Patient Presentation
A 4-month-old male came to clinic for his health supervision visit. His mother was concerned about his continued seborrhea. She had tried corn oil and olive oil without improvement and sometimes noted that it actually got worse. “Do you think we need to see dermatology?” she asked. The past medical history was negative. The pertinent physical exam showed a healthy smiling infant with normal growth parameters. His skin examination showed mild waxy-yellow thick scale in two areas of the scalp. There was no redness or excoriations. There was no extension to the ears, face or eyebrows. The rest of his examination was negative.

The diagnosis of a healthy male with very mild seborrheic dermatitis was made. The resident discussed that this was quite mild and that dermatological consultation was not warranted at this time. He told the mother that she had several options including doing nothing as it did not appear to be bothering the infant, she could use a small amount of a steroid cream on the affected areas or could use a petroleum-based oil such as mineral oil to soften and loosen the scale. “I had this problem with my son and found out that there is a yeast on the skin that can eat the olive oil or other plant-based oils. That makes the yeast grow and the seborrhea got worse. We switched to mineral oil and it was better. I usually forgot to use the oil though,” he said laughing.

Discussion
During growth, plants first store their energy as carbohydrates but during ripening switch over to carbon-rich triglycerides. Triglycerides also occur in yeasts, molds and animal fats.

A few higher plants store lipids in other forms. One example is the Jojoba which stores its oil as a lipid wax. Simmondsia chinensis (Jojoba) is a specialty-cultivated plant found mainly in the American Southwest and Mexican Northwest. Jojoba seed oil has > 50% of its weight as liquid wax esters that are used in personal care products and lubricants. Jojoba oil is naturally extracted from the seed or synthetically produced. Natural Jojoba oil is known to contain a very small amount of triglyceride, only 0.4% by weight.

Malassezia sp. are lipid-dependent yeasts that are usually commensal organisms inhabiting the skin and mucous membranes of mammalian organisms including humans. Malassezia are major components of the mycobiome of the skin (50-80%). They can cause pathology including blood stream infections (especially preterm infants or immunocompromised patients), but are more commonly associated with dermatologic disorders including seborrheic dermatitis/dandruff, pityriasis versicolor, atopic dermatitis, psoriasis, and Malassezia folliculitis. Species predominance depends on the skin location but most common species are M. globosa, M. restricta and M. sympodialis. Treatment with topical antifungals with or without corticosteroids is the recommended treatment for Malassezia species and seborrheic dermatitis that is problematic.

Learning Point
“Malassezia digests sebum into saturated and unsaturated fatty acids. Only the saturated molecules are essential while the unsaturated fatty acids are a byproduct. Organic oils (such as olive oil) contain both saturated and unsaturated lipids and may be counter productive to treat a condition whose etiology is linked to Malassezia. In fact, olive oil is a standard in vitro culture media for Malassezia. Saturated fatty acids likely encourage Malassezia overgrowth and excess unsaturated fatty acids may induce inflammation and scaling. As non-digestible oil, mineral oil may provide a triglyceride-free alternative to organic oils.” [Bolding per the author.]

Some families do not wish to use an animal-based or petroleum-based product. An alternative plant product could be recommended that contains a low amount of triglyceride such as Jojoba oil.

Questions for Further Discussion
1. What treatment do you recommend for seborrheic dermatitis?
2. What are indications for dermatology consultation for seborrheic dermatitis?

Related Cases

Disease: Seborrheic Dermatitis | Dermatitis | Fungal Infections

Symptom/Presentation: Rash

Specialty: Dermatology | General Pediatrics

Age: Infant

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for these topics: Dandruff, Cradle Cap and Other Scalp Conditions and Fungal Infections.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

Van Boven, M., Holser, R.A., Cokelaere, M. et al. J Amer Oil Chem Soc (2000) 77: 1325.

Siegfried E, Glenn E. Use of olive oil for the treatment of seborrheic dermatitis in children. Arch Pediatr Adolesc Med. 2012 Oct;166(10):967.

Dawson TL Jr. Malassezia ecology, pathophysiology, and treatment.
Theelen B, Cafarchia C, Gaitanis G, Bassukas ID, Boekhout T,
Med Mycol. 2018 Apr 1;56(suppl_1):10-25.

Cyberlipid.org. Plant Oils and Fats. Cyberlipid.org. Available from the Internet at: http://www.cyberlipid.org/glycer/glyc0005.htm (cited 5/14/18).

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa