Journal of Traditional Chinese Medical Sciences (2017) 4, 380e383

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Chinese herbal medicine for seborrheic

dermatitis complicated by allergy to topical
agent: A case report
Mingliang Xiao, Bing Zhang*, Yu Wang, Anzheng Nie

School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 100029, China

Received 18 September 2016; received in revised form 17 February 2017; accepted 18 August 2017
Available online 2 January 2018

KEYWORDS Abstract Seborrheic dermatitis is a common inflammatory dermatosis. Conventional medical

Chinese herbal treatments include corticosteroids, calcineurin inhibitors, and other therapeutic modalities.
medicine; However, the use of the conventional medicine sometimes is limited by adverse effects, such
Seborrheic as allergic reaction. We report the case of a 13-year-old girl with seborrheic dermatitis, who
dermatitis; was allergic to topical agents and was cured successfully with Chinese herbal medicine. Her
Drug eruption Chinese medical syndrome pattern was diagnosed as wind-heat invading the skin and herbs
with wind-dispelling and heat-clearing properties were prescribed. Chinese herbal medicine
is an alternative modality that can be considered for seborrheic dermatitis, in particular for
cases complicated by adverse reactions from conventional topical agents.
ª 2018 Beijing University of Chinese Medicine. Production and hosting by Elsevier B.V. This is
an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).

Introduction interaction between high sebum production, microbes (e.g,

Seborrheic dermatitis (SD) is a type of mild, chronic
dermatitis, characterized by mild (pink) erythema with
well-developed, fine, white-silver scales. Its common sites
of predilection include the scalp, periauricular area,
glabellar region, eyebrows, the paranasal region. Other
regions sometimes affected include the mid chest, geni-
talia, and groin folds. Although the exact etiology of SD is
complex and not fully understood, there appears to be an
* Corresponding author. Fax: þ86 10 52908842.
E-mail address: zhangbing6@263.net (B. Zhang).
Peer review under responsibility of Beijing University of Chinese
Medicine.
Malassezia yeasts), and other factors (e.g., abnormal host
immune response).1,2 As SD is a common chronic, recurrent
inflammatory skin disorder that sometimes afflicts in-
dividuals over a course of years, it has a bad effect on the
patient’s psychology, appearance and quality of life.
Especially when it occurs on the exposed parts, such as the
scalp and face. Mainstays of treatment for SD are antifun-
gals, corticosteroids, calcineurin inhibitors, among other
agents.3e5 However, the use of such conventional medicine
sometimes is limited due to adverse effects, such as
allergic reaction, steroid-induced rosacea, epidermal at-
rophy, telangiectasia formation, and chromatosis. In China,
Chinese herbal medicine is often used to treat dermatologic
disorders. This paper reports the case of a 13-year-old girl

