In vitro anti-Malassezia activity and potential use in anti-dandruff formulation of Asparagus racemosus.
Onlom C,Khanthawong S,Waranuch N,Ingkaninan K
International journal of cosmetic science
OBJECTIVE:Malassezia species are frequently associated with dandruff and seborrhoeic dermatitis. The study was conducted to evaluate anti-fungal activities of the extracts obtained from the roots of Asparagus racemosus Willd against Malassezia furfur and M. globosa. METHODS:Asparagus racemosus roots were successively extracted with the series of solvents, that is, hexane, ethanol and water, and also a saponin-enriched fraction was prepared. The amounts of saponin (equivalent to shatavarin IV) in the extracts were determined using ELISA. The extracts were tested for anti-fungal activity by disc diffusion and broth microdilution methods. RESULTS:By disc diffusion, only the ethanolic and saponin-enriched extracts demonstrated anti-fungal activity against M. furfur and M. globosa at the concentration of 1 mg per disc whereas the extracts with other solvents were ineffective. Multiple concentrations using the broth microdilution method against M. furfur and M. globosa yielded minimum inhibitory concentrations (MICs) of 25 mg mL(-1) for the ethanolic extract but much higher potency for the saponin-enriched extract: MICs to 0.20 and 0.40 mg mL(-1) for M. furfur and M. globosa, respectively. These extracts showed no antagonist effect with the anti-fungal agents, ketoconazole and zinc pyrithione. CONCLUSION:These studies revealed the antifungal activity of A. racemosus roots extracts. Because A. racemosus is also anti-inflammatory agent, it has the potential use as an active ingredient in an anti-dandruff formulation.
Malassezia yeasts activate the NLRP3 inflammasome in antigen-presenting cells via Syk-kinase signalling.
Kistowska Magdalena,Fenini Gabriele,Jankovic Dragana,Feldmeyer Laurence,Kerl Katrin,Bosshard Philipp,Contassot Emmanuel,French Lars E
Although being a normal part of the skin flora, yeasts of the genus Malassezia are associated with several common dermatologic conditions including pityriasis versicolour, seborrhoeic dermatitis (SD), folliculitis, atopic eczema/dermatitis (AE/AD) and dandruff. While Malassezia spp. are aetiological agents of pityriasis versicolour, a causal role of Malassezia spp. in AE/AD and SD remains to be established. Previous reports have shown that fungi such as Candida albicans and Aspergillus fumigatus are able to efficiently activate the NLRP3 inflammasome leading to robust secretion of the pro-inflammatory cytokine IL-1β. To date, innate immune responses to Malassezia spp. are not well characterized. Here, we show that different Malassezia species could induce NLRP3 inflammasome activation and subsequent IL-1β secretion in human antigen-presenting cells. In contrast, keratinocytes were not able to secrete IL-1β when exposed to Malassezia spp. Moreover, we demonstrate that IL-1β secretion in antigen-presenting cells was dependent on Syk-kinase signalling. Our results identify Malassezia spp. as potential strong inducers of pro-inflammatory responses when taken up by antigen-presenting cells and identify C-type lectin receptors and the NLRP3 inflammasome as crucial actors in this process.
Secreted lipases from Malassezia globosa: recombinant expression and determination of their substrate specificities.
Sommer Bettina,Overy David P,Haltli Bradley,Kerr Russell G
Microbiology (Reading, England)
Malassezia globosa, which is associated with skin conditions such as dandruff and seborrhoeic dermatitis, possesses 13 secreted lipases, but only MgLip1, MgMDL2 and MgLip2 have been characterized. To understand the substrate preferences of these lipases and by extension their potential role in colonizing human skin, we expressed all 13 predicted secreted lipases in Pichia pastoris and evaluated their ability to utilize mono-, di- and triolein substrates. The M. globosa family class 3 lipases were shown to be specific for mono- and diacylglycerols, but exhibited no regio-selective production of diacylglycerols, which are of special interest for industrial applications. Lipases belonging to the Lip family utilized all substrates. In a further step, five lipases previously demonstrated to be expressed on human skin were tested against the eight most common di- and triacylglycerols in human sebum. All lipases liberated free fatty acids from three to eight of these substrates, proving their ability to hydrolyse key components of human sebum. Again, only Lip family lipases showed activity on triacylglycerides. Based on the demonstrated activity and expression levels of MgLip2 in M. globosa, the Lip lipase family appears to have the highest impact for the pathogenicity of M. globosa.
β-Endorphin enhances the phospholipase activity of the dandruff causing fungi Malassezia globosa and Malassezia restricta.
Honnavar Prasanna,Chakrabarti Arunaloke,Prasad Ghandam S,Singh Pankaj,Dogra Sunil,Rudramurthy Shivaprakash M
β-Endorphin is known to stimulate phospholipase production by Malassezia pachydermatis during canine dermatoses. The role of β-endorphin in Malassezia infection in humans is not well studied. The present study compares the influence of β-endorphin on Malassezia globosa and Malassezia restricta isolated from patients with seborrhoeic dermatitis/dandruff (SD/D) and healthy controls. Malassezia isolates (five each of the two species from patients and healthy controls) were grown on modified Dixon's agar with or without 100 nmol/L β-endorphin. Phospholipase activity was quantified based on its ability to hydrolyze L-α-phosphatidylcholine dimyristoyl (phospholipid substrate). Free fatty acid was measured by a colorimetry method. In isolates from patients, the phospholipase activity significantly increased after exposure to β-endorphin (M. globosa, P = .04; M. restricta, P = .001), which did not occur in isolates from healthy controls. Moreover, after β-endorphin exposure the patient isolates had significantly higher (P = .0004) phospholipase activity compared to the healthy control isolates. The results suggest that isolates of M. globosa and M. restricta from patients may differ from those of healthy humans.
Genotype analyses of human commensal scalp fungi, Malassezia globosa, and Malassezia restricta on the scalps of patients with dandruff and healthy subjects.
Hiruma Midori,Cho Otomi,Hiruma Masataro,Kurakado Sanae,Sugita Takashi,Ikeda Shigaku
Dandruff and seborrheic dermatitis are common afflictions of the human scalp caused by commensal scalp fungi belonging to the genus Malassezia. Malassezia globosa and Malassezia restricta are the predominant species found on the scalp. The intergenic spacer regions of these species' rRNA genes contain short sequence repeats (SSR): (GT)n and (CT)n in M. globosa and (CT)n and (AT)n in M. restricta. In the present study, we compared the genotypes (SSR) of M. globosa and M. restricta colonizing the scalps of patients with dandruff and healthy individuals. For M. globosa, the genotype (GT)10:(CT)8 (40.3 %, 25/62) was predominant followed by (GT)9:(CT)8 (14.5 %, 9/62) and (GT)11:(CT)8 (14.5 %, 9/62) in patients with dandruff, whereas the genotypes in healthy subjects were diverse. For M. restricta, the genotype (CT)6:(AT)6 (59.7 %, 37/62) was predominant followed by (CT)6:(AT)8 (24.2 %, 15/62) in patients with dandruff, while four genotypes, (CT)6:(AT)6 (10.5 %, 6/57), (CT)6:(AT)7 (22.8 %, 13/57), (CT)6:(AT)8 (17.5 %, 10/57), and (CT)6:(AT)10 (21.1 %, 12/57), accounted for 71.9 % of all combinations in healthy subjects. The results of this study suggest that the M. globosa genotype (GT)10:(CT)8 and the M. restricta genotype (CT)6:(AT)6 may be involved in the development of dandruff.
Etiology and treatment of dandruff according to Persian medicine.
Zareian Mohammad Ali,Yargholi Alireza,Khalilzadeh Somayyeh,Shirbeigi Laila
Scalp dandruff is one of the most common complaints of patients visiting dermatologic clinics. It has significant influence on the self-confidence and social image of the individuals it affects. The current study aimed to analyze this problem from the viewpoint of Persian medicine. This paper is a literature review in which the text of selected books on Persian medicine is investigated using content analysis based on the theoretical sampling method. The studied keywords in the Persian medicine books included Hozaz, Ebrieh, and Ghooba. Relevant points were extracted from the text of papers selected from PubMed, Scopus, and SID and analyzed further. Persian medicine considers the incidence of scalp dandruff to be an output of the interaction between internal and external factors and concentrates more on disorder in the process of waste removal through the skin and its role in the development of scaling diseases. In order to dandruff treatment, Persian medicine sages considered nutrition, personal hygiene, status of the digestive system, and the health status of other organs in addition to topical treatment. Clinical examination of Persian medicine hypotheses, especially how the quality of skin secretions affects the development of scaly skin, can improve the treatment of scalp dandruff and other scaling skin diseases.
Treatment of Seborrhoeic Dermatitis in Asia: A Consensus Guide.
Cheong Wai Kwong,Yeung Chi Keung,Torsekar Raghunandan Govind,Suh Dae Hun,Ungpakorn Rataporn,Widaty Sandra,Azizan Noor Zalmy,Gabriel Maria Teresita,Tran Hau Khang,Chong Wei Sheng,Shih I-Hsin,Dall'Oglio Federica,Micali Giuseppe
Skin appendage disorders
Seborrhoeic dermatitis (SD) is common in Asia. Its prevalence is estimated to be 1-5% in adults. However, larger population-based studies into the epidemiology of SD in Asia are lacking, and the aetiology of SD may differ widely from Western countries and in different parts of Asia. In addition, clinically significant differences between Asian and Caucasian skin have been reported. There is a need to define standardized clinical diagnostic criteria and/or a grading system to help determine appropriate treatments for SD within Asia. With this in mind, experts from India, South Korea, Taiwan, Malaysia, Vietnam, Singapore, Thailand, the Philippines, Indonesia, and Italy convened to define the landscape of SD in Asia at a meeting held in Singapore. The consensus group developed a comprehensive algorithm to aid clinicians to recommend appropriate treatment of SD in both adults and children. In most cases, satisfactory therapeutic results can be accomplished with topical antifungal agents or topical corticosteroids. Non-steroidal anti-inflammatory agents with antifungal properties have been shown to be a viable option for both acute and maintenance therapy.
Characteristics of subjective recognition and computer-aided image analysis of facial erythematous skin diseases: a cornerstone of automated diagnosis.
Choi J W,Kim B R,Lee H S,Youn S W
The British journal of dermatology
BACKGROUND:Rosacea and seborrhoeic dermatitis are common diseases that cause facial erythema. They have common features and are frequently misdiagnosed. OBJECTIVES:To extract characteristic features of erythrotelangiectatic rosacea (ETR), papulopustular rosacea (PPR) and seborrhoeic dermatitis (SEB) through computer-aided image analysis (CAIA) and compare them with subjectively recognized features and to use these findings to construct a decision tree for differential diagnosis. METHODS:Thirty-four clinical photos of patients with facial erythema were assessed: 12 patients were classified as showing ETR, 12 as PPR and 10 as SEB. Five dermatologists blinded to the original diagnosis gave their impressions of each photo. The mean, SD and T-zone to U-zone (T/U) ratios of the erythema parameter a* (a* of the L*a*b* colour space) were calculated for each photo using CAIA. These CAIA parameters were compared between impression groups. The most closely related CAIA parameter for each disease was established using the receiver-operating characteristic curve analysis. A decision tree which predicts the diagnosis from given CAIA parameters was constructed. RESULTS:All the photos classified as PPR generated impressions of PPR. However, approximately 30% of the photos classified as ETR generated impressions of SEB and vice versa. PPR was characterized by a large SD of erythema of the cheek, ETR was characterized by a large mean erythema of the U-zone, and SEB was characterized by a large T/U ratio of mean erythema. Fifteen additional photos were examined: the decision tree predicted the original diagnosis for 14, but incorrectly predicted one case of ETR as SEB. CONCLUSIONS:The CAIA result of facial erythema is well correlated with the actual clinical diagnosis. The accuracy of differential diagnosis using a decision tree with CAIA parameters is as good as that of global examination impressions of dermatologists.
Using Neural Networks for Diagnosing in Dermatology.
Bobrova Margarita,Taranik Maksim,Kopanitsa Georgy
Studies in health technology and informatics
The paper deals with neural networks for decision support in diagnosing in dermatology. There were several iterations during development. We classified six diseases using ANN: (1) Psoriasis, (2) Seborrheic dermatitis, (3) Lichen planus, (4) Pityriasis rosea, (5) Cronic dermatitis, (6) Pityriasis rubra pilaris. At first, we used all 35 attributes to conclude skin disease diagnosis with the accuracy of 96.9%. Then, we reduced the set of analyzed attributes by Pearson correlation approach to eight attributes and increased the accuracy to 98.64%. Data collection time was reduced. Thereby, the speed of the diagnosing process was increased and, as a result, it was possible to form a treatment plan more effectively. The tools used for neural network development were the Python language, Keras library and PyCharm platform.
Whole genome sequencing analysis of the cutaneous pathogenic yeast Malassezia restricta and identification of the major lipase expressed on the scalp of patients with dandruff.
Park Minji,Cho Yong-Joon,Lee Yang Won,Jung Won Hee
Malassezia species are opportunistic pathogenic fungi that are frequently associated with seborrhoeic dermatitis, including dandruff. Most Malassezia species are lipid dependent, a property that is compensated by breaking down host sebum into fatty acids by lipases. In this study, we aimed to sequence and analyse the whole genome of Malassezia restricta KCTC 27527, a clinical isolate from a Korean patient with severe dandruff, to search for lipase orthologues and identify the lipase that is the most frequently expressed on the scalp of patients with dandruff. The genome of M. restricta KCTC 27527 was sequenced using the Illumina MiSeq and PacBio platforms. Lipase orthologues were identified by comparison with known lipase genes in the genomes of Malassezia globosa and Malassezia sympodialis. The expression of the identified lipase genes was directly evaluated in swab samples from the scalps of 56 patients with dandruff. We found that, among the identified lipase-encoding genes, the gene encoding lipase homolog MRES_03670, named LIP5 in this study, was the most frequently expressed lipase in the swab samples. Our study provides an overview of the genome of a clinical isolate of M. restricta and fundamental information for elucidating the role of lipases during fungus-host interaction.
Novel inhibitor against Malassezia globosa LIP1 (SMG1), a potential anti-dandruff target.
Guo Shaohua,Huang Wenkang,Zhang Jian,Wang Yonghua
Bioorganic & medicinal chemistry letters
Compelling evidence have demonstrated the role of lipase activity in the pathogenicity of Malassezia globosa toward dandruff and seborrheic dermatitis (D/SD). As a representative secreted lipase from M. globosa CBS 7966, Malassezia globosa LIP1 (SMG1) is considered a potential anti-dandruff target. In this study, homology modeling, docking-based virtual screening and in vitro lipase-based assay were integrated to identify the first hit compound against SMG1, with an IC50 of 20 μM against synthetic lipase substrate, and of 0.19 μM when using natural lipase substrate. Evaluation of similar compounds, along with docking, offered information on the binding patterns of the hit compound. This work is expected to serve as a starting point for the rational design of more potent inhibitors against SMG1.
Malassezia species and their associated skin diseases.
Harada Kazutoshi,Saito Mami,Sugita Takashi,Tsuboi Ryoji
The Journal of dermatology
Malassezia spp. are lipophilic fungi that occur on all skin surfaces of humans and animals as commensal and pathogenic organisms. In the 2000s, several new species were added to the Malassezia genus by Japanese researchers. The genus Malassezia now includes 14 species of basidiomycetous yeast. Culture-independent molecular analysis clearly demonstrated that the DNA of Malassezia spp. was predominantly detected in core body and arm sites, suggesting that they are the dominant fungal flora of the human body. Malassezia spp. have been implicated in skin diseases including pityriasis versicolor (PV), Malassezia folliculitis (MF), seborrheic dermatitis (SD) and atopic dermatitis (AD). While Malassezia spp. are directly responsible for the infectious diseases, PV and MF, they act as an exacerbating factor in AD and SD. The fatty acids generated by Malassezia lipase can induce inflammation of the skin, resulting in development of SD. Patch and serum immunoglobulin E tests revealed that AD patients were hypersensitive to Malassezia. However, these findings only partially elucidated the mechanism by which Malassezia spp. induce inflammation in the skin; understanding of the pathogenetic role of Malassezia spp. in SD or AD remains incomplete. In this article, the latest findings of Malassezia research are reviewed with special attention to skin diseases.
[Diseases affecting the scalp].
