There are two cases where seborrheic dermatitis symptoms were directly correlated with nerve function. In one of these, blockade of specific nerves had lead to remission, while in the other, damage to specific nerves had lead to the aggressive onset of symptoms.
Examining these two cases in detail uncovers some interesting aspects of seborrheic dermatitis and may help form a more complete understanding of the condition and bring additional treatment considerations onto the table.
Remission of Seborrheic Dermatitis Following Stellate Ganglion Block
The stellate ganglion is a cluster of ganglia responsible for autonomic (sympathetic) control of various functions of the face, neck, and upper limbs. Communication via this pathway is known to modulate blood flow, endocrine, and immune function in the area.
A procedure known as the stellate ganglion block is commonly used to relieve various autonomic system disorders of the relevant areas under its control. The procedure depends on repeat injection of an anesthetic directly into the stellate ganglia, resulting in temporary blockade of the sympathetic nervous system control over the corresponding organs.
Interestingly, several case studies have demonstrated the effectiveness of a stellate ganglion block for the treatment of acne  and atopic dermatitis . Based on these findings, a team of researchers from Korea decided to examine the impact of this procedure on a case of seborrheic dermatitis .
The outcome of this trial was that a patient who had been visiting the dermatology clinic for a period of 10 years in an effort to treat a recurring case of seborrheic dermatitis, successfully entered prolonged remission.
Upon initial treatment, skin lesions disappeared within 3 days. Unfortunately, the patient discontinued treatment for personal reasons and then subsequently returned two months later due to a relapse. Fifty additional procedures were performed and no relapse was recorder thereafter.
Authors of this paper proposed the most likely method in which the stellate ganglion block relieved the skin lesions likely had to do with one of the three effects:
- Improved blood flow
- Anti-inflammatory and immune-regulating properties
- Restored melatonin rhythm and stabilization of sympathetic tone
Decoding which of these effects had the most impact can be difficult, but the fact that the procedure had the effect of resolving a long term case of seborrheic dermatitis demonstrates the involvement of the nervous system.
Questions to Consider
– Could other approaches that aim to reduce sympathetic tone (nutrition, stress reduction, meditation) be used in a similar manner?
– Does a reduction in sympathetic tone relate to a decreased rate of sebum production?
Nerve Lesion Triggers Severe Seborrheic Dermatitis
In another case from 1953 , a woman arrived at the hospital complaining of a constant headache and vision issues in one eye for the past 18 months. An investigation revealed she had a tumor that was running through the fifth nerve. An operation was performed to remove the tumor, but she then returned several months later with complications.
The unintended side-effect of the operation was a severe onset of seborrheic dermatitis symptoms affecting only one side of her face (left side of the face remained unaffected).
The examining physicians noted several striking differences that appeared on the affected side (in comparison to the unaffected side)
- Increased relative skin temperature (~0.4 C higher)
- Absence of sweat (likely related to sympathetic lesion)
- Increased sebum output (roughly twice as much sebum was present)
- Increased concentration of free fatty acids in the sebum
- Higher microbial colonization
She was prescribed a sulfur and salicylic acid ointment for symptom relief, but relapses continued.
The symptoms prevailed during follow-up examinations for roughly a year and a half after initial symptom onset. Then on one of her regular examinations, the physicians were shocked to discover that her symptoms had completely disappeared despite the discontinues of topical therapy. Neurological examination revealed some nerve damage remained (in the fifth nerve), however, evaluation of the skin showed sweating and sebum production on both sides of her face had stabilized.
The authors of the paper noted that at the time of seborrheic dermatitis symptom remission, only slight improvement in the fifth nerve lesion was exhibited. However, the return of regular sweat production was indicative of a recovery from the sympathetic lesion. As a result, the conclusion was that damage to the sympathetic nerve and its corresponding recovery was the underlying cause of the onset and remission of her skin issues.
This section reviewed two cases where seborrheic dermatitis directly correlated with abrupt changes in nerve function to these areas of skin.
Key points include:
- A procedure known as the stellate ganglion block is most commonly used to relieve various autonomic systemic disorders occurring above the neck
- A single case report from Korea documented the stellate ganglion block procedure was able to induce prolonged remission of long term seborrheic dermatitis issues
- Authors theorized that the effectiveness of the procedure may be related to improved blood flow, anti-inflammatory properties, immune-regulating, and sympathetic tone stabilizing effects
- Another case documented that aggressive seborrheic dermatitis symptoms abruptly appeared after potential nerve damage in the facial region
- In this case, the individual’s symptoms were restricted to the side of the face that the nerve damage had occurred, while the other side remained symptom-free
- Symptoms continued to persist despite ongoing treatment with prescribed ointment, but lasting remission was attributed to the healing of underlying nerve damage
- Authors theorized the abrupt seborrheic dermatitis onset was driven by a combination of increased sebum production, increased skin temperature, and reduced sweat production
- In both cases, altered nerve function produced changes in the skin’s environment which ultimately lead to changes in skin symptoms