https://doi.org/10.1016/j.jtcms.2017.12.004
2095-7548/ª 2018 Beijing University of Chinese Medicine. Production and hosting by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Chinese herbal medicine for seborrheic dermatitis
with facial SD (combined with fungal infection), who was
allergic to conventional topical agents and was cured suc-
cessfully with Chinese herbal medicine.
Case presentation
A 13-year-old Chinese girl previously presented to a hospital
outpatient clinic in March 2015 with a rashlike appearance on
both cheeks accompanied by slight itching. Skin smear mi-
croscopy showed fungal infection (specific type not indi-
cated in original case record). She was diagnosed with
seborrheic dermatitis and prescribed topical triamcinolone
acetonide (0.1%), econazole nitrate (1%) cream and oral
itraconazole. Several hours after her first application of the
topical agents, she developed a strong reaction to the topical
agents and the lesion enlarged and worsened, getting
redder, swelling and oozing, with severe itching and burning
sensation. Her parents let her stop using both topical and oral
agents and the lesion did not worsen further. Her parents
were anxious and feared the rash may be untreatable and
ultimately affect their daughter’s appearance and future
life. They brought the girl to our clinic on the next day
wanting to try traditional Chinese treatment.
When the patient presented, she appeared depressed,
unwilling to speak, and hid behind her parents to avoid
being noticed. The skin lesion extended over her left
cheek, nose and upper lip with obvious erythema, exuda-
tion, and swelling (Fig. 1A). She complained of intense
itching aggravated at night which caused her to wake
several times every night. She also reported heavy sweat-
ing. She takes normal diets and does not have food al-
lergies. She did not use any medicine after the first
application of the topical agents, only used facial mois-
turizer. She did not have such skin disorder before.
Traditional Chinese diagnostics revealed that the tip and
border of her tongue were red, tongue coating was thin and
white, and her pulse was slippery. The Traditional Chinese
Medicine (TCM) syndrome pattern was diagnosed as inva-
sion of wind and toxic heat. Herbal prescription strategy
was to dispel wind and clear heat toxin during the acute
stage of disease (Table 1). The patient was instructed to
take the herbal decoction 1 dose daily, half in the morning
and half in the afternoon. Other instructions were to avoid
sweets, seafood, and spicy/pungent, greasy, sticky, fried,
and cold foods; to not scratch or touch her face or wear a
face mask to avoid abrasion of the skin; and to avoid
strenuous exercise that would cause sweating. She was also
Figure 1 Seborrheic dermatitis lesion. A: Severe lesion at first visit (with facial moisturizer on her face). B & C: By the second and
third visits, the lesion was significantly improved. D: At the fourth visit, a new rash developed on the right cheek, which resolved by
the time treatment was complete.
381
told to only use water to wash her face and not to use
ointments or facial moisturizer. The patient returned for
visits weekly.
At the second visit (a week later), the patient showed
substantial improvement in symptoms. Swelling and
exudation were nearly resolved and the area of skin lesion
was reduced with only rash and erythema (Fig. 1B). Day-
time itching was nearly alleviated, but she still woke from
itching during the night. Heavy sweating was also reduced.
The tip and border of her tongue remained red, but the
coating was normal, and her pulse remained slippery. The
patient appeared cheerful and lively, and when responding
to the doctor, was more talkative than during the first visit.
From the symptomatology, although wind-heat was being
effectively dispelled and eliminated, it still lingered.
Therefore, the prescription strategy of dispelling wind and
clearing heat was continued. However, to avoid tolerance
and buildup of herbal ingredients in the body, some of the
herbs were altered to ones with similar functions. Herbs
promoting blood circulation were also added to promote
recovery of the skin and prevent telangiectasia and
pigmentation (Table 1).
At the third visit, the patient’s symptoms were further
improved. The rash was nearly alleviated (Fig. 1C). Daytime
itching was occasional and she woke less frequently at night
from itching. Sweating was significantly reduced. These
improvements in symptoms suggested that pathogenic wind
was mostly dispelled. However, the red tongue tip and
slippery pulse indicated residual pathogenic heat. Thus, the
treating principle of prescription was shifted to clearing
heat and promoting blood circulation to enhance recovery
(Table 1). The dosage of the prescription was reduced to
one dose per day over the next 4 days, and half a dose per
day over the following 10 days.
At the fourth visit, the rash had cleared, but a new rash
had appeared on her right cheek (Fig. 1D). Itching was
infrequent during the day and seldom woke her at night.
Sweating was also relieved. Her tongue was red at the tip,
coating was yellow and greasy, pulse was slippery. Based on
the symptomatology, heat-clearing herbs in quantity and
dosage were used to clear the resurgence in pathogenic
heat (Table 1). The patient was instructed to take one dose
per day over the next week.
At the fifth visit, most of the patient’s symptoms dis-
appeared except a slight rash remained on the right cheek.
The tongue and pulse almost returned to normal. The
prescription strategy of dispelling wind and clearing heat
was maintained and supplemented with spleen-invigorating
382 M. Xiao et al.

Table 1 Summary of herbal prescriptions.