Casopis lekaru ceskych
The skin of the scalp differs from the skin on the other areas of the body because of a higher density of hair follicles and higher sebum production. These, together with the presence of hair, provide a suitable environment for superficial infections, infestations and inflammatory diseases. The good condition of the scalp has a significant impact on the patient's mental well-being and social interaction. The visibility of this part of the skin and the presence of hair itself restrict the range of possible therapeutic agents that can be used due to the complicated application and poor cosmetic outcome. That is the reason why different galenic forms are usually chosen for the scalp compared to the other sites of the skin. The article provides an overview of the most common scalp disorders, the diagnostic approach and recommendations for the treatment.
Quality of life assessment of patients with scalp dermatitis using the Italian version of the Scalpdex.
Sampogna Francesca,Linder Dennis,Piaserico Stefano,Altomare Gianfranco,Bortune Marco,Calzavara-Pinton Piergiacomo,Vedove Camilla Dalle,Girolomoni Giampiero,Peserico Andrea,Sala Raffaella,Abeni Damiano
The aim of this study was to assess quality of life in patients with scalp dermatitis using the Italian version of the Scalpdex, and to validate the instrument in Italian. The survey was conducted in outpatients with psoriasis, seborrhoeic dermatitis, alopecia, or follicular lichen. Data were completed on 194 patients, 78% of whom had psoriasis. Scalpdex scores were always higher in women than in men, and in younger people compared to elderly people. The most frequent items were: being ashamed, embarrassed, bleeding scalp, feeling self-conscious, bothered that the condition is incurable, having the choice of colour of clothes affected, having a negative effect on daily life. The Italian Scalpdex showed good internal consistency, test-retest reliability, convergent validity, and responsiveness. In conclusion, the Italian version of the Scalpdex is a useful instrument to measure quality of life in patients with a scalp condition.
Role of sebaceous glands in inflammatory dermatoses.
Shi Vivian Y,Leo Michael,Hassoun Lauren,Chahal Dev S,Maibach Howard I,Sivamani Raja K
Journal of the American Academy of Dermatology
Skin is an important interface between the host and its environment. Inflammatory dermatoses often have disrupted skin barrier function, rendering patients more susceptible to allergenic triggers leading to an exaggerated immune response. The skin surface lipid film, an important component of the skin barrier, comprises a mixture of keratinocyte and sebaceous gland-derived lipids. Recent evidence demonstrated that defective keratinocyte lipid synthesis predisposes for the development of atopic dermatitis. However, the important role of sebaceous gland-derived lipids in skin inflammatory diseases may be underrecognized. This overview focuses on the importance of the contribution of sebaceous glands to barrier function. Sebaceous gland alteration may play a role in the pathogenesis of common skin diseases including acne vulgaris, atopic dermatitis, psoriasis, rosacea, and seborrheic dermatitis.
A new therapeutic option for facial seborrhoeic dermatitis: indole-3-acetic acid photodynamic therapy.
Kwon S H,Jeong M Y,Park K C,Youn S W,Huh C H,Na J I
Journal of the European Academy of Dermatology and Venereology : JEADV
BACKGROUND:Indole-3-acetic acid (IAA) is a newly introduced photosensitizer of photodynamic therapy (PDT) for acne, presenting sebum-reducing, anti-inflammatory and antimicrobial activity. OBJECTIVE:This study was designed to evaluate the efficacy and safety of IAA-PDT in the treatment of facial seborrhoeic dermatitis. METHOD:In this prospective, single-blinded, 6-week trial, 23 patients with facial seborrhoeic dermatitis were treated with IAA-PDT with green light (520 nm) three times with 1-week intervals. Patients were evaluated at baseline, week 1, 2, 3 and week 6 (3 weeks after last treatment). Efficacy was determined by Seborrhoeic dermatitis Area and Severity Index (SASI), patient's assessment of the symptoms (4-point scale of itchiness, burning, erythema, scale and tightness), sebum secretion rate (measured with Sebumeter(®)), Erythema Index (EI, measured with Mexameter(®)) and physician's photographic assessment. Safety was evaluated by questionnaire at each visit. RESULT:For the 22 subjects completing the trial, SASI and total symptom significantly improved at week 2, which lasted until week 6. Sebum excretion was significantly reduced at week 2 and stayed reduced until week 6. EI presented continuous reduction throughout the study. Photographic assessment showed significant improvement at each visit. The procedure was painless, and no adverse event was observed during and after the treatment. CONCLUSION:IAA-PDT is a safe and effective therapeutic option for facial seborrhoeic dermatitis.
Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp.
Kastarinen Helena,Oksanen Tuija,Okokon Enembe O,Kiviniemi Vesa V,Airola Kristiina,Jyrkkä Johanna,Oravilahti Tuomas,Rannanheimo Piia K,Verbeek Jos H
The Cochrane database of systematic reviews
BACKGROUND:Seborrhoeic dermatitis is a chronic inflammatory skin disorder affecting primarily the skin of the scalp, face, chest, and intertriginous areas, causing scaling and redness of the skin. Current treatment options include antifungal, anti-inflammatory, and keratolytic agents, as well as phototherapy. OBJECTIVES:To assess the effects of topical pharmacological interventions with established anti-inflammatory action for seborrhoeic dermatitis occurring in adolescents and adults. SEARCH METHODS:We searched the following databases up to September 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 9), MEDLINE (from 1946), Embase (from 1974), LILACS (from 1982), and the GREAT database. We searched five trials databases and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA:We included RCTs in adults or adolescents (> 16 years) with diagnosed seborrhoeic dermatitis of the scalp or face, comparing topical anti-inflammatory treatments (steroids, calcineurin inhibitors, and lithium salts) with other treatments. DATA COLLECTION AND ANALYSIS:Pairs of authors independently assessed eligibility for inclusion, extracted data, and evaluated the risk of bias. We performed meta-analyses if feasible. MAIN RESULTS:We included 36 RCTs (2706 participants), of which 31 examined topical steroids; seven, calcineurin inhibitors; and three, lithium salts. The comparative interventions included placebo, azoles, calcipotriol, a non-steroidal anti-inflammatory compound, and zinc, as well as different anti-inflammatory treatments compared against each other. Our outcomes of interest were total clearance of symptoms, erythema, scaling or pruritus scores, and adverse effects. The risk of bias in studies was most frequently classified as unclear, due to unclear reporting of methods.Steroid treatment resulted in total clearance more often than placebo in short-term trials (four weeks or less) (relative risk (RR) 3.76, 95% confidence interval (CI) 1.22 to 11.56, three RCTs, 313 participants) and in one long-term trial (lasting 12 weeks). Steroids were also more effective in reducing erythema, scaling, and pruritus. Adverse effects were similar in both groups.There may be no difference between steroids and calcineurin inhibitors in total clearance in the short-term (RR 1.08, 95% 0.88 to 1.32, two RCTs, 60 participants, low-quality evidence). Steroids and calcineurin inhibitors were found comparable in all other assessed efficacy outcomes as well (five RCTs, 237 participants). Adverse events were less common in the steroid group compared with the calcineurin group in the short-term (RR 0.22, 95% CI 0.05 to 0.89, two RCTs, 60 participants).There were comparable rates of total clearance in the steroid and azole groups (RR 1.11, 95% CI 0.94 to 1.32, eight RCTs, 464 participants, moderate-quality evidence) as well as of adverse effects in the short-term, but less erythema or scaling with steroids.We found mild (class I and II) and strong (class III and IV) steroids comparable in the assessed outcomes, including adverse events. The only exception was total clearance in long-term use, which occurred more often with a mild steroid (RR 0.79, 95% CI 0.63 to 0.98, one RCT, 117 participants, low-quality evidence).In one study, calcineurin inhibitor was more effective than placebo in reducing erythema and scaling, but there were similar rates in total clearance or adverse events for short-term treatment. In another study, calcineurin inhibitor was comparable with azole when erythema, scaling, or adverse effects were measured for longer-term treatment.Lithium was more effective than placebo with regard to total clearance (RR 8.59, 95% CI 2.08 to 35.52, one RCT, 129 participants) with a comparable safety profile. Compared with azole, lithium resulted in total clearance more often (RR 1.79, 95% CI 1.10 to 2.90 in short-term treatment, one RCT, 288 participants, low-quality evidence). AUTHORS' CONCLUSIONS:Topical steroids are an effective treatment for seborrhoeic dermatitis of the face and scalp in adolescents and adults, with no differences between mild and strong steroids in the short-term. There is some evidence of the benefit of topical calcineurin inhibitor or lithium salt treatment. Treatment with azoles seems as effective as steroids concerning short-term total clearance, but in other outcomes, strong steroids were more effective. Calcineurin inhibitor and azole treatment appeared comparable. Lithium salts were more effective than azoles in producing total clearance.Steroids are similarly effective to calcineurin inhibitors but with less adverse effects.Most of the included studies were small and short, lasting four weeks or less. Future trials should be appropriately blinded; include more than 200 to 300 participants; and compare steroids to calcineurin inhibitors or lithium salts, and calcineurin inhibitors to azoles or lithium salts. The follow-up time should be at least one year, and quality of life should be addressed. There is also a need for the development of well-validated outcome measures.
Identification of Malassezia species in the facial lesions of Chinese seborrhoeic dermatitis patients based on DNA sequencing.
Lian C-h,Shen L-l,Gao Q-y,Jiang M,Zhao Z-j,Zhao J-j
The genus Malassezia is important in the aetiology of facial seborrhoeic dermatitis (FSD), which is the most common clinical type. The purpose of this study was to analyse the distribution of Malassezia species in the facial lesions of Chinese seborrhoeic dermatitis (SD) patients and healthy individuals. Sixty-four isolates of Malassezia were isolated from FSD patients and 60 isolates from healthy individuals. Sequence analysis of the internal transcribed spacer (ITS) region was used to identify the isolates. The most frequently identified Malassezia species associated with FSD was M. furfur (76.56%), followed by M. sympodialis (12.50%) and M. japonica (9.38%). The most frequently isolated species in healthy individuals were M. furfur (61.67%), followed by M. sympodialis (25.00%), M. japonica (6.67%), M. globosa (3.33%), and M. obtusa (3.33%). Overall, our study revealed that while M. furfur is the predominant Malassezia species in Chinese SD patients, there is no significant difference in the distribution of Malassezia species between Chinese SD patients and healthy individuals.
Physiological and microbiological verification of the benefit of hair washing in patients with skin conditions of the scalp.
Kobayashi Miwa,Ito Kei,Sugita Takashi,Murakami Yumi,Yamashita Ryoko,Matsunaka Hiroshi,Nakamura Motonobu
Journal of cosmetic dermatology
BACKGROUND:It is unclear whether hair washing is effective against scalp eruption and pruritus caused by seborrheic dermatitis or psoriasis vulgaris. AIMS:To assess whether a proper hair-washing regimen, including the use of antibacterial shampoo, can ameliorate scalp eruption symptoms and alter the composition of the scalp microflora. METHODS:Eighteen patients with seborrheic dermatitis or psoriasis vulgaris scalp eruptions were instructed in proper techniques of daily hair washing, rinsing, and shampooing, which they underwent for 12 weeks. They used control shampoo in weeks 1-4 and 9-12, and an antibacterial shampoo during weeks 5-8. At the start of the test period and at weeks 4, 8, and 12, we assessed scalp symptoms (erythema, scaling/desquamation, dryness, itchiness, and scratching scars); microbial DNA levels from lesion and nonlesion areas; and levels of interleukin (IL)-1α, IL-1ra, and total protein in the scalp's horny layer. RESULTS:Compared to baseline values, scaling/desquamation and itchiness improved significantly at weeks 8 and 12. Other observed skin symptoms also improved over time. Malassezia colonization levels in lesion and nonlesion areas decreased gradually; the decrease was significant at week 8 in lesion areas and at weeks 4 and 8 in nonlesion areas. Bacterial colonization levels also decreased gradually, achieving significance in lesion areas at week 4. Gradual decreases in IL-1ra/IL-1α level showed statistical significance at weeks 4 and 12, while the protein quantity significantly decreased at week 12. CONCLUSION:Proper hair washing improved scalp condition symptoms, and possibly the underlying etiology.
iTRAQ-based quantitative proteomics of stratum corneum of dandruff scalp reveals new insights into its aetiology and similarities with atopic dermatitis.
Cavusoglu Nükhet,Delattre Caroline,Donovan Mark,Bourassa Sylvie,Droit Arnaud,El Rawadi Charles,Jourdain Roland,Bernard Dominique
Archives of dermatological research
The study aimed at detecting differentially expressed proteins in the stratum corneum of dandruff versus non-dandruff scalps to better understand dandruff aetiology. iTRAQ-based quantitative proteomic analysis revealed a total of 68 differentially expressed biomarkers. A detailed analysis of their known physiological functions provided new insights into the affected metabolic pathways of a dandruff scalp. Dandruff scalp showed (1) profound changes in the expression and maturation of structural and epidermal differentiation related proteins, that are responsible for the integrity of the skin, (2) altered relevant factors that regulate skin hydration, and (3) an imbalanced physiological protease-protease inhibitor ratio. Stratum corneum proteins with antimicrobial activity, mainly those derived from sweat and sebaceous glands were also found modified. Comparing our data with those reported for atopic dermatitis revealed that about 50 % of the differentially expressed proteins in the superficial layers of the stratum corneum from dandruff and atopic dermatitis are identical.
Multicenter, double-blind, parallel group study investigating the non-inferiority of efficacy and safety of a 2% miconazole nitrate shampoo in comparison with a 2% ketoconazole shampoo in the treatment of seborrhoeic dermatitis of the scalp.
Buechner Stanislaw A
The Journal of dermatological treatment
OBJECTIVES:This study investigated the non-inferiority of efficacy and tolerance of 2% miconazole nitrate shampoo in comparison with 2% ketoconazole shampoo in the treatment of scalp seborrheic dermatitis. METHODS:A randomized, double-blind, comparative, parallel group, multicenter study was done. A total of 274 patients (145 miconazole, 129 ketoconazole) were enrolled. Treatment was twice-weekly for 4 weeks. Safety and efficacy assessments were made at baseline and at weeks 2 and 4. Assessments included symptoms of erythema, itching, scaling ['Symptom Scale of Seborrhoeic Dermatitis' (SSSD)], disease severity and global change [Clinical Global Impressions (CGIs) and Patient Global Impressions (PGIs)]. CONCLUSIONS:Miconazole shampoo is at least as effective and safe as ketoconazole shampoo in treating scalp seborrheic dermatitis scalp.
Clinical and biochemical assessment of maintenance treatment in chronic recurrent seborrheic dermatitis: randomized controlled study.
Turlier Virginie,Viode Cécile,Durbise Elisabeth,Bacquey Adeline,LeJeune Ophélie,Oliveira Soares Rui,Lauze Christophe,Villeneuve Cécile,Rouquier Amandine,Casas Christiane,Redoules Daniel,Mengeaud Valérie,Schmitt Anne-Marie
Dermatology and therapy
INTRODUCTION:Few studies have investigated the long-term effects of a maintenance regimen in the prevention of relapses in scalp seborrheic dermatitis (SD), in particular following biomarker changes. MATERIALS AND METHODS:A new shampoo containing beta-glycyrrhetinic acid (18βGA) in addition to cyclopiroxolamine (CPO) and zinc pyrithione (ZP) was tested in 67 subjects suffering from SD with moderate to severe erythema and itching in a biphasic study. After a first common intensive treatment phase (investigational product thrice a week × 2 weeks), subjects randomly received the investigational product once a week × 8 weeks (maintenance) or a neutral shampoo (discontinuation) in a comparative, parallel group maintenance phase. Efficacy was assessed clinically (overall clinical dandruff score, erythema, overall efficacy, self-evaluation), biochemically and microbiologically by quantitative polymerase chain reaction (qPCR), high performance liquid chromatography (HPLC) or enzyme-linked immunoabsorbent assay (ELISA) analysis of scale samples (Malassezia species (restricta and globosa), cohesion proteins (plakoglobins), inflammation (Interleukin (IL)-8, IL-1RA/IL-1α) and pruritus (histamine, cathepsin S) markers). RESULTS:During the intensive treatment phase, SD improved significantly (p < 0.0001) with a decrease in clinical signs as well as Malassezia species, cohesion proteins, inflammation and pruritus markers. During the maintenance phase, the improvement persisted in the 'maintenance' group only, with a significant intergroup difference. A consistently positive relationship was found between dandruff, itching, erythema and Malassezia populations, histamine levels and IL-1RA/IL-1α ratio. CONCLUSION:The effectiveness of this maintenance regimen was objectively demonstrated at the clinical, biochemical and microbiological level. Correlations between clinical signs and biomarkers could provide clues to explain the resolution of SD and confirm the interest of biomarkers for SD treatment assessment.
