Addressing Patient Needs in Seborrheic Dermatitis with Novel Therapies - Episode 12

Silently Struggling: Discussing the Unseen Burdens of SD

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Experts discuss the profound impact of seborrheic dermatitis on a patients' well-being, examining the common misconceptions, diagnostic delays, and societal judgments that hinder effective management and necessitate enhanced clinical outreach and patient education.


Linda Stein Gold, MD: I think what we’re understanding is, this is a condition that is highly prevalent. It is symptomatic, it’s itchy, it can be painful. It’s emotionally devastating because people are judged. And we wonder if our patients are paranoid because they say, I’m not getting the promotion that I want. I was not picked to be the one to present. But the truth is, we’ve seen studies where people are being judged based on their skin conditions. And you mentioned earlier this Harris study. This did involve a lot of seborrheic dermatitis patients. Do these patients know that they have a skin disease, or do they think that they just have a little dandruff and that this is not something that deserves medical treatment?

James Song, MD: Great question, Linda. I think one of the challenges is that there’s very little out there on education for seborrheic dermatitis. So many patients don’t actually realize this is a medical condition that could be potentially treated. They look it up online, to Neal’s point, they’re like, “Is this psoriasis? Is this eczema?” And they realize that seborrheic dermatitis can actually affect areas outside of the scalp. A lot of these patients, they do feel embarrassed, but they also feel like sometimes maybe it’s not serious enough to bring up to a health care provider, even though that Harris poll data showed it has such a profound impact on quality of life. So it’s a tough situation to be in.

Linda Stein Gold, MD: And I think as dermatologists, we don’t necessarily understand the journey that these patients have gone through. They ask dermatologists, well, how long do you think it takes for the diagnosis to be made? And they estimate maybe a year and a half or so. And then, as you mentioned, you ask the patients, and they say it takes between 3 and 4 years to make that diagnosis. In the meantime, these people are walking around without the care that they need. I think we really [owe] it to our patients to ask them a little bit more about their journey and what they’re going through.

Neal Bhatia, MD: I think part of that equation, too, is the perception. Again, we talked before about [how] they just think it’s dry skin. They think it’s bad hygiene. They blow it off to things that they can correct at home. But I think the other population that deserves that, again, we mentioned before about the neurological patients, the HIV and the AIDS patients, they don’t realize that’s a significant part of their disease. And I don’t think they’re getting the treatment that they probably should be getting because I don’t think it’s identified as serious enough.

Adelaide Hebert, MD: Yes, many patients think that it’s a hygiene problem. I’ve heard parents say about the children, we just can’t get them to wash his hair enough or we can’t get them to use the shampoo that I put there for them. And so there are a lot of misconceptions here. And I think also some patients feel like they should be able to go to their local pharmacy and treat themselves. The failure of recognition of its medical condition or that a dermatologist can be so impactful in getting them better, it’s just not part of the everyday regimen that we see. So our outreach has to be better.

Linda Stein Gold, MD: I agree. I have seen so many teenage patients who come in. When you have seborrheic dermatitis, no matter what you do, I think your hair looks dirty because it’s flaky. You ask patients about hairstyles, and that impacts both men and women. I have one patient who’s actually grown his beard and his hair long and he said, I will kind of shave and trim it up once I don’t have this problem because by wearing the hair really long and keeping the beard, it covers a lot of the redness, the scaling and everything else. It’s embarrassing.

Neal Bhatia, MD: Well, you wonder too how many physicians outside of dermatology are just also sending that message to them, saying, “Well, that’s just dry skin. It’ll go away. Shower once a day, shower twice a day.” So some of it’s not just on the dermatologist and the patient. I mean, there’s probably some disconnect somewhere where people aren’t getting treated.

Linda Stein Gold, MD: And I think education is so important, because unfortunately, if you shower 2 or 3 times a day, you’re going to end up having a worse problem. You’re not going to make the seborrheic dermatitis any better. It’s going to be really, really a significant problem. So I think what we’ve identified here is the fact that this is a major problem. I tell people, I could walk out into the waiting room today and find people with seborrheic dermatitis. You are not alone. It’s so common. And, unfortunately, I think this is something that our patients cannot necessarily handle on their own. For those with the most mild [cases], I think it’s appropriate, certainly, to try an over-the-counter product, try a medicated shampoo, see how it does. But I think what we’ve learned from the polls and our patients and actually doing these trials is that this is very prevalent. We’re not diagnosing it when it’s there in front of us, necessarily, if we’re not looking for it and the patient’s not complaining about it. And the patient doesn’t necessarily think about telling us about it. So there’s a lot going on. I’m glad we have a new option. It sounds like we don’t have a whole lot more on the horizon at this point, but fortunately we do have something that is safe and effective.

Transcript was AI-generated and edited for clarity.