Visit Herbs
1 Baikal skullcap root (Scutellaria baicalensis Georgi) 10 g; Mulberry root bark (Morus alba L.) 10 g; Sophora root (Sophora
flavescens Aiton) 6 g; arnebia. groomwell root (Lithospermum erythrorhizon Siebold & Zucc.) 6 g; Chrysanthemum
flower (Chrysanthemum morifolium Ramat.) 10 g; Dictamnus root bark (Dictamnus albus L. ssp. dasycarpus (Turcz.)
Wint.) 10 g; Kochia fruit (Kochia scoparia (L.) Schrad.) 10 g; Coix seed (Coix lacryma-jobi L.) 30 g; Plantago (Plantago
asiatica L.) 10 g; Saposhnikovia root (Saposhnikovia divaricata (Turcz.) Schischk) 10 g; Schizonepeta stem/bud
(Schizonepeta tenuifolia Briq.) 10 g; Angelica root (Angelica dahurica (Hoffm.) Benth.) 10 g; Bugbane rhizome (Actaea
cimicifuga L.) 10 g; Chuanxiong root (Ligusticum chuanxiong Hort.) 10 g; Bark of silktree Albizia (Albizia julibrissin
Durazz.) 10 g
2 Baikal skullcap root (Scutellaria baicalensis Georgi) 8 g; Mulberry root bark (Morus alba L.) 8 g; Sophora root (Sophora
flavescens Aiton) 8 g; arnebia. groomwell root (Lithospermum erythrorhizon Siebold & Zucc.) 8 g; Wild chrysanthemum
flower (Dendranthema morifolium (Ramat.) Tzvelev) 8 g; Ningpo figwort root (Scrophularia ningpoensis Hemsl.) 8 g;
Dictamnus root bark (Dictamnus albus L. ssp. dasycarpus (Turcz.) Wint.) 10 g; Kochia fruit (Kochia scoparia (L.) Schrad.)
8 g; Cogongrass (Imperata cylindrica (L.) P. Beauv.) 20 g; Tree peony root bark (Paeonia suffruticosa Andr.) 8 g; salvia
root (Salviae miltiorrhizae Bunge) 15 g; Red peony root (Paeonia lactiflora Pall.) 8 g; Paniculate swallowwort root
(Cynanchum paniculatum (Bunge) Kitag. ex H.Hara) 8 g; Chinese clematis root (Clematis chinensis Osbeck) 8 g;
Saposhnikovia root (Saposhnikovia divaricata (Turcz.) Schischk) 8 g; Schizonepeta stem/bud (Schizonepeta tenuifolia
Briq.) 8 g; Bugbane rhizome (Actaea cimicifuga L.) 8 g
3 Baikal skullcap root (Scutellaria baicalensis Georgi) 8 g; Mulberry root bark (Morus alba L.) 8 g; arnebia. groomwell root
(Lithospermum erythrorhizon Siebold & Zucc.) 8 g; Dictamnus root bark (Dictamnus albus L. ssp. dasycarpus (Turcz.)
Wint.) 8 g; Kochia fruit (Kochia scoparia (L.) Schrad.) 8 g; Uncaria vine (Uncaria rhynchophylla (Miq.) Miq.ex Havil.) 8 g;
Cogongrass (Imperata cylindrica (L.) P. Beauv.) 20 g; Tree peony root bark (Paeonia suffruticosa Andr.) 6 g; Salvia root
(Salviae miltiorrhizae Bunge) 20 g; Bark of silktree Albizia (Albizia julibrissin Durazz.) 10 g; Campsis flower (Campsis
grandiflora (Thunb.) K. Schum.) 5 g; False daisy (Eclipta prostrata (L.) L.) 8 g
4 Baikal skullcap root (Scutellaria baicalensis Georgi) 10 g; Mulberry root bark (Morus alba L.) 10 g; Ningpo figwort root
(Scrophularia ningpoensis Hemsl.) 10 g; Sophora root (Sophora flavescens Aiton) 8 g; Honeysuckle flower (Lonicera
japonica Thunb.) 10 g; Forsythia fruit (Forsythia suspensa (Thunb.) Vahl) 10 g; Dictamnus root bark (Dictamnus albus L.
ssp. dasycarpus (Turcz.) Wint.) 10 g; Kochia fruit (Kochia scoparia (L.) Schrad.) 10 g; Cogongrass (Imperata cylindrica
(L.) P. Beauv.) 20 g; Tree peony root bark (Paeonia suffruticosa Andr.) 10 g; Salvia root (Salviae miltiorrhizae Bunge)
10 g; Saposhnikovia root (Saposhnikovia divaricata (Turcz.) Schischk) 10 g
5 Coix seed (Coix lacryma-jobi L.) 15 g; Amomum fruit (Amomum villosum Lour.) 4 g; Round cardamon fruit (Amomum
compactum Sol. ex Maton) 4 g; Figwort root (Scrophularia ningpoensis Hemsl.) 10 g; Great burdock fruit (Arctium lappa
L.) 6 g; Mulberry root bark (Morus alba L.) 4 g; Dictamnus root bark (Dictamnus albus L. ssp. dasycarpus (Turcz.) Wint.)
4 g; Kochia fruit (Kochia scoparia (L.) Schrad.) 6 g; lophatherum stem and leaves (Lophatherum gracile Brongn.) 6 g;
Saposhnikovia root (Saposhnikovia divaricata (Turcz.) Schischk) 6 g; Schizonepeta stem/bud (Schizonepeta tenuifolia
Briq.) 6 g; Bark of silktree Albizia (Albizia julibrissin Durazz.) 6 g
Herbs in each prescription are recorded in both English common name and Latin botanical name.