Presence, species distribution, and density of Malassezia yeast in patients with seborrhoeic dermatitis - a community-based case-control study and review of literature.
Barac Aleksandra,Pekmezovic Marina,Milobratovic Danica,Otasevic-Tasic Suzana,Radunovic Milena,Arsic Arsenijevic Valentina
Malassezia yeast belongs to the normal cutaneous flora and under certain conditions it causes seborrhoeic dermatitis (SD). There is no culture-based study about the presence and density of the Malassezia in SD patients in Serbia. Aim was to show the presence, species distribution and density of Malassezia in patients with SD on lesional skin (LS) and non-lesional skin (NLS) and healthy controls (HC) and to compare data between Serbia and other countries. The study included 70 HC and 60 patients with SD in the study group (SG). Isolation, identification and examination of density of Malassezia colony-forming units from LS and NLS were performed. Malassezia was found more frequently in the SG than in HC, 90% and 60%, respectively (P < 0.01). The most frequent isolates in SG on LS were M. slooffiae (26%), followed by M. globosa (17%) and M. sympodialis (17%). The yeast density was much higher on LS of SG than on NLS of SG or in the HC group (P < 0.05). Higher density of Malassezia was shown on LS of SG than on NLS of SG and HC. M. slooffiae is the most prevalent species in SD patients in Serbia. This study demonstrated a positive relationship between severity of SD and presence of Malassezia spp.
Topical antifungals for seborrhoeic dermatitis.
Okokon Enembe O,Verbeek Jos H,Ruotsalainen Jani H,Ojo Olumuyiwa A,Bakhoya Victor Nyange
The Cochrane database of systematic reviews
BACKGROUND:Seborrhoeic dermatitis is a chronic inflammatory skin condition that is distributed worldwide. It commonly affects the scalp, face and flexures of the body. Treatment options include antifungal drugs, steroids, calcineurin inhibitors, keratolytic agents and phototherapy. OBJECTIVES:To assess the effects of antifungal agents for seborrhoeic dermatitis of the face and scalp in adolescents and adults.A secondary objective is to assess whether the same interventions are effective in the management of seborrhoeic dermatitis in patients with HIV/AIDS. SEARCH METHODS:We searched the following databases up to December 2014: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 11), MEDLINE (from 1946), EMBASE (from 1974) and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982). We also searched trials registries and checked the bibliographies of published studies for further trials. SELECTION CRITERIA:Randomised controlled trials of topical antifungals used for treatment of seborrhoeic dermatitis in adolescents and adults, with primary outcome measures of complete clearance of symptoms and improved quality of life. DATA COLLECTION AND ANALYSIS:Review author pairs independently assessed eligibility for inclusion, extracted study data and assessed risk of bias of included studies. We performed fixed-effect meta-analysis for studies with low statistical heterogeneity and used a random-effects model when heterogeneity was high. MAIN RESULTS:We included 51 studies with 9052 participants. Of these, 45 trials assessed treatment outcomes at five weeks or less after commencement of treatment, and six trials assessed outcomes over a longer time frame. We believe that 24 trials had some form of conflict of interest, such as funding by pharmaceutical companies.Among the included studies were 12 ketoconazole trials (N = 3253), 11 ciclopirox trials (N = 3029), two lithium trials (N = 141), two bifonazole trials (N = 136) and one clotrimazole trial (N = 126) that compared the effectiveness of these treatments versus placebo or vehicle. Nine ketoconazole trials (N = 632) and one miconazole trial (N = 47) compared these treatments versus steroids. Fourteen studies (N = 1541) compared one antifungal versus another or compared different doses or schedules of administration of the same agent versus one another. KetoconazoleTopical ketoconazole 2% treatment showed a 31% lower risk of failed clearance of rashes compared with placebo (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.59 to 0.81, eight studies, low-quality evidence) at four weeks of follow-up, but the effect on side effects was uncertain because evidence was of very low quality (RR 0.97, 95% CI 0.58 to 1.64, six studies); heterogeneity between studies was substantial (I² = 74%). The median proportion of those who did not have clearance in the placebo groups was 69%.Ketoconazole treatment resulted in a remission rate similar to that of steroids (RR 1.17, 95% CI 0.95 to 1.44, six studies, low-quality evidence), but occurrence of side effects was 44% lower in the ketoconazole group than in the steroid group (RR 0.56, 95% CI 0.32 to 0.96, eight studies, moderate-quality evidence).Ketoconozale yielded a similar remission failure rate as ciclopirox (RR 1.09, 95% CI 0.95 to 1.26, three studies, low-quality evidence). Most comparisons between ketoconazole and other antifungals were based on single studies that showed comparability of treatment effects. CiclopiroxCiclopirox 1% led to a lower failed remission rate than placebo at four weeks of follow-up (RR 0.79, 95% CI 0.67 to 0.94, eight studies, moderate-quality evidence) with similar rates of side effects (RR 0.9, 95% CI 0.72 to 1.11, four studies, moderate-quality evidence). Other antifungalsClotrimazole and miconazole efficacies were comparable with those of steroids on short-term assessment in single studies.Treatment effects on individual symptoms were less clear and were inconsistent, possibly because of difficulties encountered in measuring these symptoms.Evidence was insufficient to conclude that dose or mode of delivery influenced treatment outcome. Only one study reported on treatment compliance. No study assessed quality of life. One study assessed the maximum rash-free period but provided insufficient data for analysis. One small study in patients with HIV compared the effect of lithium versus placebo on seborrhoeic dermatitis of the face, but treatment outcomes were similar. AUTHORS' CONCLUSIONS:Ketoconazole and ciclopirox are more effective than placebo, but limited evidence suggests that either of these agents is more effective than any other agent within the same class. Very few studies have assessed symptom clearance for longer periods than four weeks. Ketoconazole produced findings similar to those of steroids, but side effects were fewer. Treatment effect on overall quality of life remains unknown. Better outcome measures, studies of better quality and better reporting are all needed to improve the evidence base for antifungals for seborrhoeic dermatitis.
Seborrhoeic dermatitis of the scalp.
Naldi Luigi,Diphoorn Janouk
BMJ clinical evidence
INTRODUCTION:Seborrhoeic dermatitis affects a variable proportion of the general population, ranging from 3% to 10%. Malassezia yeast species (previously referred to as Pityrosporum) are thought to be the responsible organisms, and cause inflammation by still poorly defined mechanisms. Seborrhoeic dermatitis tends to relapse after treatment. METHODS AND OUTCOMES:We conducted a systematic review and aimed to answer the following clinical question: What are the effects of topical treatments for seborrhoeic dermatitis of the scalp in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS:We found 14 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS:In this systematic review we present information relating to the effectiveness and safety of the following interventions: bifonazole, ciclopirox, ketoconazole, pyrithione zinc, selenium sulfide, tar shampoo, terbinafine, and topical corticosteroids (betamethasone valerate, clobetasol propionate, clobetasone butyrate, hydrocortisone, mometasone furoate).
Precipitation of free fatty acids generated by Malassezia - a possible explanation for the positive effects of lithium succinate in seborrhoeic dermatitis.
Mayser P,Schulz S
Journal of the European Academy of Dermatology and Venereology : JEADV
BACKGROUND:Lithium succinate and gluconate are effective alternative options licensed for the topical treatment of seborrhoeic dermatitis (SD). OBJECTIVE:Their mode of action is not fully elucidated. Minimal inhibitory concentrations against Malassezia (M.) yeasts, which play an important role in SD, are very high. METHODS:An assay based on the hydrolysis of ethyl octanoate enables us to test the hydrolytic activity of reference strains of the species M. globosa, M. sympodialis and M. furfur solely without interference by fungal growth as the free octanoic acid generated has antifungal activity. RESULTS:In this assay the presence of alkali salts (lithium, sodium and potassium succinate resp.) in concentrations of 2%, 4% and 8% does not influence hydrolytic activity but the availability of the generated free fatty acid in a dose-dependent manner which was analysed by means of high-performance thin layer chromatography and densitometry. This was best effected with the lithium, followed by the sodium and only to a low degree by the potassium salt. As shown by attenuated total reflection Fourier transform infrared spectroscopy the free fatty acid reacted to the respective alkali soap and precipitate from solution. The alkali soaps could not be utilized by the M. spp. as shown in a modified Tween auxanogram and in lack of fungal growth by ethyl oleate in the presence of 8% lithium succinate. CONCLUSION:The effect of lithium succinate on growth of M. yeasts and presumably in SD can be explained by a precipitation of free fatty acids as alkali soaps limiting their availability for the growth of these lipid-dependent yeasts.
The genetic basis of seborrhoeic dermatitis: a review.
Karakadze M A,Hirt P A,Wikramanayake T C
Journal of the European Academy of Dermatology and Venereology : JEADV
Seborrhoeic Dermatitis (SD) is a common inflammatory skin disease that presents as itchy, flaking skin in the seborrhoeic areas. Various environmental and intrinsic factors have been identified as predisposing factors for SD, but its aetiology remains poorly understood. Although it was recognized that genetic factors play a role in SD aetiology, there have not been studies that systematically review the literature specifically for causal mutations or protein deficiencies in SD. In this review, we searched various databases for gene mutations and protein deficiencies that cause SD or SD-like phenotype in humans and experimental animals, and summarize 11 gene mutations or protein deficiencies that were described in the literature. Most of the encoded proteins play a role either in the immune response (ACT1, C5, IKBKG/NEMO, STK4, 2C TCR) or epidermal differentiation (ZNF750, MPZL3). Understanding the genetic basis of SD can impart knowledge of the pathobiology of the disease and help identify novel therapeutic targets.
Complete Genome Sequence of CBS 7877, an Opportunist Pathogen Involved in Dandruff and Seborrheic Dermatitis.
Morand Stanislas C,Bertignac Morgane,Iltis Agnes,Kolder Iris C R M,Pirovano Walter,Jourdain Roland,Clavaud Cécile
Microbiology resource announcements
Malassezia restricta, one of the predominant basidiomycetous yeasts present on human skin, is involved in scalp disorders. Here, we report the complete genome sequence of the lipophilic Malassezia restricta CBS 7877 strain, which will facilitate the study of the mechanisms underlying its commensal and pathogenic roles within the skin microbiome.
Interventions for infantile seborrhoeic dermatitis (including cradle cap).
The Cochrane database of systematic reviews
BACKGROUND:Infantile seborrhoeic dermatitis (ISD) is a chronic, inflammatory, scaling skin condition, which causes redness and a greasy scaling rash in infants and young children. It can last from weeks to months, but rarely years. When it occurs on the scalp, it is referred to as 'cradle cap'. While benign and self-limiting, irrelevant of its location on the body, it can distress parents. The effectiveness of commonly promoted treatments is unclear. OBJECTIVES:To assess the effects of interventions for infantile seborrhoeic dermatitis in children from birth to 24 months of age. SEARCH METHODS:We searched the following databases up to 22 May 2018: Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We searched trials registers and checked reference lists of included studies for further references to randomised controlled trials (RCTs). We searched for unpublished RCTs and grey literature via web search engines, and wrote to authors and pharmaceutical companies. SELECTION CRITERIA:We included RCTs of interventions for ISD in children from birth up to 24 months who were clinically diagnosed by a healthcare practitioner with ISD or cradle cap. We allowed comparison of any treatment to no treatment or placebo, and the comparison of two or more treatments or a combination of treatments. DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane. The primary outcome measures were 'Change in severity score from baseline to end of study' and 'Percentage of infants treated who develop adverse effects or intolerance to treatment'. The secondary outcome was 'Improvement in quality of life (QoL) as reported by parents'. MAIN RESULTS:We included six RCTs (one with a cross-over design) randomising 310 children and reporting outcomes for 297 children. Most participants were aged under seven months with only two participants aged over one year (seven and 12 years old); where specified, 60% were boys. In two studies, condition severity was mild to moderate; one study included two participants with severe ISD; the other studies did not describe baseline severity or described it as body surface area affected.The study setting was not always clear but likely a paediatric outpatient clinic in the following countries: Thailand, Israel, USA, France, and Australia.Two studies compared oral biotin (a B group vitamin) against placebo, two studies compared proprietary products against placebo cream or a control shampoo, and two studies compared topical corticosteroids against other products. The studies were generally short-term, between 10 and 42 days' duration; only one study followed the participants until resolution of the rash or eight months of age.We assessed the risk of bias as unclear for most aspects due to lack of reporting, but two of the studies were at high risk of performance and detection bias due to the appearance of the intervention, the trial design (open-label), or use of overlabelled tubes. Two trials had a high risk of attrition bias.All the results given below were based on very low-quality evidence. Treatment duration ranged from one week to three weeks.For the two trials comparing biotin versus placebo (n = 35), one did not report a measure of change in severity (only change in duration of rash) while the other did not report raw data (only 'no statistically significant difference'), measured at three weeks. Neither trial reported on adverse events.Two trials compared proprietary products against placebo (n = 160). One trial assessed change in severity via percentage success (96% of participants in non-steroidal cream Promiseb versus 92% in placebo), and reported no adverse events (both assessed at day 14). The other trial assessed change in severity via reduction in lesional score (surface area covered), finding better results for lactamide MEA gel (a moisturising agent) plus shampoo (81.4%) compared with shampoo only (70.2%; P = 0.0092). No adverse events were described, but signs of discomfort were similar in both groups (both assessed at day 21).In the comparison of topical steroids versus another product, change in severity was measured through evaluation of cure and body surface (n = 102).In one trial comparing hydrocortisone 1% lotion with licochalcone 0.025% lotion, there was no significant difference in participants cured (95.8% with hydrocortisone compared to 97.1% with licochalcone). One person in the licochalcone group developed more erythema, but there were no other adverse events (both outcomes assessed at day 14). In the trial comparing flumethasone pivalate 0.02% ointment versus eosin 2% aqueous solution, a reduction in body surface area affected was seen in both groups at day 10 (9% with corticosteroid versus 7% with aqueous solution), with all infants showing less than 10% involvement. There were no adverse events (both outcomes assessed at day 10).No studies measured QoL.We found no trials testing commonly used treatments such as mineral oils, salicylic acid, or antifungals. AUTHORS' CONCLUSIONS:Our review identified only a limited number of studies investigating the effects of interventions for ISD in infants and young children. Unlike the reviews investigating the effects of treatments in adults, our results showed that there is uncertainty regarding the effectiveness and safety of studied treatments due to the very low-certainty evidence for all comparisons and outcomes.We assessed most bias domains as at unclear risk, but there was a high risk of bias for (mainly) performance, attrition, and detection bias. Evidence was limited further by imprecision (small studies, low number of events), indirectness (mainly with the outcomes assessed), and poor trial reporting. In most studies, the prognosis for the condition was favourable regardless of intervention but interpretation is limited by the very low-certainty evidence.Further research is needed with large, well-conducted, and well-reported intervention trials, particularly of interventions commonly recommended or used, such as emollients or shampoos and brushing, antifungals, or steroids. All studies should report standardised and validated relevant outcome measures, including adverse events, severity, and QoL, and they should be conducted in primary care settings where the majority of ISD is managed. Future trials should compare against placebo, no treatment, or standard care.
Systematic review of oral treatments for seborrheic dermatitis.
