Topical and oral phosphodiesterase-4 inhibitors for refractory seborrheic dermatitis: A systematic review

Summary: Abstract Body: Seborrheic dermatitis (SD) is a chronic inflammatory condition characterized by erythema, scaling, and pruritus, primarily affecting sebaceous-rich areas. Treatment typically includes antifungals, corticosteroids, and other anti-inflammatory medications. Recently, Phosphodiesterase-4 (PDE-4) inhibitors emerged as a promising therapeutic option for managing treatment-resistant SD cases. Current literature lacks a summary of this rising therapy option. We present a systematic review summarizing the efficacies and outcomes regarding treatment of SD with topical and oral PDE-4 inhibitors. Of 200 articles screened from three databases, authors included 7 articles describing 638 patients. The most common treatment utilized was topical roflumilast 0.3% applied daily (94.51%). Topical crisaborole 2% (5.02%) and oral apremilast 30mg (0.47%) were also used. Average follow-up time was 1.91 months. A majority of patients, 50.31%, experienced improvement in their condition, 28.37% achieved full resolution, and 21.32% showed no change. Only 16.77% reported adverse effects like nausea and nasopharyngitis. By increasing cAMP levels, suppressing pro-inflammatory cytokines, and promoting anti-inflammatory cytokines (such as IL-10), PDE-4 inhibitors downregulate the skin’s inflammatory response. Modulating the immune response is beneficial in SD where immune dysregulation is a key factor. Unlike corticosteroids, PDE-4 inhibitors provide effect without long-term use side effects, such as skin thinning and barrier dysfunction. The use of PDE-4 inhibitors represents a significant advancement in the management of SD, especially in patients needing long-term management, with these results highlighting their efficacy and tolerability. As more clinical data become available, PDE-4 inhibitors are likely to become a cornerstone in the treatment of SD. Zane M. Berry¹, Meghan R. Mansour², Joseph W. Fakhoury² 1. Michigan State University College of Human Medicine, East Lansing, MI, United States. 2. Henry Ford Health System, Detroit, MI, United States. Clinical Research: Epidemiology and Observational Research