At the 1st stage of the study, the clinical, laboratory, microbiological, and instrumental data of 4 groups were studied: 1st group - 98 patients with metabolic-associated fatty liver disease and seborrheic dermatitis (MAFLD+SD); 2nd group - 19 patients with non-alcoholic fatty liver disease and diabetes type 2 (NAFLD+DM2), group 3 (SD) - 62 patients with seborrheic dermatitis and metabolic-associated diseases and 18 people with seborrheic dermatitis without comorbidities; group 4 - 28 healthy people.
During the 2nd stage of the study, the following treatment was carried out for patients with MAFLD+SD: UDHC –an 8-week course of ursodeoxycholic acid (UDHC) with a dose of 12-15 mg/kg of body weight per day; UDHC+AAC – UDHC with supplementation of the amino acid complex (AAC) (arginine citrate 1 g, betaine 1 g, L-carnitine 300 mg – 3 times a day). All patients received an individual dose of metformin and followed recommendations for diet and physical activity.
Patients with MAFLD+SD were significantly more likely to suffer from obesity (р≤0.001) and more severe symptoms of seborrheic dermatitis: scaling (р=0.012), erythema (р=<0.001), itching (р=0.042), greasiness (р=0.002) and edema (p=0.035); the exacerbation period lasted longer (p=0.036), the number of exacerbations per year was greater (p=0.024), the quality of life was lower compared to patients from SD group.
No significant difference was found between the results of examinations of lipid and carbohydrate metabolism, biochemical blood tests, as well as the stage of steatosis and fibrosis between MAFLD+SD and NAFLD+DM2 groups. The severity of seborrheic dermatitis was correlated with the increase in Liver Fat Score (p=0.086). A direct correlation between CAP score and FIB-4 (p=0.002), BMI (p=0.002), and SEDASI score (p=0.034) was also found.
The skin of MAFLD+SD patients was significantly more colonized by Staphylococcus epidermidis both in inflamed (p=0.052) and intact areas (p=0.074) and significantly less often colonized by Propionibacterium acnes (p=0.062) compared to the SD group. It was established that the severity of seborrheic dermatitis is positively correlated with the number of colony-forming units (CFU) of Malassezia spp. on the face (p≤0.001) and trunk (p≤0.001) and CFU bacteria: S. epidermidis (0.842 p≤0.001), S. aureus (0.452 p=0.023), P. acnes (0.454 p=0.016), P. acnes + HA (0.364 p=0.044) and S. epidermidis + HA (0.323 p=0.041).
The level of beta-endorphin (BE) was correlated with the severity of seborrheic dermatitis: mild form (BE 26.0±6.13 pg/mL, SEDASI 11±2.0); moderate form (BE 35.0±3.97 pg/mL, SEDASI 20±3.5 p=0.024), severe form (BE 43.0±5.24 pg/mL, SEDASI 36±3.1, p= 0.006) and the intensity of itching (р=0.009). Malassezia spp. MAFLD+SD patients, after exposure to BE, showed a significant increase in the intensity of lipolysis both in non-inflamed 0.06 p≤0.031 and in inflamed areas 0.22 p≤0.001. A correlation was found between the intensity of Malassezia spp. lipolysis with the level of BE (р=0.023).
After the course of treatment, the average weight (p=0.215, p=0.186), body mass index (p=0.285, p=0.221) and waist circumference (p=0.109, p=0.097) decreased in both examined groups. Significantly decreased the level of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma glutamine transferase, and glycosylated hemoglobin. There was a trend toward a decrease in the NAFLD-LFS index (p=0.09) and a significant decrease in HSI (p=0.024) in patients receiving UDCA and a significant decrease of steatosis stage in patients receiving UDCA+AAC (NAFLD-LFS p= 0.001; HSI p=0.007). A significant decrease in CAP score, dC/m was found in both groups (р=0.041).
Such changes had a positive effect on the intensity of skin inflammation. In the UDHC group: 22% of patients achieved remission, 63% had a mild form (p=0.046; reduced mean SEDASI p=0.034), and 15% had seborrheic dermatitis of moderate severity (SEDASI p=0.035). In the UDHC+AAC group: 35% achieved remission, 40% had a mild form (SEDASI p=0.001), and 25% had seborrheic dermatitis of moderate severity (p=0.043). The intensity of erythema, scaling, itching, and swelling of the skin decreased significantly (p=0.001; p=0.009) and the quality of life increased (p=0.001).
The skin of UDHC (p=0.0751) and UDHC+AAC (p=0.0799) groups had more S. epidermidis and less S. epidermidis + HA (p=0.054; p=0.042). The P. acne to S. epidermidis ratio on inflamed areas significantly increased (1.53±0.16) in the UDCA group (1.81±0.25 p=0.051) and UDCA+AAC (1.82±0.26 p=0.043 ).
Thus, reducing the intensity of liver inflammation, stage of steatosis and weight loss leads to the improvement of skin symptoms, microbiome recovery, and better life quality in patients with seborrheic dermatitis and comorbid metabolic-associated fatty liver disease.