Gupta A K,Richardson M,Paquet M
Journal of the European Academy of Dermatology and Venereology : JEADV
Seborrheic dermatitis (SD) is normally treated with topical corticosteroids and antifungals. Oral therapies can be prescribed in severe or unresponsive cases. This review aims to assess the quantity and quality of published reports on oral therapies for SD. MEDLINE and Embase databases and the reference listings of publications were searched for any publication using oral treatment for SD. The quality of the included publications was assessed using a modified 27 item checklist by Downs and Black. Twenty-one publications (randomized controlled trials, open trials and case reports) covering eight oral therapies (itraconazole, terbinafine, fluconazole, ketoconazole, pramiconazole, prednisone, isotretinoin and homeopathic mineral therapy) were identified. Most of the publications investigated oral antifungals and the quality of the evidence was generally low. The clinical efficacy outcome reported varied considerably between the studies, preventing statistical analysis and direct comparison between treatments. However, ketoconazole therapy was associated with more relapses compared with other treatments. Itraconazole dosing regimen for SD was generally 200 mg/day for the first week of the month followed by 200 mg/day for the first 2 days for 2-11 months. Terbinafine was prescribed at 250 mg/day either as a continuous (4-6 weeks) or as an intermittent regimen (12 days per month) for 3 months. Fluconazole has administered daily (50 mg/day for 2 weeks) or weekly (200-300 mg) for 2-4 weeks. Ketoconazole dosing regimen was 200 mg daily for 4 weeks. Finally, a single 200 mg dose of pramiconazole was administered to patients. This review also highlights key areas for consideration when designing future studies.
Topical nicotinamide for seborrheic dermatitis: an open randomized study.
Fabbrocini Gabriella,Cantelli Mariateresa,Monfrecola Giuseppe
The Journal of dermatological treatment
BACKGROUND:Treatment of seborrheic dermatitis (SD) includes various options with different success and safety limitations. OBJECTIVE:To evaluate the efficacy of topical nicotinamide (NCT) in the treatment of SD. METHODS:A total of 48 patients with mild to moderate SD of the face were enrolled in the study (36 males and 12 females; age 20-50 years). Patients were randomized into two groups A and B, who were treated once a day with topical administration of NCT 4% cream and with the vehicle without NCT (placebo), respectively. Clinical measures were assessed by erythema, scaling, and infiltration, which were evaluated using a four-point scale 0-3 before starting treatment and after 2, 6, and 12 weeks' therapy. RESULTS:In comparison with baseline, a reduction of 75% of the total score was observed in patients treated with NCT, whereas for placebo-treated patients the reduction was of 35% (p < 0.05). CONCLUSION:Topical NCT 4% can have a potential for the treatment of SD.
A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production.
Arsic Arsenijevic Valentina S,Milobratovic Danica,Barac Aleksandra M,Vekic Berislav,Marinkovic Jelena,Kostic Vladimir S
BACKGROUND:Seborrheic dermatitis (SD) and Parkinson's disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD. METHODS:This case-control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated. RESULTS:The most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667).The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro. CONCLUSION:From this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data lead to conclusion that local skin performance of PD patient's characterized with increased sebum excretion ratio play a role in SD by stimulation of yeasts replication and enzyme production.
Topical anti-inflammatory agents for seborrheic dermatitis of the face or scalp: summary of a Cochrane Review.
Kastarinen Helena,Okokon Enembe O,Verbeek Jos H
CLINICAL QUESTION:Are there differences in effectiveness between topical anti-inflammatory treatments (steroids, calcineurin inhibitors, or lithium salts) and placebo or azoles in the treatment of seborrheic dermatitis of the face and scalp in adults? BOTTOM LINE:The topical anti-inflammatory treatments were more effective in achieving total clearance of symptoms than placebo by 1.4-fold to 8.5-fold, but there are no considerable differences in the anti-inflammatory topical treatments or in comparison with azoles for short-term treatment. There is no evidence of treatment effects in long-term, continuous, or intermittent use of these compounds despite the chronic nature of the disease.
Malassezia intra-specific diversity and potentially new species in the skin microbiota from Brazilian healthy subjects and seborrheic dermatitis patients.
Soares Renan Cardoso,Zani Marcelo Bergamin,Arruda Ana Carolina Belini Bazán,Arruda Lucia Helena Fávaro de,Paulino Luciana Campos
Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD). The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.
Collapse of human scalp microbiome network in dandruff and seborrhoeic dermatitis.
Park Taehun,Kim Hye-Jin,Myeong Nu Ri,Lee Hyun Gee,Kwack Ilyoung,Lee Johnhwan,Kim Beom Joon,Sul Woo Jun,An Susun
We investigate the relationship between scalp microbiota and dandruff/seborrhoeic dermatitis (D/SD), an unpleasant scalp disorder common in human populations. Bacterial and fungal community analyses on scalp of 102 Korean were performed by next-generation sequencing. Overall scalp microbiome composition significantly differed between normal and disease groups, and especially co-occurrence network of dominant members was breakdown in disease groups. These findings will provide novel insights into shifts of microbial community relevant to D/SD.
The Role of Combination Calcipotriol plus Betamethasone Dipropionate Gel in the Treatment of Moderate-to-Severe Scalp Seborrhoeic Dermatitis.
Yap Felix B
Sultan Qaboos University medical journal
OBJECTIVES:This study aimed to investigate the off-label use of a combination calcipotriol plus betamethasone dipropionate (CBD) gel in the treatment of moderate-to-severe scalp seborrhoeic dermatitis (SSD). METHODS:This retrospective study involved 32 patients with SSD who were prescribed CBD gel at the Subang Jaya Medical Centre, Selangor, Malaysia, between January 2016 and December 2017. The Physician Global Assessment Scale was used to assess disease severity. Itching/discomfort was evaluated using a visual analogue scale. RESULTS:The mean age was 35.8 ± 6.9 years. Severe disease was seen in 53.1%. Complete clearance was recorded in 15.6%, 40.6% and 59.4% of patients at weeks two, six and 10, respectively. By week 10, 87.5% had achieved marked improvement. Both mean itching and discomfort scores significantly improved at weeks two, six and 10 ( <0.001). Better outcomes were significantly associated with disease duration and itching intensity and discomfort at presentation ( <0.050). CONCLUSION:CBD gel should be considered as an option for SSD cases not adequately controlled by prior conventional treatment.
Efficacy of Oral Itraconazole in the Treatment and Relapse Prevention of Moderate to Severe Seborrheic Dermatitis: A Randomized, Placebo-Controlled Trial.
Ghodsi Seyedeh Zahra,Abbas Zaheer,Abedeni Robabeh
American journal of clinical dermatology
BACKGROUND:Seborrheic dermatitis (SD) is a chronic and relapsing disease and topical therapy may be associated with failure, particularly in severe disease. Itraconazole has been suggested as an effective treatment for severe SD. Previous studies have been open clinical trials with variable results. OBJECTIVE:The aim of this study was to determine the efficacy of oral itraconazole in the treatment of patients with moderate to severe SD. METHODS:Sixty-eight patients with moderate to severe SD were randomly assigned to the itraconazole (n = 35) or placebo (n = 33) groups. The trial was undertaken in Razi Hospital, Tehran. An internet-generated table was used to allocate treatments. Patients and investigator were blinded to treatments. Itraconazole 200 mg/daily or placebo was prescribed for 1 week and then for the first 2 days of every month for the following 3 months. Patients were followed for 4 months and the Seborrheic Dermatitis Area Severity Index (SDASI) was measured on nine anatomical sites. Fifty-seven patients (29 in the itraconazole group and 28 in the placebo group) completed the study. RESULTS:Statistically significant improvement was observed in SDASI of both itraconazole and placebo groups (p = 0.000) but the itraconazole group showed significantly higher efficacy compared with placebo (p = 0.023). We observed clinical improvements of 93.8, 87.5, and 93.1% at the end of 2 weeks, 1 month, and 4 months, respectively, in the itraconazole group, and 82.1, 64.3, and 53.6% in the placebo group. Furthermore, recurrence rate in the itraconazole group was significantly lower than in the placebo group (p = 0.003). No blood test abnormality was seen in any patient. CONCLUSION:Itraconazole is not only an effective and safe therapy for controlling exacerbations of SD but may also be used as maintenance therapy to prevent disease recurrence.
Maintenance Therapy of Facial Seborrheic Dermatitis with 0.1% Tacrolimus Ointment.
Kim Hye One,Yang Yoon Seok,Ko Hyun Chang,Kim Gyung Moon,Cho Sang Hyun,Seo Young Joon,Son Sang Wook,Lee Jong Rok,Lee Joong Sun,Chang Sung Eun,Che Jae We,Park Chun Wook
Annals of dermatology
BACKGROUND:Topical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment. OBJECTIVE:The aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD. METHODS:During the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect. RESULTS:The time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well. CONCLUSION:The results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.
Noncorticosteroid Combination Shampoo versus 1% Ketoconazole Shampoo for the Management of Mild-to-Moderate Seborrheic Dermatitis of the Scalp: Results from a Randomized, Investigator-Single-Blind Trial Using Clinical and Trichoscopic Evaluation.
Dall'Oglio Federica,Lacarrubba Francesco,Verzì Anna Elisa,Micali Giuseppe
Skin appendage disorders
PURPOSE:The aim of this study was to assess the efficacy and tolerability of a combination noncorticosteroid, antiinflammatory/antifungal shampoo versus 1% ketoconazole shampoo in the treatment of mild-to-moderate scalp seborrheic dermatitis (SD). PROCEDURES:Twenty patients were randomized to using the combination shampoo (group A, 10 patients) or the 1% ketoconazole shampoo (group B, 10 patients) 3 times a week every other day for 8 weeks. Efficacy was evaluated by measuring the degree of scaling and pruritus by clinical and trichoscopic examination using a 4-point scale. Additionally, a physician global assessment (PGA) was assessed at the end of the study. RESULTS:At 4 weeks, there was a significant reduction of scaling from baseline for both groups, while pruritus showed a significant reduction only for group A. After 8 weeks, there was a significant reduction of scaling and pruritus for both groups. PGA showed a complete response in 90% of the cases in both groups. CONCLUSIONS:The results of our study demonstrate that the combination noncorticosteroid, antiinflammatory/antifungal shampoo represents an alternative approach to standard topical treatment for scalp SD. A noncorticosteroid shampoo may be equally safe and effective as ketoconazole shampoo for scalp SD, and trichoscopy provides accurate and reliable quantifiable data to assist in therapeutic monitoring.
Seborrheic Dermatitis and Dandruff: A Comprehensive Review.
Borda Luis J,Wikramanayake Tongyu C
Journal of clinical and investigative dermatology
Seborrheic Dermatitis (SD) and dandruff are of a continuous spectrum of the same disease that affects the seborrheic areas of the body. Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD can affect the scalp as well as other seborrheic areas, and involves itchy and flaking or scaling skin, inflammation and pruritus. Various intrinsic and environmental factors, such as sebaceous secretions, skin surface fungal colonization, individual susceptibility, and interactions between these factors, all contribute to the pathogenesis of SD and dandruff. In this review, we summarize the current knowledge on SD and dandruff, including epidemiology, burden of disease, clinical presentations and diagnosis, treatment, genetic studies in humans and animal models, and predisposing factors. Genetic and biochemical studies and investigations in animal models provide further insight on the pathophysiology and strategies for better treatment.
Effect of itraconazole on the quality of life in patients with moderate to severe seborrheic dermatitis: a randomized, placebo-controlled trial.
Abbas Zaheer,Ghodsi Seyedeh Z,Abedeni Robabeh
Dermatology practical & conceptual
BACKGROUND:Few studies have examined the effect of seborrheic dermatitis (SD) and/or its consequent therapy on a patient's quality of life. Itraconazole has been suggested as an effective therapy for severe SD but its impact on Quality of Life (QoL) in these patients has never been studied before. OBJECTIVE:The study aimed to verify the efficacy of the itraconazole on the quality of life in patients with moderate to severe SD. METHODS:A randomized, double-blind, placebo controlled trial was planned to describe the effect of SD per se on QoL and to determine the impact of oral itraconazole or placebo on QoL of SD patients. Sixty-eight patients with moderate to severe SD participated in the study to receive either itraconazole or placebo. Dermatology Life Quality Index was used to evaluate their quality of life before and after treatment. Itraconazole 200 mg/daily or placebo was prescribed for one week and then the first two days of every month for the following three months. Fifty-seven patients completed the study. RESULTS:Significant improvement was observed in QoL of both itraconazole and placebo groups, but itraconazole group showed significantly higher improvement as compared to placebo (p=0.001). QoL was impaired significantly with high disease severity (p=0.002) and facial involvement (p=0.017). CONCLUSIONS:Itraconazole significantly improves the QoL in patients with moderate to severe SD.
Treatment of Seborrheic Dermatitis Using a Novel Herbal-based Cream.
Barak-Shinar Deganit,Del Río Ruben,Green Lawrence J
The Journal of clinical and aesthetic dermatology
Seborrheic dermatitis is a common relapsing inflammatory skin condition occurring in approximately 3 to 5 percent of the general population. Current available therapies control, but do not cure seborrhea. The study's objective was to determine the safety and efficacy of a barrier-based, nonsteroidal cream incorporating herbal extracts as a treatment for facial seborrheic dermatitis. Interventional, open label, safety/efficacy study. At the baseline visit, the investigator selected a target area on the face. The target area was evaluated for Investigator Static Global Assessment, desquamation (scaling), induration (inflammation), and erythema (redness) as well as self-assessed pruritus. Thirty-two subjects with seborrheic dermatitis were enrolled in the study. Subjects were instructed to use the study medication twice a day, morning and evening, for a consecutive period of 42 days. In addition to the baseline visit (Day 0), subjects visited the clinic for two follow-up visits at Days 14 and 28 and for a final visit at Day 42. At each visit, all parameters were evaluated. A reduction in all parameters evaluated was seen at almost all timepoints, improving more from one timepoint to the next during the study period. In addition, the patients expressed a high degree of satisfaction with the treatment. No adverse events were reported during this study. The study showed that after six weeks of treatment, the face cream provided improvement in Investigator Static Global Assessment, pruritus, desquamation, induration, and erythema. NCT02656368 (https://clinicaltrials.gov/ct2/sh ow/NCT02656368?term=Kamedis&rank=2).
Prevalence and determinants of seborrhoeic dermatitis in a middle-aged and elderly population: the Rotterdam Study.
Sanders M G H,Pardo L M,Franco O H,Ginger R S,Nijsten T
The British journal of dermatology
BACKGROUND:Seborrhoeic dermatitis is a chronic relapsing inflammatory skin disease with unclear pathophysiological mechanisms. OBJECTIVES:To establish which lifestyle and physiological determinants are associated with seborrhoeic dermatitis. METHODS:Seborrhoeic dermatitis was diagnosed by a trained physician during a full-body skin examination within the Rotterdam Study, a prospective population-based cohort study in middle-aged and elderly people. The current design is a comparative cross-sectional study embedded in the Rotterdam Study. Potential factors were identified from the literature and analysed in a multivariable logistic regression, including: age, sex, obesity, skin colour, stress, depression, education level, hypertension, climate, xerosis cutis, alcohol and tobacco use. RESULTS:Of the 5498 participants, 788 participants were diagnosed with seborrhoeic dermatitis (14·3%). We found associations between seborrhoeic dermatitis and male sex [adjusted odds ratio (OR) 2·09, 95% confidence interval (CI) 1·77-2·47], darker skin (adjusted OR 0·39, 95% CI 0·22-0·69), season (summer vs. winter: adjusted OR 0·63, 95% CI 0·48-0·82) and generalized xerosis cutis (adjusted OR 1·41, 95% CI 1·11-1·80). CONCLUSIONS:Seborrhoeic dermatitis is one of the most common inflammatory dermatoses in middle-aged and elderly individuals, especially during winter. Men, and people with a light and dry skin were most likely to have seborrhoeic dermatitis.
Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population-based study in 161 269 employees.
Zander N,Sommer R,Schäfer I,Reinert R,Kirsten N,Zyriax B-C,Maul J-T,Augustin M
The British journal of dermatology
BACKGROUND:Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. OBJECTIVES:To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. METHODS:In the course of voluntary company skin checks, full-body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. RESULTS:In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35-64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9-18·1], onychomycosis (9·1%, 95% CI 8·3-10·0), tinea pedis (7·1%, 95% CI 6·3-7·8), rosacea (4·1%, 95% CI 3·6-4·7), acne (4·0%, 95% CI 3·4-4·5) and psoriasis (2·7%, 95% CI 2·3-3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0-2·3], contact dermatitis (OR 1·8, 95% CI 1·1-2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4-2·2), rosacea (OR 1·6, 95% CI 1·4-1·8), acne (OR 1·4, 95% CI 1·2-1·7), pyoderma (OR 1·4, 95% CI 1·1-1·8), tinea corporis (OR 1·4, 95% CI 1·0-2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0-1·7) and psoriasis (OR 1·2, 95% CI 1·0-1·5). CONCLUSIONS:Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.
