KJA

Case Report
pISSN 2005-6419 • eISSN 2005-7563

Seborrheic dermatitis treatment
Korean Journal of Anesthesiology with stellate ganglion block
-a case report-
Gun Woo Kim, Ki Ho Mun, Jeong Yun Song, Byung Gun Kim,
Jong Kwon Jung, Choon Soo Lee, Young Deog Cha, and Jang Ho Song
Department of Anesthesiology and Pain Medicine, Inha University College of Medicine, Incheon, Korea

Seborrheic dermatitis is a chronic recurrent inflammatory disorder presumed to be caused by increased sebaceous gland
secretion, metabolic changes in the cutaneous microflora, and changes in the host immune function. Stellate ganglion
block (SGB) is known to increase the blood flow rate without altering the blood pressure, heart rate, or cardiac output, to
stabilize hypertonic conditions of the sympathetic nerves, and to affect the endocrine and immune systems. It is used in
the differential diagnosis and treatment of autonomic nervous system disorders of the head, neck, and upper limbs. The
authors report the first case of successful treatment of a patient with seborrheic dermatitis through repeated SGB trials.

Key Words: Nerve block, Seborrheic dermatitis, Stellate ganglion.

Seborrheic dermatitis is a chronic recurrent inflammatory major causes [1]. According to Uchida et al. [2], stellate ganglion
disorder characterized by hyperkeratosis, acanthosis, accentu- block (SGB) is effective in the treatment of skin disorders of the
ated rete ridges, focal spongiosis, and parakeratosis. It is usually head and neck. According to the authors, this treatment mecha-
caused by increased sebaceous gland activity, and manifests nism maintains the homeostasis of hormones by improving the
itself through the apparition of ill-defined eryhematous patches blood flow in the brain. There has been a report of successful
accompanied by fine scaling in areas of high sebum secretion, treatment of acne vulgaris — which has a similar etiology to
including the scalp, face, eyebrows, nasal alar creases, melola- seborrheic dermatitis — with SGB [3]. Therefore, we predicted
bial folds, ears, central chest, and genital region. Although the that SGB would also be effective in the treatment of seborrheic
fundamental cause of seborrheic dermatitis has not yet been es- dermatitis. Indeed, repeated SGB trials on a patient who had
tablished, many etiologic factors are believed to play a role in the previously undergone unsuccessful dermatologic treatments
development of the disorder. In particular, increased sebaceous were effective. This was the first case of seborrheic dermatitis
gland secretions, metabolic changes in the cutaneous microflora, treatment with SGB.
and host immune function changes are considered some of the
Case Report
Corresponding author: Jang Ho Song, M.D., Ph.D.
A 31-year-old male patient (height 173 cm, weight 70 kg)
Department of Anesthesiology and Pain Medicine, Inha University
College of Medicine, 27, Inhang-ro, Jung-gu, Incheon 22332, Korea
with no medical history of particular significance had been
Tel: 82-32-890-3968, Fax: 82-32-881-2476 receiving treatment at a dermatology clinic for ten years for
E-mail: jhs@inha.ac.kr erythematous patches accompanied by non-painful itching in
Received: July 1, 2015.
both nasal alar creases, both perioral areas, and both posterior
Revised: August 24, 2015. auricular folds (Fig. 1). A topical steroid treatment was chosen,
Accepted: September 3, 2015. as he had tested negative on the KOH test. The steroid treat-
Korean J Anesthesiol 2016 April 69(2): 171-174
ment alleviated the symptoms but could not eliminate them
http://dx.doi.org/10.4097/kjae.2016.69.2.171 completely. It was notable that even on the steroid treatment,

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licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright ⓒ the Korean Society of Anesthesiologists, 2016 Online access in http://ekja.org

The patient was on the topical steroid treatment when tion occurred but faded about two hours later. Patient’s skin lesions disappeared. We initiated the same patient. The patient treatment procedure and the patient’s skin lesions disappeared was positioned with the anterior spine extended. Fig. April 2016 Fig. the patient had reported a case of acne vulgaris treatment with SGB [3]. Fifty more trials were performed. increased sebaceous gland secretions.Seborrheic dermatitis treatment with SGB VOL. During and the mechanisms of acne vulgaris and seborrheic dermatitis the follow-up. After administration not yet been identified. skin lesions appeared when he consumed alcohol or was dehy. The same procedure Although the fundamental cause of seborrheic dermatitis has was performed daily. A needle was vertically inserted at the since. 1. The skin lesions he visited our hospital. and erythematous patches were visible disappeared within three days. An anterior blind approach was selected. As a previous study to stop the treatment for personal reasons. 69. Photo of patient after treatment. 2. Photo of patient before treatment. 2. Erythematous patches were visible in the perioral areas and posterior auricular folds. we determined to use SGBs on this toms up to one week before the revisit. anterior tubercle and was placed on the transverse process. of the injection on one side. revisited the hospital two months later due to a relapse. the patient noted that there had been no symp- are presumed to be similar. so that the after five trials (Fig. However. and transverse process of the C6 vertebra (Chassaignac’s tubercle) the patient has not seen a relapse of the symptoms or side effects could be easily detected. 172 Online access in http://ekja. 2). on one side each day.org . after which the patient wished in the nasal alar creases and perioral areas. NO. ipsilateral ptosis and nasal obstruc- drated. Five ml of 1% mepivacaine were injected after fixing the needle in Discussion position and confirming that there were no abnormal sensations in the upper limb or blood aspiration [4].