herbs to prevent injury of the spleen from the wind-heat
clearing herbs (Table 1). The weight and dosage of herbs
were decreased in view of near resolution of the symptoms.
When followed up 3 months and 6 months later, the
patient reported that after she finished the last 7 doses of
herbs prescribed at the fifth visit, her symptoms were
completely gone. Since then she had not experienced
recurrence of seborrheic dermatitis or incidence of any
other skin disorder such as acne or skin sensitivity.
Discussion and conclusion
In this patient, topical corticosteroid and an antifungal
agent were used as first-line medical treatments, but
allergic reaction to the ointment exacerbated the lesion.
Besides, the usage of topical corticosteroids (including mid-
potency and low-potency agents) for SD may be limited by
the side effects with prolonged application and the com-
mon finding of early relapse after their discontinuation.
Other agents such as non-hormonal immunosuppressive
calcineurin inhibitors have a comparable efficacy to topical
corticosteroids with fewer side effects.6 However, calci-
neurin inhibitors may not have been appropriate for our
patient due the U.S. FDA’s Black Box warning7 about long-
term use in the pediatric population, though ongoing
studies have not concluded the warning is warranted.8,9
Therefore, Chinese herbal medicine can be used as a safe
and effective alternative to pharmaceutical drugs for SD. In
Chinese medicine theory, the syndrome pattern of this
patient was wind-heat invading the skin based on the
symptoms and signs. Sweating and pruritus are signs of
exogenous wind invasion. Redness and swelling of the skin,
red tip and sides of the tongue, and slippery pulse point to
external invasion of pathogenic heat. The initial herbal
prescription strategy was therefore aimed at dispelling
wind and clearing heat. When the skin symptoms were
alleviated, promoting blood circulation herbs were used to
achieve a curative effect. Investigations of heat-clearing
herbs have found that they have anti-inflammatory and/
or anti-allergic effect, such as Baikal skullcap root, sophora
root, and arnebia. groomwell root.10 Some herbs have
Chinese herbal medicine for seborrheic dermatitis
antifungal properties, such as dictamnus root bark.10 Blood
circulation promoting herbs, such as salvia root have been
shown to improve microcirculation,10 which in our case
helped promote recovery of the skin. Dosages of herbs may
be increased appropriately for adults.
In conclusion, Chinese herbal medicine can be an
effective alternative option to topical pharmaceuticals for
treating seborrheic dermatitis.
Funding
The authors are grateful for the support of the National
Science Foundation (81403152), Ministry of Education
Research Fund for the Doctoral Program (20130013120001,
20120013130002).
Authors’ contributions
MX drafted and revised the manuscript; BZ treated the
patient and provided case analysis; YW and AN provided
critical analysis in preparing this paper; all the authors
approved the final version.
Conflicts of interest
The authors declare no conflict of interest.
Consent
Written consent was obtained from the patient and her
parents for publication of this case report and accompa-
nying photos.
383
Acknowledgments
We thank Nissi S. Wang, MSc, for developmental editing of
this paper.
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