Clinical Evaluation of a New-Formula Shampoo for Scalp Seborrheic Dermatitis Containing Extract of Rosa centifolia Petals and Epigallocatechin Gallate: A Randomized, Double-Blind, Controlled Study.
Kim Yu Ri,Kim Jeong-Hwan,Shin Hong-Ju,Choe Yong Beom,Ahn Kyu Joong,Lee Yang Won
Annals of dermatology
BACKGROUND:Scalp seborrheic dermatitis is a chronic type of inflammatory dermatosis that is associated with sebum secretion and proliferation of Malassezia species. Ketoconazole or zinc-pyrithione shampoos are common treatments for scalp seborrheic dermatitis. However, shampoos comprising different compounds are required to provide patients with a wider range of treatment options. OBJECTIVE:This study was designed to evaluate a new-formula shampoo that contains natural ingredients-including extract of Rosa centifolia petals and epigallocatechin gallate (EGCG)-that exert antioxidative, anti-inflammatory, and sebum secretion inhibitory effects, and antifungal agents for the treatment of scalp seborrheic dermatitis. METHODS:Seventy-five patients were randomized into three treatment groups; new-formula shampoo, 2% ketoconazole shampoo, and 1% zinc- pyrithione shampoo. The clinical severity scores and sebum levels were assessed by the same dermatologists at baseline (week 0), and at 2 and 4 weeks after using the shampoo. User satisfaction and irritation were also assessed with the aid of a questionnaire. RESULTS:The efficacy of the new-formula shampoo was comparable to that of both the 1% zinc-pyrithione shampoo and the 2% ketoconazole shampoo. Furthermore, it was found to provide a more rapid response than the 1% zinc-pyrithione shampoo for mild erythema lesions and was associated with greater user satisfaction compared with the 2% ketoconazole shampoo. However, the new-formula shampoo did not exhibit the previously reported sebum inhibitory effect. CONCLUSION:Extract of R. centifolia petals or EGCG could be useful ingredients in the treatment of scalp seborrheic dermatitis.
Isolation and identification of Malassezia species from Chinese and Korean patients with seborrheic dermatitis and in vitro studies on their bioactivity on sebaceous lipids and IL-8 production.
Kim Soo Young,Kim Se Hyun,Kim Su Na,Kim Ah-Reum,Kim Yu Ri,Kim Min Jung,Park Won-Seok,Lee John Hwan,Jung Won Hee,Lee Yang Won,Choe Yong Beom,Ahn Kyu Joong
We investigated the distribution of Malassezia yeast in 120 Chinese (20 patients from each of six cities) and 20 Korean patients with scalp seborrheic dermatitis (SD) and dandruff (SD/D) using ITS1 and ITS2 polymerase chain reaction-restriction fragment length polymorphism. Bioactivity was studied by quantifying sebum lipid production by human primary sebocytes and inflammatory cytokine, interleukin-8 (IL-8) production was studied by exposing HaCaT keratinocytes with extracts of five standard Malassezia strains; M. globosa, M. restricta, M. sympodialis, M. dermatis and M. slooffiae. M. restricta and M. globosa were the most frequently encountered species from both Chinese and Korean patients. These two Malassezia species also promoted neutral lipid synthesis although the result was not statistically significant and induced significant increase in IL-8 production among the five Malassezia species studied. The study suggests a possible role of these organisms in the pathogenesis of SD/D.
Malassezia arunalokei sp. nov., a Novel Yeast Species Isolated from Seborrheic Dermatitis Patients and Healthy Individuals from India.
Honnavar Prasanna,Prasad Gandham S,Ghosh Anup,Dogra Sunil,Handa Sanjeev,Rudramurthy Shivaprakash M
Journal of clinical microbiology
The majority of species within the genus Malassezia are lipophilic yeasts that colonize the skin of warm-blooded animals. Two species, Malassezia globosa and Malassezia restricta, are implicated in the causation of seborrheic dermatitis/dandruff (SD/D). During our survey of SD/D cases, we isolated several species of Malassezia and noticed vast variations within a few lipid-dependent species. Variations observed in the phenotypic characteristics (colony morphology, absence of catalase activity, growth at 37°C, and precipitation surrounding wells containing Tween 20 or Cremophor EL) suggested the possible presence of a novel species. Sequence divergence observed in the internal transcribed spacer (ITS) region, the D1/D2 domain, and the intergenic spacer 1 (IGS1) region of rDNA and the TEF1 gene, PCR-restriction fragment length polymorphism (RFLP) analysis of the ITS2 region, and fluorescent amplified fragment length polymorphism analysis support the existence of a novel species. Based on phenotypic and molecular characterization of these strains, we propose a new species, namely, M. arunalokei sp. nov., and we designate NCCPF 127130 (= MTCC 12054 = CBS 13387) as the type strain.
Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review.
Gupta Aditya K,Versteeg Sarah G
American journal of clinical dermatology
BACKGROUND:Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition. OBJECTIVE:Our objective was to critically review the published literature on topical treatments for facial SD. METHODS:We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies. RESULTS:A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment. CONCLUSION:Promiseb, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials).
Efficacy and tolerability of 1% ciclopirox shampoo in the treatment of moderate-to-severe scalp seborrheic dermatitis: a multicenter, prospective, assessor-blinded trial.
Veraldi Stefano,Barbareschi Mauro,Martella Alessandro,Milani Massimo
Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia
BACKGROUND:Seborrheic dermatitis (SD) is a very common inflammatory skin disease. It occurs in 1-3% of the population. The most supported pathogenetic theory links SD to dandruff via a common etiology, yeasts of the genus Malassezia. Ketoconazole and ciclopirox (CPX) shampoo are considered as the first line treatment of SD of the scalp. CPX is a broad-spectrum, hydroxypyridone-derived, synthetic antifungal agent with anti-bacterial, anti-inflammatory, and anti-oxidant properties. The aim of this study was to assess the efficacy and tolerability of 1% CPX shampoo in SD of the scalp. METHODS:A total of 40 patients, 31 men and 9 women, mean age 33±6 years, with scalp SD of moderate-to-severe grade were enrolled, after their informed consent, in this 12-week prospective assessor-blinded trial. One-percent CPX shampoo (5 mL) was applied twice a week for 12 weeks. The primary efficacy parameter was the Total Dandruff Severity Score (TDSS), based on 4-point ordinal scales describing signs and symptoms (scaling, inflammation, and itching) of the disease, evaluated in an assessor-blinded fashion, at baseline and after 6 and 12 weeks. Secondary outcomes were the single items of the TDSS and the evaluation of local tolerability. RESULTS:At baseline the TDSS was 17±5. After 1% CPX TDSS was reduced to 10±5 at week 6 and to 6.6±4 at the end of study period (P=0.0001; ANOVA test). This difference represents a 62% reduction in comparison with baseline. At week 12, the reduction of scaling, inflammation and itching scores were -55%, -65%, and -69%, respectively. The product was very well tolerated. No side effects were reported or observed during the study. CONCLUSIONS:The study supports the use of 1% CPX shampoo in the treatment of SD of the scalp. CPX shampoo was able to reduce desquamation, inflammation and itching associated with scalp SD. Furthermore, 1% CPX shampoo was found to be safe and well tolerated.
Novel Non-Steroidal Facial Cream Demonstrates Antifungal and Anti-Inflammatory Properties in Ex Vivo Model for Seborrheic Dermatitis.
Granger Corinne,Balato Anna,Goñi-de-Cerio Felipe,Garre Aurora,Narda Mridvika
Dermatology and therapy
INTRODUCTION:Seborrheic dermatitis (SEBD) is a chronic, recurrent skin disorder that typically occurs as an inflammatory response to fungi of the genus Malassezia. The development of an ex vivo model that mimics the fungal proliferation and skin inflammation of SEBD would play an important role in screening formulations for their efficacy in treating SEBD. METHODS:An ex vivo model for SEBD using human skin explants that had been mechanically manipulated to facilitate colonization of Malassezia furfur was developed. This model was used to evaluate the efficacy of a novel non-steroidal facial cream (NSFC) in inhibiting M. furfur proliferation and reducing inflammatory cytokine levels. RESULTS:This model reproduced some of the key pathological features of SEBD, including M. furfur proliferation and inflammatory cytokine production. Topical application of NSFC facial cream reduced M. furfur counts by 92% (p < 0.05) and levels of interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-α) by 82% and 40%, respectively (p < 0.05, both). CONCLUSION:The proposed ex vivo model for SEBD could be a useful tool to evaluate topical antifungal treatments. The novel NSFC tested in this study reduced M. furfur proliferation and inflammatory cytokine levels following topical application and may be helpful in the management of SEBD. FUNDING:ISDIN.
Exploring Anti-Fungal, Anti-Microbial and Anti-Inflammatory Properties of a Topical Non-Steroidal Barrier Cream in Face and Chest Seborrheic Dermatitis.
Balato Anna,Caiazzo Giuseppina,Di Caprio Roberta,Scala Emanuele,Fabbrocini Gabriella,Granger Corinne
Dermatology and therapy
INTRODUCTION:The pathogenesis of seborrheic dermatitis (SD) is multifactorial and traditional treatments may not target all aspects of it. The aim of this study was to evaluate short-term anti-fungal, anti-microbial, anti-inflammatory and anti-pruritus properties of a novel non-steroidal cream (NSC) containing piroctone olamine, zinc salt of L-pyrrolidone carboxylate (PCA), hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2 and stearyl glycyrrhetinate in patients with face and chest SD. METHODS:Twelve male subjects affected by SD, presenting face and chest manifestations, were enrolled. Patients were instructed to apply NSC twice a day, performing regular visits at baseline (W0), after 7 (W1) and 14 (W2) days of treatment. A limitation of the study was that no control group treated with the vehicle without active ingredients was enrolled. To evaluate the efficacy of the NSC, investigator's assessments were represented by scoring index (SI) and investigator's global assessment score (IGA). In order to assess NSC anti-fungal and anti-microbial effects, skin scale scrapings were collected and used for Malassezia furfur (MF) and Staphylococcus epidermidis (SE) cultures. In parallel, in order to assess NSC anti-inflammatory effects, gene expression of IL-1α, IL-1β, IL-6, IL-8, and TNF-α was assessed. In addition, anti-pruritus effects were also evaluated through gene expression of cathepsin S and L-histidine decarboxylase. RESULTS:SI mean scores significantly decreased at W1 and, to a greater extent, at W2 compared with W0. The IGA score registered an important improvement efficacy both for face and chest, from W1 to W2. MF and SE growth was already inhibited at W1, with a more pronounced decrease at W2. Gene expression of all analyzed mediators was significantly reduced at W1 compared to W0. CONCLUSION:In conclusion, our assessment is that NSC is an effective and well tolerated treatment option for SD with anti-fungal, anti-microbial and anti-inflammatory properties. TRIAL REGISTRATION:ISRCTN registry, ISRCTN77871064 (retrospectively registered October 17, 2019). EudraCT number, 2019-003813-32. FUNDING:ISDIN.
Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country.
Araya Manapajon,Kulthanan Kanokvalai,Jiamton Sukhum
Indian journal of dermatology
BACKGROUND:Seborrheic dermatitis is a common chronic inflammatory skin condition that can have a negative impact on a patient's quality of life. Few studies have been conducted to assess the clinical characteristics of the disease and quality of life of the patients, especially in tropical countries. AIMS AND OBJECTIVES:The aim of this study was to demonstrate the clinical characteristics and quality of life of patients with seborrheic dermatitis in Thailand. MATERIALS AND METHODS:A cross-sectional study was performed at a university-based hospital and tertiary referral center in Bangkok, Thailand. The validated Thai version of the dermatology life quality index (DLQI) was used to evaluate patients' quality of life. RESULTS:A total of 166 participants were included. One hundred and forty-seven patients (88.6%) experienced multiple episodes of the eruption. The mean of outbreaks was 7.8 times per years, ranging from once every 4 years to weekly eruption. The most common factor reported to aggravate seborrheic dermatitis was seasonality (34.9%), especially hot climate. The mean (SD) of the total DLQI score was 8.1 (6.0) with a range of 0 to 27. There was no statistically significant difference between the two DLQI categories regarding duration of disease, extent of involvement, symptoms or course of the disease. CONCLUSION:Although mild and asymptomatic, seborrheic dermatitis can have a great impact on the quality of life. Youth, female gender, and scalp lesions were significantly associated with higher DLQI scores.
Clinical manifestation and associated factors of seborrheic dermatitis in Korea.
Park Seon Yong,Kwon Hyuck Hoon,Min Seonguk,Yoon Ji Young,Suh Dae Hun
European journal of dermatology : EJD
UNLABELLED:Systematic investigations of clinical manifestation and factors associated with the severity of seborrheic dermatitis (SD) have rarely been reported in Asia. We investigated the clinical manifestation and associated factors of SD. Patients were asked to fill a self-questionnaire including symptom severity and aggravating factors. We evaluated objective severity and involved sites of SD. Patients were categorized into three groups; young age group (age <30), middle age group (30≤ age <60), and old age group (age ≥60) and we compared clinical features among them. RESULTS:Among 253 patients included, scalp was the most frequently involved site and the most frequently reported aggravating factor was psychological stress. Different age groups have distinct clinical features and severity. Severity of SD decreased with age and patients in the old age group had less frequent involvement of the lower face. Risk factors of scalp involvement were male gender, disease duration ≥7 years and a history of acne. We investigated associated factors of SD and observed different clinical features between the age groups. We suggest that the adult form of SD can be categorized into three groups; young age SD, middle age SD and old age SD.
Comprehensive pyrosequencing analysis of the bacterial microbiota of the skin of patients with seborrheic dermatitis.
Tanaka Akiomi,Cho Otomi,Saito Chie,Saito Mami,Tsuboi Ryoji,Sugita Takashi
Microbiology and immunology
Seborrheic dermatitis (SD) is a chronic inflammatory dermatologic condition in which erythema and itching develop on areas of the body with sebaceous glands, such as the scalp, face and chest. The inflammation is evoked directly by oleic acid, which is hydrolyzed from sebum by lipases secreted by skin microorganisms. Although the skin fungal genus, Malassezia, is thought to be the causative agent of SD, analysis of the bacterial microbiota of skin samples of patients with SD is necessary to clarify any association with Malassezia because the skin microbiota comprises diverse bacterial and fungal genera. In the present study, bacterial microbiotas were analyzed at non-lesional and lesional sites of 24 patients with SD by pyrosequencing and qPCR. Principal coordinate analysis revealed clear separation between the microbiota of non-lesional and lesional sites. Acinetobacter, Corynebacterium, Staphylococcus, Streptococcus and Propionibacterium were abundant at both sites. Propionibacterium was abundant at non-lesional sites, whereas Acinetobacter, Staphylococcus and Streptococcus predominated at lesional sites; however, the extent of Propionibacterium colonization did not differ significantly between lesional and non-lesional sites according to qPCR. Given that these abundant bacteria hydrolyze sebum, they may also contribute to SD development. To the best of our knowledge, this is the first comprehensive analysis of the bacterial microbiotas of the skin of SD patients.
New perspectives on dandruff and seborrheic dermatitis: lessons we learned from bacterial and fungal skin microbiota.
Paulino Luciana Campos
European journal of dermatology : EJD
The human body is inhabited by complex microbial communities, which positively impact different aspects of our health, and might also be related to the development of diseases. Progress in technologies, particularly sequencing methods and bioinformatics tools, has been crucial for the advances in this field. Microbial communities from skin can modulate immune response and protect the host against pathogens, and there are also data supporting their association with several skin conditions; including dandruff and seborrheic dermatitis. For decades, they have been thought to be related to Malassezia yeasts; however, the microbial role has not been elucidated, and their etiology remains poorly understood. This review discusses the recent findings in dandruff and seborrheic dermatitis and their relation to the skin microbiota. Data provided new perceptions to aid in the understanding of these skin disorders, broadening our view of their etiology and the possible roles of microbial communities in symptom development.
Efficacy of Oral Itraconazole in the Treatment of Seborrheic Dermatitis in Vietnamese Adults Patients.