causes. and M. SGBs the lower face. and upper limbs cross the stellate gan. sebum to form free fatty acids and triglycerides. the proliferation of Malassezia spp. IL-10. seborrheic dermatitis patients are treated with conducted a study on severe trauma patients and reported that antifungals and steroids. Gupta MM. Tateda T. SGB affects the neural and immune systems. Park et al. multiple topical therapies (antifungal trations of brain norepinephrine and serum cortisol are propor- shampoo. ultimately helping patients reactions. regulate the neuroendocrine-immune network and restore ho- glion. In cases in which the patients are unre- the concentrations of IL-b. and adrenergic receptors are expressed ganglion. 3: 294-304. gamma interferon. globose. Online access in http://ekja. restricta break down the lipids in the hence. such as seborrheic dermatitis. Subsequently. Liu et al. IL-6. are presumed to be some of the major improving the symptoms of diseases responsive to steroids. SGB can also be applied to seborrheic dermatitis. the immune organs are innervated by Stellate ganglion is also called cervicothoracic sympathetic the sympathetic nerves. increase in sympathetic tone undermines the pinealocyte func- pertonic conditions of the sympathetic nerves. Novel mechanism of action hypothesized for stellate ganglion block related to melatonin. in sympathetic tone. Hino H. neuroendocrine-immune network. TNF-a)[9]. of unbalanced statuses. [3] successfully treated an acne useful.6]. The sympathetic fibers of nerve activities strongly affect the immune functions [13]. 4. 41: 500-2.KOREAN J ANESTHESIOL Kim et al. Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography. therefore. which stems from the nucleus flammation. and thus in mitigating the related symptoms. Acknowledgments tive in reducing hyper inflammations caused by seborrheic der- matitis. [IL-1]. [11] ous disorders with similar mechanisms. The sympathetic nervous system. neck. It is also known resulting in sleep deprivation. Del Rosso JQ. the proliferation of complements — which come as a result of which travel along the paravertebral ganglia and prevertebral changes in the host immune function — are clearly visible in the ganglia. SGB improves the blood and subsequent inflammation increase. the pain associated with visceral afferents [7. plays an important role in the neural (NK1+). 5. as well as changes in the flow in the brain and influences hormone secretions. globosa and M. References 1. These results indicate that SGB is effec. 2. on the surface of most granulocytes. J Clin Aesthet Dermatol 2011. SGBs can also be useful in the treatment of other cutane- vulgaris patient with over 50 trials of SGB. unsaturated fatty acids can penetrate the skin and induce in. Mahajan RP. and inflammatory interleukins. SGB is meostasis within the body by blocking the sympathetic nervous used in the differential diagnosis and treatment of autonomous system. The resulting Furthermore. The concen- skin lesions. a skin biopsy performed on a seb. M. corticosteroid cream. IL-4. From a SGB increases the blood flow rate without altering the blood different perspective. IL-2. Elias M. these fibers can be blocked with SGB. 95: 669-73. Med Hypotheses 2002. Br J Anaesth 2005. In the same study. IL-12. Lee SK. Bithal PK. cervical. In general. thereby blocking tions. Cervical sympathetic and stellate ganglion blocks. and TNF-a decreased 24 to 72 sponsive to these traditional treatment modalities. IL. 4: 32-8. According This work was supported by Inha University. and upper limbs. the plasma melatonin level is reduced. SGBs block this sympathetic cycle and A previous study reported that SGBs reduce inflammatory restore a normal melatonin rhythm. Effect of a stellate ganglion block on acne vulgaris: a case report. Pain Physician 2000. Park JG. 6. 3. to maintain a normal sympathetic tone. Cha YD. it is located on the first anterior rib or the anterior tu. increased amounts of natural killer cells ceruleus of the brainstem. Uchida et al.8]. Uchida K. This in turn is presumed to contribute to the restoration nervous system disorders of the head. Therefore. [2] suggested that a chronic pressure. 59: 446-9. and Wajima et al. This restoration of a orrheic dermatitis patient’s lesion revealed increased counts of normal rhythm also contributes to the effective regulation of the inflammatory mediators (interleukin-1. reported that SGB decreases the levels of serum IgE and eosino- phil in atopic dermatitis. restricta to a previous study by Wakusugi [12]. and cardiac output [5. antifungal cream) are used as a tionately raised to maintain the reflex circuit of the hypothala- treatment to eliminate the cause and to improve the symptoms mus-pituitary-adrenal and sympathetic nerve systems. Moreover. effectively host immune function. which in turn causes an increase to affect the endocrine and immune systems [2]. [10] In conclusion. Cha DC. and stabilizes hy. Chaturvedi A. release norepinephrine into various tissues. Korean J Anesthesiol 2001. sympathetic bercle of the C7 transverse process [4]. Under [1]. M. Dash HH. CD16+ cells.org 173 . The post-ganglionic sympathetic nerves. as well as and immune systems. SGBs can be hours after a SGB. heart rate. Adult seborrheic dermatitis: a status report on practical topical management. physiological conditions.

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