well tolerated.
Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Expert Rev Clin Pharmacol. 2012 Jan;5(1):91-7.
[B]Pimecrolimus 1% cream for the treatment of seborrheic dermatitis: a systematic review of randomized controlled trials.[/B]
Ang-Tiu CU, Meghrajani CF, Maano CC.

Source Section of Dermatology, Department of Internal Medicine, University of the Philippines-Philippine General Hospital, Taft Avenue, Manila 1000, Philippines.
Abstract Seborrheic dermatitis is a common, chronic, relapsing inflammatory skin disorder that manifests as erythema, scaling and pruritus in sebum gland-rich areas of the skin. The objective of this article is to evaluate the clinical efficacy of pimecrolimus 1% cream in the treatment of seborrheic dermatitis compared with corticosteroids, antimycotics, placebo or no intervention. Pimecrolimus 1% cream appears to be a well-tolerated and effective treatment for seborrheic dermatitis. It has comparable efficacy, in terms of decreasing severity of erythema, scaling and pruritus, to the standard treatments: topical corticosteroids and antimycotics. However, future studies with more standardized measures of treatment outcome are recommended. More studies may also be conducted to further evaluate pimecrolimus 1% cream as a long-term maintenance therapy for seborrheic dermatitis.
J Am Acad Dermatol. 2011 Nov 17. [Epub ahead of print]

Am J Clin Dermatol. 2007;8(4):235-8.
[B]Efficacy of oral fluconazole in the treatment of seborrheic dermatitis: a placebo-controlled study.[/B]
Cömert A, Bekiroglu N, Gürbüz O, Ergun T.
Source Department of Dermatology, School of Medicine, Maltepe University, Maltepe, Istanbul, Turkey. [email]asuata@superonline.com[/email]
[B]Abstract[/B]
BACKGROUND: Seborrheic dermatitis (SD) is a common, chronic dermatosis. Although the pathogenetic mechanisms of SD are not clear, Malassezia spp. yeasts are known to cause the disease. Previous studies have shown that topical and systemic antifungals provide clinical benefit.
OBJECTIVE: To evaluate the safety and efficacy of short-term oral fluconazole in patients with SD.
METHODS: Sixty-three patients with mild-to-moderate SD were randomly allocated to receive either oral fluconazole 300 mg in a single dose per week or placebo, for 2 weeks. Twenty-seven patients taking fluconazole and 23 patients taking placebo completed the study and were analyzed. The SD area severity index (SDASI) score and the patient's subjective assessment of pruritus and burning sensation were evaluated before and after treatment. Both the investigator and the patients were blinded to treatment.
RESULTS: A statistically significant improvement in SDASI score after treatment compared with baseline was obtained with fluconazole (p=0.01) but not with placebo. However, the difference between the treatment groups was not statistically significant (p>0.05). Subjective improvements in symptoms, such as pruritus and burning sensation, were observed in both groups but no statistically significant differences versus baseline were seen.
CONCLUSION: The results of this study indicate that fluconazole provides marginal and statistically insignificant benefit for the therapy of SD. However, larger studies using different dosages and/or durations of fluconazole therapy may provide a rationale for systemic use of fluconazole in SD.

Indian J Dermatol. 2011 Sep-Oct;56(5):515-6.
[B]Oral itraconazole for the treatment of severe seborrhoeic dermatitis.[/B]
Das J, Majumdar M, Chakraborty U, Majumdar V, Mazumdar G, Nath J.
Source Department of Dermatology, Calcutta School of Tropical Medicine, Kolkata, West Bengal.
[B]Abstract[/B]
BACKGROUND: Seborrheic dermatitis (SD) is an inflammatory skin disorder in which colonies of Malassezia furfur have been found in affected areas.
AIM: The aim of this study was to evaluate the efficacy of itraconazole in the treatment of severe SD.
MATERIALS AND METHODS: Itraconazole was given to 30 patients of SD in a dose of 100 mg twice daily for 1 week followed by 200 mg/day for first 2 days of the following 2 months. The response was noted on day 15, 30, 60, and 90. The clinical response was graded as markedly effective, effective, or ineffective.
RESULTS: Clinical improvement (evaluated as markedly effective or effective) was observed in 83.3% cases.
CONCLUSION: The anti-inflammatory activity of oral itraconazole suggests that it should be the first-line therapy in severe SD.

[B]Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults.
Papp KA, Papp A, Dahmer B, Clark CS.[/B]
Source Probity Medical Research Inc., Waterloo, Ontario, Canada.
[B]Abstract[/B]
BACKGROUND: Tacrolimus is a topical calcineurin inhibitor with immunomodulatory, anti-inflammatory, and fungicidal properties that may be beneficial in the treatment of facial seborrheic dermatitis.
OBJECTIVES: We sought to compare the efficacy and safety of tacrolimus with standard corticosteroid treatment in adults with facial seborrheic dermatitis in a phase II, single-blind, randomized controlled trial.
METHODS: Adult patients were enrolled in a 12-week study. Subjects were randomized to tacrolimus 0.1% ointment (n = 16) or hydrocortisone 1% ointment (n = 14) applied twice daily to symptomatic regions of the face. The primary efficacy measure was the severity of facial seborrhea at the end of treatment (day 84) as measured by the Seborrhea Area and Severity Index-Face. Secondary efficacy measures included physician and patient assessment of seborrhea, the frequency of medication application, and adverse events.
RESULTS: The severity of facial seborrhea was similarly improved in both treatment groups (P = .86). Tacrolimus 0.1% ointment was used on significantly fewer days than 1% hydrocortisone ointment (mean missed doses per patient at first visit: 15.6 vs 7.6, P < .05; at last visit: 13.5 vs 7.7, P = .08). The majority of doses were missed because of lack of symptoms. The adverse event profile for both agents was similar; however, there was a numerically higher incidence of adverse events in the hydrocortisone group.
LIMITATIONS: This was a small, open-label study.
CONCLUSION: Tacrolimus 0.1% ointment required significantly fewer applications compared with hydrocortisone 1% ointment to achieve a comparable clinical response in adults with facial seborrheic dermatitis. Tacrolimus was generally well tolerated.
Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Expert Rev Clin Pharmacol. 2012 Jan;5(1):91-7.
[B]Pimecrolimus 1% cream for the treatment of seborrheic dermatitis: a systematic review of randomized controlled trials.[/B]
Ang-Tiu CU, Meghrajani CF, Maano CC.

Source Section of Dermatology, Department of Internal Medicine, University of the Philippines-Philippine General Hospital, Taft Avenue, Manila 1000, Philippines.
Abstract Seborrheic dermatitis is a common, chronic, relapsing inflammatory skin disorder that manifests as erythema, scaling and pruritus in sebum gland-rich areas of the skin. The objective of this article is to evaluate the clinical efficacy of pimecrolimus 1% cream in the treatment of seborrheic dermatitis compared with corticosteroids, antimycotics, placebo or no intervention. Pimecrolimus 1% cream appears to be a well-tolerated and effective treatment for seborrheic dermatitis. It has comparable efficacy, in terms of decreasing severity of erythema, scaling and pruritus, to the standard treatments: topical corticosteroids and antimycotics. However, future studies with more standardized measures of treatment outcome are recommended. More studies may also be conducted to further evaluate pimecrolimus 1% cream as a long-term maintenance therapy for seborrheic dermatitis.
J Am Acad Dermatol. 2011 Nov 17. [Epub ahead of print]