Van Thuong Nguyen,Thi Ngo Hoang,Van Tam Hoang,Van Hung Le,Huu Nghi Dinh,Minh Phuong Pham Thi,Cam Van Tran,Huyen My Le,Hau Khang Tran,Gandolfi Marco,Satolli Francesca,Feliciani Claudio,Tirant Michael,Vojvodic Aleksandra,Lotti Torello
Open access Macedonian journal of medical sciences
AIM:This longitudinal study aims to evaluate the efficacy of oral itraconazole in the treatment of seborrheic dermatitis in Vietnamese patients. METHODS:Thirty patients were enrolled at National Hospital of Dermatology and Venereology, Hanoi, Vietnam and were treated with oral itraconazole (200 mg daily in 14 days followed by 200 mg weekly in 4 weeks). The clinical severity was assessed by a four-parameter scoring system. All patients completed the six-week regimen with good adherence. RESULTS:At the week 2nd, 70% of the patients had moderate to severe diseases. At the week 6th, 63.4% of the patients achieve clearance of the lesions, and none had severe disease. No side effects were reported. CONCLUSION:Oral itraconazole can be an option for seborrheic dermatitis because of good efficacy, safety profile and adherence.
Comparison of efficacy and safety of atorvastatin 5% lotion and betamethasone 0.1% lotion in the treatment of scalp seborrheic dermatitis.
Sobhan Mohammadreza,Gholampoor Ghazal,Firozian Farzin,Mohammadi Younes,Mehrpooya Maryam
Clinical, cosmetic and investigational dermatology
Seborrheic dermatitis (SD) is a chronic inflammatory skin disorder that mainly affects areas rich in sebaceous glands, such as the scalp. Although the exact cause of SD is not clearly understood, it seems that skin colonization with Malassezia fungus and the inflammatory responses of the immune system to this fungus play an important role in the pathology of SD. Recently a growing body of evidence has shown anti-inflammatory and anti-fungal effects of statins. Thus, this study aimed to evaluate the efficacy of topical atorvastatin in the treatment of scalp SD. In this double-blind, clinical trial, 86 patients with mild-to-moderate scalp SD were divided into either atorvastatin (n=45) or betamethasone groups (n=41) by block randomization method. In addition to the ketoconazole 2% shampoo (3 times per week), the atorvastatin group received atorvastatin 5% lotion and the betamethasone group received betamethasone 0.1% lotion daily for 4 weeks. The SD severity of each patient was determined by Symptom Scale of Seborrheic Dermatitis (SSSD) at baseline and 4 weeks after treatment. Also, the patient's satisfaction of the treatment and adverse effects were investigated through individual reporting. After 4 weeks of treatment, the score of SD severity decreased significantly in both groups, while changes of SSSD score from baseline to the fourth week of treatment were comparable in the two groups (-value=0.476). Regarding patient's satisfaction of the treatment, results demonstrated the non-inferiority of atorvastatin as compared to betamethasone. Topical atorvastatin was also well-tolerated in almost all patients. Although preliminary, the results of the present study showed that topical atorvastatin has a comparable effect to topical betamethasone and can be considered as an alternative therapeutic modality in the treatment of scalp SD. However, these results need to be confirmed in future studies while taking into consideration the improvement of topical statin formulations.
History of Seborrheic Dermatitis: Conceptual and Clinico-Pathologic Evolution.
Mameri Angela Cristina Akel,Carneiro Sueli,Mameri Letícia Maria Akel,Telles da Cunha José Marcos,Ramos-E-Silva Marcia
Seborrheic dermatitis is an inflammatory and chronic disease with a high incidence and prevalence (1% to 3% in the general population, 3% to 5% in young adults, and 40% to 80% in HIV-positive individuals). Although the condition was first described in 1887, its clinical aspects and clinical forms have still not been well individualized, nor has its etiopathogenesis been fully elucidated. The disease, despite having clinical features similar to dermatitis, does not have the same histopathologic features or the same progressive clinical behavior. This contribution reviews the history of seborrheic dermatitis.
Seborrheic Dermatitis in Skin of Color: Clinical Considerations
Elgash May,Dlova Ncoza,Ogunleye Temitayo,Taylor Susan C.
Journal of drugs in dermatology : JDD
Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic “cradle cap” appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color.J Drugs Dermatol. 2019;18(1):24-27.
Scalp Seborrheic Dermatitis and Dandruff Therapy Using a Herbal and Zinc Pyrithione-based Therapy of Shampoo and Scalp Lotion.
Barak-Shinar Deganit,Green Lawrence J
The Journal of clinical and aesthetic dermatology
The aim of this study was to evaluate the safety and efficacy of an herbal and zinc pyrithione shampoo and a scalp lotion (Kamedis Derma-Scalp Dandruff Therapy, Kamedis Ltd., Tel Aviv, Israel) for the treatment of scalp seborrheic dermatitis and dandruff. This was an interventional, open-label, safety and efficacy study. This open-label study was conducted at Consumer Product Testing Company Inc. in Fairfield, New Jersey. At the baseline visit (Day 0), an examination of the scalp was conducted by a board-certified dermatologist. The entire scalp was evaluated for evidence of seborrheic dermatitis using the Adherent Scalp Flaking Score with a 10-point scale. Only subjects with evidence of moderate-to-greater seborrheic dermatitis or moderate-to-greater dandruff were deemed qualified for inclusion in the study. Fifty subjects were recruited and included in the study. Study subjects were evaluated by the same dermatologist for erythema and flaking at Days 0, 14, 28, and 42 using a five-point scale for each parameter. At each time point, a total severity score was calculated based on the findings of the evaluations. Following the scalp evaluation, each subject had a standardized digital photograph taken of his or her scalp. Each subject was also asked to answer a satisfaction questionnaire regarding the product treatment enhancement and characteristics. A reduction in both parameters evaluated was seen at all time points. Statistical significance was achieved at each time point when compared with the baseline visit. In addition, the subjects expressed a high degree of satisfaction with the treatment. No adverse events were reported during this study. The study showed that the herbal zinc pyrithione shampoo and scalp lotion provided improvement in the main symptoms of seborrheic dermatitis.
Treatment of seborrheic dermatitis: a comprehensive review.
Borda Luis J,Perper Marina,Keri Jonette E
The Journal of dermatological treatment
Seborrheic dermatitis (SD) is a chronic, recurring inflammatory skin disorder that manifests as erythematous macules or plaques with varying levels of scaling associated with pruritus. The condition typically occurs as an inflammatory response to Malassezia species and tends to occur on seborrheic areas, such as the scalp, face, chest, back, axilla, and groin areas. SD treatment focuses on clearing signs of the disease; ameliorating associated symptoms, such as pruritus; and maintaining remission with long-term therapy. Since the primary underlying pathogenic mechanisms comprise Malassezia proliferation and inflammation, the most commonly used treatment is topical antifungal and anti-inflammatory agents. Other broadly used therapies include lithium gluconate/succinate, coal tar, salicylic acid, selenium sulfide, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, mud treatment, phototherapy, among others. Alternative therapies have also been reported, such as tea tree oil, Quassia amara, and Solanum chrysotrichum. Systemic therapy is reserved only for widespread lesions or in cases that are refractory to topical treatment. Thus, in this comprehensive review, we summarize the current knowledge on SD treatment and attempt to provide appropriate directions for future cases that dermatologists may face.
Assessing Biophysical and Physiological Profiles of Scalp Seborrheic Dermatitis in the Thai Population.
BioMed research international
BACKGROUND:Scalp seborrheic dermatitis (SD) is a common and chronic inflammatory skin disease which tends to recur over time. By measuring biophysical properties of the stratum corneum, many studies report abnormal biophysical profiles and their association in various dermatologic diseases. The aim of the study is to analyze the biophysical properties and skin barrier defects of scalp SD compared to healthy controls. MATERIALS AND METHODS:This study is a cross-sectional study assessing the correlation of various biophysical and physiological profiles in scalp SD. Forty-two Thai participants with scalp SD were enrolled in the study and 40 healthy participants were also enrolled as the control group. Both SD and control group were subjected to a one-time biophysical and physiological properties' measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin surface pH, skin surface lipid, and skin roughness. RESULTS:The mean TEWL of lesional skin of SD cases were significantly higher than those of control group (<0.05). Relating to high mean TEWL, the mean SCH was found to be significantly lower in SD cases (<0.05). Skin surface lipid was also found to be significantly higher in SD group (<0.05). However, there were no differences in skin surface pH (=0.104) and roughness (=0.308) between the two groups. Pairwise comparison of each subgroup found that moderate and severe SD demonstrated significantly higher mean skin surface lipid than that of control group (<0.05). CONCLUSION:Scalp SD may be associated with seborrhea in Thai population. Monitoring of SCH, TEWL, and skin surface lipid could be helpful in assessing severity and evaluating the treatment outcome in patients with scalp SD.
Topical Non-Pharmacological Treatment for Facial Seborrheic Dermatitis.
Piquero-Casals Jaime,Hexsel Doris,Mir-Bonafé Juan Francisco,Rozas-Muñoz Eduardo
Dermatology and therapy
Facial seborrheic dermatitis (FSD) is a chronic and relapsing inflammatory skin disorder occurring in areas of the face rich in sebaceous glands. It clinically manifests as erythematous scaly macules or plaques, often associated with pruritus. Although the pathogenesis of seborrheic dermatitis is not yet fully understood, Malassezia yeast, hormones, sebum levels, and immune response are known to play important roles. Additional factors including drugs, cold temperatures, and stress may exacerbate the condition. Currently, the available treatments do not cure the disease but relieve symptoms. Various pharmacological treatments are available, including antifungal agents, keratolytics, topical low-potency steroids, and calcineurin inhibitors. All of them provide several benefits, but they also have potential side effects. Seborrheic dermatitis tends to have a chronic, recurrent course. To avoid the long-term use of drugs, topical non-pharmacological products such as cosmetics or medical devices may improve clinical outcomes. Products with antimicrobial and anti-inflammatory ingredients such as zinc, piroctone olamine, dihydroavenanthramide, biosaccharide gum-2, and stearyl glycyrrhetinate may speed FSD recovery and avoid flare-ups. Finally, the use of specific cleansers, moisturizers, and sunscreens formulated as light creams or gel/creams should be strongly recommended to all FSD patients. We provide a brief review of the most used non-pharmacological cleansers, topical gel/creams, and specific sunscreens in the management of FSD.
Clinical Evaluation of Sequential Transdermal Delivery of Vitamin B6, Compound Glycyrrhizin, Metronidazole, and Hyaluronic Acid Using Needle-Free Liquid Jet in Facial Seborrheic Dermatitis.
Zhang Xiaomin,Luo Bizhu,Mo Huihui,Liao Lexi,Wang Shuai,Du Juan,Liu Qiuting,Liang Yanhua
Frontiers in medicine
Facial seborrheic dermatitis (FSD) is a common facial inflammatory dermatitis. Needle-free transdermal jet injection (NTJI) is a non-invasive injection of drug solution by using a high-pressure liquid injection instrument. To explore a safer, more tolerable, and convenient medical way using NTJI in the treatment of FSD, the patients were treated with vitamin B6, glycyrrhizin compound, metronidazole, and hyaluronic acid sequentially using NTJI every 2 weeks, and only those treated for more than three times were included. A VISIA facial imaging system for the evaluation of erythema, superficial lipid level, and roughness of skin surface and a CK analyzer for biophysical parameters, including the stratum corneum hydration, facial surface lipid, and trans-epidermal water loss, were applied. Erythema was significantly reduced after every treatment (weeks 2, 4, and 6; < 0.05), whereas superficial lipid level was not improved significantly until week 6 ( < 0.05), and roughness of the skin surface was not improved significantly during the whole treatment. The stratum corneum hydration of lesional skin was significantly increased after three times of treatment ( < 0.05). No observable adverse effect, such as marked erythema, blistering, or atrophy, was observed. Sequential transdermal delivery of small molecular weight drugs (vitamin B6, glycyrrhizin compound, metronidazole, and hyaluronic acid) using NTJI is a safe, low-toxicity, and take-home drug-free therapy for the treatment of FSD.
Effective Picosecond Nd:YAG laser on seborrheic dermatitis and its mechanism.
Liu Junru,Han Chunyu,Feng Xien,Liang Jinning,Qu Yan
Journal of cosmetic dermatology
BACKGROUND:The Picosecond Nd:YAG laser has advantages in skin rejuvenation, which has little damage to surrounding tissues due to the ultra-short pulse width. We perform clinical application of Picosecond Nd:YAG laser's tender skin mode, which could improve the seborrheic dermatitis. MATERIALS AND METHODS:Sixty-three subjects with facial seborrheic dermatitis are randomized to be control and observation groups. Records regarding skin subjective improvement, skin barrier function-related data, skin microbial status, and dermoscopy detection of the two patient groups before and after treatments are investigated. RESULTS:Improvements of erythema and scales in observation group are significant compared with controls (p < 0.05). In terms of skin barrier function, there are significant changes regarding transepidermal water loss and epidermal seborrhea content in observation group after the laser treatments. Skin microbial state, pityrosporum furfur, and Demodex significantly decrement in observation group. Microscopical findings of infiltration mode advise that scales and capillary congestion and dilatation are significantly improved in observation group. Compared with controls, epidermal gloss increases, pore fineness improves, and capillary density decreases in the observation group. CONCLUSIONS:Picosecond Nd:YAG laser could efficiently decrease erythema area and seborrheic dermatitis scales and reduce pruritus incidence. The sebaceous gland secretion of seborrhea and multiplying of epidermal parasitic microbiological are inhibited after laser treatment. Less epidermal seborrhea content and inflammation are induced by parasitic microbiology, which is helpful for skin barrier function and microvascular remodeling.
Insulin Resistance and Metabolic Syndrome in Patients with Seborrheic Dermatitis: A Case-Control Study.
Metabolic syndrome and related disorders
Our knowledge of the systemic effects of seborrheic dermatitis (SD) as a chronic inflammatory skin disease remains limited. We aimed to evaluate metabolic syndrome (MS) and glucose metabolism disorders in patients with SD. The study includes 53 patients over the age of 18 diagnosed with SD and 50 age-, gender-, and body mass index-matched healthy controls. Demographic data, anthropometric measurements, blood pressure levels, family history of SD and metabolic disorder, smoking history, and severity of the disease in SD patients were obtained. Fasting plasma glucose, insulin, hemoglobin A1c, lipid profile levels, and two-hour plasma glucose in the oral glucose tolerance test (OGTT 2-h PG), homeostasis model assessment of insulin resistance (HOMA-IR), and presence of MS were determined. Weight, waist circumference, family history of SD, family history of metabolic disorder, and smoking status were significantly higher in the SD group compared with the control group ( = 0.04, = 0.007, = 0.004, = 0.004, and = 0.048, respectively). The levels of fasting plasma insulin and triglyceride, HOMA-IR and OGTT 2-h PG were also significantly higher in the SD group than in the control group ( = 0.0001, = 0.033, = 0.0001, and = 0.049, respectively). In addition, the number of those with insulin resistance was significantly higher in the group with SD ( = 31, 58.49%) than in the control group ( = 11, 22%) ( = 0.0001). Although the rate of MS was higher in patients with SD ( = 12, 22.64%) than the controls ( = 6, 12%), the difference was not significant ( = 0.155). Our findings suggest an association between SD and insulin resistance, which may be due to their common inflammatory pathogenesis. This may be an indicator of susceptibility to diabetes, and these patients can be followed up for conditions associated with insulin resistance and encouraged to adopt a healthy lifestyle.
Presence of Hyphae Is Correlated with Pathogenesis of Seborrheic Dermatitis.
Li Juanjuan,Feng Yahui,Liu Chen,Yang Zhiya,de Hoog Sybren,Qu Yuying,Chen Biao,Li Dongmei,Xiong Huabao,Shi Dongmei
Seborrheic dermatitis (SD) is a common, chronic, and relapsing skin disease. The roles of spp. in the pathogenesis of SD are still not clear due to the lack of direct evidence for the existence of hyphae within affected skin tissues. We set out to elucidate if mycelium contributes to the onset and development of SD and if mycelium is correlated with the clinical severity of SD patients. We detected hyphae in patients with SD using potassium hydroxide (KOH) and calcofluor white (CFW) staining. Fluorescent microscopy was performed for the analysis of fungal cell wall and morphological characteristics of under CFW staining. Culture growth in modified Dixon agar was used for DNA extraction and sequencing, and species were confirmed by a sequencing data BLAST search against the NCBI database. We demonstrated that hyphae were positively correlated with the clinical severity of SD patients (= 3.1738 × 10). All the patients responded well to antifungal treatment. There is no significant difference for species dominance across the variant groups. However, the exact molecular mechanisms of how spp. affect SD need to be further explored. The results show that spp. in the hyphal stage are restricted to SD patients compared with healthy controls, suggesting that the presence of hyphae contributes to the pathogenesis of SD. The results highlight the importance of the antifungal therapy for the future treatment of SD patients. Our results support the proposal that the hyphal form of could be one of the pathogenic factors that contribute to SD, which has been previously less well studied. This clinical observation paves the way for further investigations of the molecular mechanisms of hyphal pathogenicity in SD.
Diagnosis and treatment of seborrheic dermatitis.
Clark Gary W,Pope Sara M,Jaboori Khalid A
American family physician
Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.
Metabolic syndrome may be an important comorbidity in patients with seborrheic dermatitis.
Imamoglu Betul,Hayta Sibel Berksoy,Guner Rukiye,Akyol Melih,Ozcelik Sedat
Archives of medical sciences. Atherosclerotic diseases
INTRODUCTION:Seborrheic dermatitis is a chronic inflammatory skin disease. One of the components of metabolic syndrome is inflammation, and many inflammatory cytokines play a critical role in the disease. The aim of this study is to investigate metabolic syndrome and to evaluate the relationship between the parameters of the disease and disease severity in patients with seborrheic dermatitis. MATERIAL AND METHODS:Forty-seven patients with seborrheic dermatitis and 36 healthy controls were included in the study. The parameters of metabolic syndrome were recorded in both groups. In the patient group, disease severity was determined with the seborrheic dermatitis area and severity index (SDASI). All the venous blood samples were taken at 8 a.m. after 10 h of fasting. RESULTS:High-density lipoprotein (HDL) levels in the patient group were statistically significantly lower than in the controls. There was no significant difference between groups according to other parameters. In terms of history of metabolic disease in first degree relatives (diabetes mellitus, cardiovascular disease, and dyslipidaemia), 78.7% of those in the patient group ( = 37) and 55.6% of those in the control group ( = 20) had a history of metabolic disease in their families, and the difference between the patient and control groups was found to be statistically significant ( < 0.05). There was a significant correlation between disease severity and plasma HDL levels ( = 0.033, = -0.312). CONCLUSIONS:The presence of seborrheic dermatitis may be a predictive factor for metabolic syndrome.
Cutaneous fungal microbiome: yeasts in seborrheic dermatitis scalp in a randomized, comparative and therapeutic trial.
Kamamoto C S L,Nishikaku A S,Gompertz O F,Melo A S,Hassun K M,Bagatin E
spp in skin microbiome scalp has been implicated in seborrheic dermatitis pathogenesis. Thus, treatment based in antifungal combined to topical keratolitic agents have been indicated as well as oral isotretinoin as it reduces the sebum production, glandular's size and possesses anti-inflammatory properties. This randomized, comparative and therapeutic trial aimed toper form the genotypic identification of species before and after low-dose oral isotretinoin or topical antifungal treatments for moderate to severe seborrhea and/or seborrheic dermatitis on scalp. Scales and sebum of the scalp were seeded in the middle of modified Dixon and incubated at 32°C. For genotypic identification polymerase chain reaction primers for the ITS and D1/D2 ribossomal DNA were used and followed by samples sequencing. The procedure was conducted before and after therapeutic and randomized intervention for moderate to severe seborrhea/seborrheic dermatitis on the scalp, including oral isotretinoin, 10 mg, every other day and anti-seborrheic shampoo (piroctone olamine), over six months. The and were the most frequent species isolated on the scalp before and after both treatments. Other non- species were also identified. The spp. were maintained in the scalp after both treatments that were equally effective for the control of seborrhea/seborrheic dermatitis clinical signs.
Seborrheic dermatitis-Looking beyond Malassezia.
Wikramanayake Tongyu C,Borda Luis J,Miteva Mariya,Paus Ralf
Seborrhoeic Dermatitis (SD) is a very common chronic and/or relapsing inflammatory skin disorder whose pathophysiology remains poorly understood. Yeast of the genus Malassezia has long been regarded as a main predisposing factor, even though causal relationship has not been firmly established. Additional predisposing factors have been described, including sebaceous activity, host immunity (especially HIV infection), epidermal barrier integrity, skin microbiota, endocrine and neurologic factors, and environmental influences. Genetic studies in humans and mouse models-with particularly interesting insights from examining the Mpzl3 knockout mice and their SD-like skin phenotype, and patients carrying a ZNF750 mutation-highlight defects in host immunity, epidermal barrier and sebaceous activity. After synthesizing key evidence from the literature, we propose that intrinsic host factors, such as changes in the amount or composition of sebum and/or defective epidermal barrier, rather than Malassezia, may form the basis of SD pathobiology. We argue that these intrinsic changes provide favourable conditions for the commensal Malassezia to over-colonize and elicit host inflammatory response. Aberrant host immune activity or failure to clear skin microbes may bypass the initial epidermal or sebaceous abnormalities. We delineate specific future clinical investigations, complemented by studies in suitable SD animal models, that dissect the roles of different epidermal compartments and immune components as well as their crosstalk and interactions with the skin microbiota during the process of SD. This research perspective beyond the conventional Malassezia-centric view of SD pathogenesis is expected to enable the development of better therapeutic interventions for the management of recurrent SD.
Serum zinc levels in seborrheic dermatitis: a case-control study
Aktaş Karabay Ezgi,Aksu Çerman Aslı
Turkish journal of medical sciences
Background/aim:Malassezia colonization, sebaceous gland activity, hormones, immune system defects, environmental factors, and the interactions between these factors are thought to contribute to the pathogenesis of seborrheic dermatitis (SD). Zinc, an essential element, is involved in many biological processes including the ones that contribute to the development of SD. The aim of this study is to evaluate serum zinc levels in patients with SD. Materials and methods:Forty-three patients with SD and 41 healthy controls were enrolled in the study. Disease activity was assessed by the Seborrheic Dermatitis Area and Severity Index by a single dermatologist. Serum zinc levels of all subjects were evaluated. Results:Statistically significantly lower serum zinc levels were noted in SD patients than in the control group (79.16 ± 12.17 vs. 84.88 ± 13.59, respectively; P = 0.045). Conclusion:The results of the study demonstrated that patients who had SD had lower levels of serum zinc levels than healthy subjects.
The Effectiveness of a New Topical Formulation Containing GSH-C4 and Hyaluronic Acid in Seborrheic Dermatitis: Preliminary Results of an Exploratory Pilot Study.
Clinical, cosmetic and investigational dermatology
INTRODUCTION:Seborrheic dermatitis is a common skin disease with clinical aspects similar to those of psoriasis, eczema or allergic reactions, appearing on the sebum-rich areas of the scalp, face, and trunk. Yeast like Malassezia species, immunologic abnormalities and activation of complement are recognized as a crucial pathogen for the onset of seborrheic dermatitis. Intermittent and active phases are characterized by burning, scaling and itching, then followed by inactive periods. The disease is sometimes severe up to the erythrodermia; thus, it has a great influence on the patient's quality of life. In vitro and vivo studies have shown that the exogenous intake of glutathione-GSH-C4 and tocopherol inhibits lipid peroxidation and effectively fights and reduces oxidative stress in inflammatory disorders. METHODS:We have carried out a study enrolling 20 patients affected by SD to evaluate the effectiveness and tolerability of a new topical formulation in cream (hereinafter SEB) containing GSH-C4 0.4% in hyaluronic acid 0.25% - a new synthetic glutathione derivate called INCI (butyroyl glutathione)-assigned by the Personal Care Council. Investigator Global Assessment score and Patient Global Assessment of Treatment scales were used to test the efficacy of this new formulation. RESULTS:All patients showed a good clinical response to the treatment with topical SEB demonstrated by the gradual reduction in inflammatory skin lesions. DISCUSSION:The results of our pilot study confirm the efficacy and tolerability of this new topical formulation in a real-life assessment and patients showed strong adherence to therapy. These promising results - still to be confirmed on a larger number of patients - emphasize the potential SEB has in controlling the chronic inflammation of seborrheic dermatitis.
Malassezia and Staphylococcus dominate scalp microbiome for seborrheic dermatitis.
Lin Qingbin,Panchamukhi Ananth,Li Pan,Shan Wang,Zhou Hongwei,Hou Lihua,Chen Wei
Bioprocess and biosystems engineering
Seborrheic dermatitis (SD) is a common disease of the human scalp that causes physical damage and psychological problems for patients. Studies have indicated that dysbiosis of the scalp microbiome results in SD. However, the specific fungal and bacterial microbiome changes related to SD remain elusive. To further investigate the fungal and bacterial microbiome changes associated with SD, we recruited 57 SD patients and 53 healthy individuals and explored their scalp microbiomes using next generation sequencing and the QIIME and LEfSe bioinformatics tools. Skin pH, sebum secretion, hydration, and trans-epidermal water loss (TWEL) were also measured at the scalp. We found no statistically significant differences between the normal and lesion sites in SD patients with different subtypes of dandruff and erythema. However, the fungal and bacterial microbiome could differentiate SD patients from healthy controls. The presence of Malassezia and Aspergillus was both found to be potential fungal biomarkers for SD, while Staphylococcus and Pseudomonas were found to be potential bacterial biomarkers. The fungal and bacterial microbiome were divided into three clusters through co-abundance analysis and their correlations with host factors indicated the interactions and potential cooperation and resistance between microbe communities and host. Our research showed the skin microbe dysbiosis of SD and highlighted specific microorganisms that may serve as potential biomarkers of SD. The etiology of SD is multi-pathogenetic-dependent on the linkage of several microbes with host. Scalp microbiome homeostasis could be a promising new target in the risk assessment, prevention, and treatment of SD disease.
Non-Steroidal Topical Therapy for Facial Seborrheic Dermatitis.
Piquero-Casals Jaime,La Rotta-Higuera Edgar,Francisco Mir-Bonafé Juan,Rozas-Muñoz Eduardo,Granger Corinne
Journal of drugs in dermatology : JDD
Seborrheic dermatitis (SD) is a chronic, recurrent, inflammatory skin disorder occurring in areas rich in sebaceous glands. It manifests clinically as erythematous macules or plaques with varying levels of scaling and associated pruritus. Although the pathogenesis of SD has yet to be fully understood, Malassezia yeasts, hormones, sebum levels, and immune response are known to play important roles. Additional factors including drugs, winter temperatures, and stress may exacerbate SD. Current available treatments include antifungal agents, topical low-potency steroids, and calcineurin inhibitors. We aimed to evaluate the effectiveness of a topical non-steroidal cream in treating facial seborrheic dermatitis (FSD). We performed a case series of 11 patients with mild or moderate FSD and a history of several previous treatments without improvement. The patients were treated for 8 weeks with a topical non-steroidal facial cream (NSFC) containing zinc PCA, piroctone olamine, hydroxyphenyl propamidobenzoic acid, biosaccharide gum-2, and stearyl glycyrrhetinate. Signs and symptoms and tolerance were assessed before, during, and at the end of treatment. All of the patients had improved symptoms of FSD (desquamation, pruritus, erythema, and stinging sensation); 81.8% showed an excellent response and 18.1% showed a good response. None of the patients had adverse effects. J Drugs Dermatol. 2020;19(6): doi:10.36849/JDD.2020.5121.
Guinea pig seborrheic dermatitis model of Malassezia restricta and the utility of luliconazole.
Koga Hiroyasu,Munechika Yukimi,Matsumoto Hiroko,Nanjoh Yasuko,Harada Kazutoshi,Makimura Koichi,Tsuboi Ryoji
Seborrheic dermatitis (SD) is a multifactorial disease in which Malassezia restricta has been proposed as the predominant pathogenic factor. However, experimental evidence supporting this hypothesis is limited. A guinea pig SD model using a clinical isolate of M. restricta was used to elucidate the pathogenicity of M. restricta. Also, the efficacy of 1% luliconazole (LLCZ) cream, a topical imidazole derivative, against M. restricta was compared with that of a 2% ketoconazole (KCZ) cream in the same guinea pig model. Dorsal skin hairs of guinea pig were clipped and treated with M. restricta by single or repeated inoculations without occlusion. Skin manifestations were examined macroscopically and histologically. A quantitative polymerase chain reaction (PCR) assay was also performed for mycological evaluation. An inflammatory response mimicking SD occurred after repeated as well as single inoculation but not in abraded skin. The inflammation score attained its maximum on day 11 and persisted until day 52. The yeast form of the fungal elements was distributed on the surface of stratum corneum and around the follicular orifices, and an epidermal and dermal histological reaction was observed. Application of 1% LLCZ or 2% KCZ cream significantly improved the skin manifestations and decreased the quantity of M. restricta rDNA in the skin lesions. The efficacy of topical antifungal drugs suggested that M. restricta is a pathogenic factor contributing to SD.
Clinical characteristics and quality of life in seborrheic dermatitis patients: a cross-sectional study in China.
Xuan Meiling,Lu Chuanjian,He Zehui
Health and quality of life outcomes
BACKGROUND:Seborrheic dermatitis (SD) is a common, chronic, inflammatory skin disorder, yet few studies have reported its clinical characteristics, or addressed its effect on quality of life (QoL). This study assesses the clinical characteristics and QoL of SD patients in China. It also identifies the clinical, demographic and environmental factors that may influence QoL. METHODS:Three hundred twelve SD outpatients from 9 hospitals completed a survey. QoL was measured with the dermatology-specific instrument Skindex-29. We collected social demographic characteristics and disease severity, and conducted logistic regression to determine the factors associated with QoL impairment. RESULTS:67.3% of the patients were females. The mean Skindex-29 overall score was 33.97 (SD = 20.55). The breakdown was 40.79 (SD = 24.24) for emotions, 32.83 (SD = 19.84) for symptoms and 28.3 (SD = 23.24) for functioning. 48.1% had severe emotional problems. Logistic regression analysis showed that BMI less than 25 (OR = 0.223; 95% CI: 0.072-0.692; P = 0.009), skin disease-related hospitalization (OR = 6.882; 95% CI:1.767-26.795; P = 0.005), environmental PM 10 levels above 120 μg/m (OR = 3.386; 95% CI: 1.253-9.15; P = 0.016) and severe disease conditions (OR = 4.438; 95% CI:1.26-15.626; P = 0.02) were risk factors for severe emotional impairment. Moreover, skin disease-related hospitalization (OR = 6.057; 95% CI:1.351-27.149; P = 0.019), environmental PM 10 levels between 70 and 120 μg/m (OR = 6.317; 94% CI: 1.704-23.42; P = 0.006), moderate (OR = 2.388; 95% CI: 1.272-4.487; P = 0.007) and severe disease conditions (OR = 5.732; 95% CI: 1.838-17.88; P = 0.003) were each risk factors for overall severe impairment. CONCLUSION:In China, nearly half of SD patients had severely emotional problems. Disease severity, BMI, dermatologic hospitalization, and ambient PM 10 levels are each risk factors for QoL impairment in SD patients. These implications are alarming, and warrant public health attention in SD disease management.
Herbal Therapy for the Management of Seborrheic Dermatitis: A Narrative Review.
Ayatollahi Azin,Firooz Alireza,Lotfali Ensieh,Mojab Faraz,Fattahi Mahsa
Recent advances in anti-infective drug discovery
INTRODUCTION:Dandruff and Seborrheic Dermatitis (SD) are similar skin conditions with different degrees ofseverity. Since the current therapies cannot remove dandruff efficiently, herbal extracts with better effectiveness and fewer side effects are used in the pharmaceutical and cosmetic industries. Due to the adverse effects of chemical drugs, the use of natural products and traditional medicine has significantly increased over the past few decades. Therefore, in this review, we reported the herbs used as anti-dandruff agents in traditional medicine worldwide. METHODS:The review was conducted on the literature available on the medicinal utility of certain plants as anti-dandruff agents using PubMed and Google Scholar and the following search terms: Dandruff and plants or medicinal plant and dandruff treatment, and essential oil and dandruff. RESULTS:Since the current therapies cannotefficiently remove dandruff, herbal extracts with better effectiveness and fewer side effects are used in the pharmaceutical and cosmetic industries. Nowadays, there are numerous different types of herbal antidandruff shampoos. They are effective and safe without the side effects of chemical agents. Recently, herbal medicine has attracted a great deal of scientific attention. Clinical evidence on the therapeutic effects of herbal products has resulted in the study of far more herbs for their therapeutic roles. CONCLUSION:Herbal therapy plays a significant role in the development of favorable therapeutics, either alone or in combination with conventional antibiotics. However, the major challenges in this regard include finding compounds with satisfactorily lower MICs, low toxicity, and high bioavailability for effective and safe use in humans and animals.
Comparison of different regimens of pimecrolimus 1% cream in the treatment of facial seborrheic dermatitis.
Zhao Juemin,Sun Wenjia,Zhang Chengfeng,Wu Jiaqiang,Le Yan,Huang Chunyun,Liu Ye,Xiang Leihong
Journal of cosmetic dermatology
BACKGROUND:Pimecrolimus 1% cream has already been proved to be an effective and safe alternative to treat seborrheic dermatitis. However, the treatment periods were inconstant in previous studies. OBJECTIVE:To evaluate the comparative efficacy of pimecrolimus 1% cream with different regimens for the treatment of facial seborrheic dermatitis. METHOD:Thirty patients with facial seborrheic dermatitis were enrolled and randomly distributed to three groups. Patients of Group 1 were treated with topical pimecrolimus cream 1% twice daily for 2 weeks and then a moisturizer cream twice daily for 2 weeks. Patients of Group 2 were treated with pimecrolimus cream 1% twice daily for 2 weeks and then once daily for another 2 weeks. Patients of Group 3 had a consecutive course of pimecrolimus cream 1% twice daily for 4 weeks. Objective symptoms, subjective symptoms, and dermatology life quality index (DLQI) were measured at weeks 0, 2, 4, and 6. RESULTS:At week 4, the clinical severity scores of all three regimens significantly decreased (P<.01). The improvement of total severity score in Group 3 was more remarkable than groups 1 and 2 (both P<.05). This effect was maintained until the end of the study in Group 3. Life quality of all three groups was significantly improved at week 4 (P<.001), while there was no statistical difference on the improvement of life quality among three groups. CONCLUSION:We recommend pimecrolimus 1% cream could be applied twice a day for 4 weeks to treat seborrheic dermatitis.
is the most common bacterial agent of the skin flora of patients with seborrheic dermatitis.
Tamer Funda,Yuksel Mehmet Eren,Sarifakioglu Evren,Karabag Yavuz
Dermatology practical & conceptual
BACKGROUND:Seborrheic dermatitis is an inflammatory skin disease that affects 1-3% of the general population. The species has been implicated as the main causative agent; however, the bacterial flora of the skin may also play role in the etiopathogenesis. Therefore, we investigated the most common bacterial agent of the skin flora of patients with seborrheic dermatitis. MATERIALS AND METHODS:Fifty-one patients with seborrheic dermatitis and 50 healthy individuals are included in this study. Sterile cotton swabs were rubbed on the scalp of the participants for bacterial culture. Colonial morphology was identified with gram stain and catalase test. RESULTS: was isolated from 25 (49%) patients with seborrheic dermatitis and 10 (20%) healthy individuals within the control group. Coagulase-negative staphylococci were isolated from 24 (47.1%) patients with seborrheic dermatitis and 17 (34%) healthy individuals within the control group. Diphtheroids were present in 2 (3.9%) patients and 1 (2%) subject within the control group. Gram-negative bacilli were present only in 1 (2%) patient. Hemolytic streptococci and bacilli were identified in 1 (2%) subject from each group. Colonization of coagulase-negative staphylococci, diphtheroids, gram-negative bacilli, hemolytic streptococci, and bacillus did not differ between patients and healthy controls. However, colonization was significantly more common in patients with seborrheic dermatitis than in healthy controls. CONCLUSION:Within this study we revealed that colonization was significantly higher among the patients. Therefore, we propose that, in addition to the species, may play a role in the etiopathogenesis of seborrheic dermatitis.
Topical Application of 5-Fluorouracil Associated with Distant Seborrheic Dermatitis-like Eruption: Case Report and Review of Seborrheic Dermatitis Cutaneous Reactions after Systemic or Topical Treatment with 5-Fluorouracil.
Werbel Tyler,Cohen Philip R
Dermatology and therapy
INTRODUCTION:5-Fluorouracil is a fluoropyrimidine antineoplastic medication that is used to topically treat actinic keratoses. Although local adverse effects to the drug are common and anticipated, distant skin reactions are rare and unexpected. In this case report, we describe a patient who developed seborrheic dermatitis-like eruption at a distant site after topical application of 5-fluorouracil to his arms. CASE REPORT:A 63-year-old man with actinic keratoses on his arms developed a facial seborrheic dermatitis-like reaction after topically applying 5-fluorouracil 5% cream twice daily to actinic keratoses on his forearms for 7 days. The facial dermatosis resolved shortly after discontinuation of the 5-fluorouracil; upon rechallenge of topical 5-fluorouracil on his arms, the facial seborrheic dermatitis recurred. DISCUSSION:Several case reports have been published which describe exacerbations of preexisting seborrheic dermatitis with local topical 5-fluorouracil. Additionally, one case series describes the development of scrotal dermatitis in two patients after distant treatment with 5-fluorouracil. The pathogenesis that causes this distant reaction is unclear. CONCLUSION:We describe a patient with a seborrheic dermatitis eruption after topical application of 5-fluorouracil at a distant site. The etiologic association between the drug and adverse effect was confirmed with multiple cycles of application and discontinuation of the offending agent.
Association between Diet and Seborrheic Dermatitis: A Cross-Sectional Study.
Sanders Martijn G H,Pardo Luba M,Ginger Rebecca S,Kiefte-de Jong Jessica C,Nijsten Tamar
The Journal of investigative dermatology
Current treatments for seborrheic dermatitis provide only temporary relief. Therefore, identifying modifiable lifestyle factors may help reduce disease burden. The objective of this study was to determine whether specific dietary patterns or total antioxidant capacity are associated with seborrheic dermatitis. Participants of the Rotterdam Study with a skin examination and a food frequency questionnaire were included. Total antioxidant capacity was assessed on the basis of ferric reducing antioxidant potential of each food item. Dietary patterns were identified with principal component analysis (PCA). Multivariable logistic regression analyses were used to assess the association between total antioxidant capacity, dietary pattern-derived PCA factors, and seborrheic dermatitis adjusted for confounders. In total, 4,379 participants were included, of whom 636 (14.5%) had seborrheic dermatitis. The PCA identified vegetable, Western, fat-rich and fruit dietary patterns. The fruit pattern was associated with a 25% lower risk (quartile 1 vs. quartile 4: adjusted odds ratio = 0.76, 95% confidence interval = 0.58-0.97, P = 0.03), and the Western pattern with a 47% increased risk (quartile 1 vs. quartile 4: adjusted odds ratio = 1.47; 95% confidence interval = 0.98-2.20, P = 0.03), but only for females. Other factors were not associated with seborrheic dermatitis. In conclusion, a high fruit intake was associated with less seborrheic dermatitis, whereas high adherence to a "Western" dietary pattern in females was associated with more seborrheic dermatitis.
Evaluation of dry eye disase and meibomian gland dysfunction with meibography in seborrheic dermatitis.
Yasar Erdogan,Kemeriz Funda,Gurlevik Ugur
Contact lens & anterior eye : the journal of the British Contact Lens Association
PURPOSE:To evaluate the dry eye disase and meibomian gland dysfunction with meibography of Seborrheic Dermatit patients. METHODS:A hundred-ten of 50 patients with Seborrheic Dermatitis (group 1) and 100 eyes of 50 healthy individuals (group 2) were enrolled in this prospective study. All subjects were performed a comprehensive ophthalmic examination including lid margin alterations and meibomian gland obstruction assessment, Ocular Surface Disease Index assessment, tear film break-up time test, corneal and conjunctival fluorescein staining assessment, Schirmer test. In addition, upper and lower lids were evaluated for meibomian gland loss with non-contact meibography. The Meibomian glands were graded from grade 0 (no loss of Meibomian glands) to grade 3 (gland loss >2/3 of the total Meibomian glands). RESULTS:The mean ages of Group 1 and Group 2 were 29.1 ± 9.1(range, 18-48) and 30.6 ± 6.3(range, 20-49) years, respectively. MGD(n = 19, %34.5), Meibium gland loss(%36.4 ± 18.1), upper meiboscore (0.7 ± 0.8), lower meiboscore(0.6 ± 0.7) and DED (n = 10, %18.2) were significantly higher in the SD patients compared with the control participants (p = 0.002, p < 0.001, p = 0.011, p = 0.005, p = 0.048, respectively). There was significant relationship between age with Meibomian gland loss, MGD and DED (p = 0.017, p = 0.004, p = 0.002, respectively). CONCLUSIONS:Seborrheic Dermatitis may influence meibomian gland morphology and as a result causing meibomian gland dysfunction and dry eye disase. For this reason, patients with Seborrheic Dermatitis should be evaluated for meibomian gland dysfunction and dry eye disase, and start treatment when needed.
Isolation of Malassezia spp. in HIV-positive patients with and without seborrheic dermatitis.
Moreno-Coutiño Gabriela,Sánchez-Cárdenas Carlos D,Bello-Hernández Yesenia,Fernández-Martínez Ramón,Arroyo-Escalante Sara,Arenas Roberto
Anais brasileiros de dermatologia
BACKGROUND:Malassezia, a skin saprophyte, is frequently isolated from patients with seborrheic dermatitis, which is one of the most common dermatoses in HIV-infected patients. Its role in pathophysiology has not been defined. OBJECTIVE:To determine whether patients living with HIV and seborrheic dermatitis have more Malassezia than those without seborrheic dermatitis. METHOD:This is an descriptive, observational, prospective cross-sectional study to which all adult patients living with HIV that attend the infectious disease outpatient clinic at the Dr. Manuel Gea González General Hospital were invited. Patients presenting with scale and erythema were included in Group 1, while patients without erythema were included in Group 2. Samples were taken from all patients for smear and culture. RESULTS:Thirty patients were included in each group. All patients with seborrheic dermatitis had a positive smear, with varying amounts of yeasts. In the control group, 36.7% of patients had a negative smear. The results are statistically significant, as well as the number of colonies in the cultures. Study limitations The study used a small sample size and the subspecies were not identified. CONCLUSIONS:Patients with clinical manifestations of seborrheic dermatitis have larger amounts of Malassezia. Further studies need to be performed to analyze if the greater amount is related to imbalances in the microbiota of the skin.
Demodex folliculorum infestations in common facial dermatoses: acne vulgaris, rosacea, seborrheic dermatitis.
Aktaş Karabay Ezgi,Aksu Çerman Aslı
Anais brasileiros de dermatologia
BACKGROUND:Demodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role. OBJECTIVE:To investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis. METHODS:This prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups. RESULTS:In terms of gender and age, no significant difference was found between the patients and controls (p>0.05). Demodex infestation rates were significantly higher in patients than in controls (p=0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p=0.001; p=0.024; p=0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p=0.001 and p=0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p=0.294). STUDY LIMITATIONS:Small sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation. CONCLUSION:The findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.
An update on the microbiology, immunology and genetics of seborrheic dermatitis.
Adalsteinsson Jonas A,Kaushik Shivani,Muzumdar Sonal,Guttman-Yassky Emma,Ungar Jonathan
The underlying mechanism of seborrheic dermatitis (SD) is poorly understood but major scientific progress has been made in recent years related to microbiology, immunology and genetics. In light of this, the major goal of this article was to summarize the most recent articles on SD, specifically related to underlying pathophysiology. SD results from Malassezia hydrolysation of free fatty acids with activation of the immune system by the way of pattern recognition receptors, inflammasome, IL-1β and NF-kB. M. restricta and M. globosa are likely the most virulent subspecies, producing large quantities of irritating oleic acids, leading to IL-8 and IL-17 activation. IL-17 and IL-4 might play a big role in pathogenesis, but this needs to be further studied using novel biologics. No clear genetic predisposition has been established; however, recent studies implicated certain increased-risk human leucocyte antigen (HLA) alleles, such as A*32, DQB1*05 and DRB1*01 as well as possible associations with psoriasis and atopic dermatitis (AD) through the LCE3 gene cluster while SD, and SD-like syndromes, shares genetic mutations that appear to impair the ability of the immune system to restrict Malassezia growth, partially due to complement system dysfunction. A paucity of studies exists looking at the relationship between SD and systemic disease. In HIV, SD is thought to be secondary to a combination of immune dysregulation and disruption in skin microbiota with unhindered Malassezia proliferation. In Parkinson's disease, SD is most likely secondary to parasympathetic hyperactivity with increased sebum production as well as facial immobility which leads to sebum accumulation.
Tacrolimus 0.1% versus ciclopiroxolamine 1% for maintenance therapy in patients with severe facial seborrheic dermatitis: A multicenter, double-blind, randomized controlled study.
Joly Pascal,Tejedor Ines,Tetart Florence,Cailleux Hélène Collas,Barrel Alice,De Preville Paul Arnaud,Mion-Mouton Nathalie,Gabison Germaine,Baricault Sophie,Tordeur Catherine Girardin,Dore Martin Xavier,Rossi Bernard,Bourseau-Quetier Catherine,Chamaillard Mélanie,Ly Sandra,Chosidow Olivier,Richard-Lallemand Marie-Aleth,Rzeznik Jean-Claude,Amici Jean-Michel,Lair Guillaume,Bechu Sylvie,Benichou Jacques,Thill Caroline,Beylot-Barry Marie
Journal of the American Academy of Dermatology
BACKGROUND:No long-term maintenance therapy has been tested in patients with seborrheic dermatitis (SD). OBJECTIVE:We sought to compare the efficacy and tolerance of tacrolimus 0.1% ointment versus ciclopiroxolamine 1% cream as maintenance therapy for severe SD. METHODS:This double-blind randomized controlled study was conducted from 2014 to 2017 in 5 Dermatology Departments and 15 dermatology practices in France. Consecutive patients with severe and chronic facial SD were included. Patients were initially treated with desonide 0.05% cream twice daily for 7 days. Patients cleared after this open phase were randomized to receive tacrolimus 0.1% or ciclopiroxolamine 1% cream 2 times a week 24 weeks. The primary endpoint was disease-free-duration, defined as the time from randomization to first relapse. RESULTS:One hundred fourteen patients were randomized (tacrolimus, n = 57; ciclopiroxolamine, n = 57). Twelve patients relapsed in the tacrolimus group after a median delay of 91.5 days (range 15-195 days) versus 23 patients in the ciclopiroxolamine group (median delay, 27 days [range 13-201 days]). Comparison of disease-free duration curves showed that patients in the tacrolimus group had a longer duration of complete remission than those in the ciclopiroxolamine group (P = .018), corresponding to a hazard ratio of relapse of 0.44 (95% confidence interval 0.22-0.89; P = .022). LIMITATIONS:The theoretical sample size was not reached. CONCLUSION:Tacrolimus 0.1% is more effective than ciclopiroxolamine 1% as maintenance therapy for patients with facial SD.
Clinical study on treatment of facial seborrheic dermatitis with intense pulsed light combined with 30% supramolecular salicylic acid.
Gu Rui-Long,Wang Shan-Qing
Clinics (Sao Paulo, Brazil)
OBJECTIVES:In this study, we investigated the effects of intense pulsed light (IPL) combined with 30% supramolecular salicylic acid on facial seborrheic dermatitis. METHODS:A total of 45 patients with mild or moderate facial seborrheic dermatitis were selected from our hospital between September 2018 and September 2019. The patients were divided into three groups consisting of 15 patients each. The first group was exposed to a combination of IPL and 30% supramolecular salicylic acid treatment, the second group was exposed to the IPL treatment alone, and the third group was exposed to the 30% supramolecular salicylic acid treatment alone. They were treated once every 4 weeks in three consecutive rounds. RESULTS:Facial lesions and symptoms were observed 4 and 12 weeks after the first treatment, and adverse reactions were recorded. The combination group showed significant improvement in symptoms 4 weeks after the first treatment, while the individual treatment groups showed no significant improvement. After three rounds of treatments, seborrheic dermatitis had significantly decreased in the three groups; the efficacy of the combined treatment group was significantly higher than that of the IPL group and the 30% supramolecular salicylic acid group. CONCLUSION:IPL combined with 30% supramolecular salicylic acid was effective in the treatment of facial seborrheic dermatitis and provided a quicker result with no adverse reactions.
A Review of the Current Evidence Connecting Seborrheic Dermatitis and Parkinson's Disease and the Potential Role of Oral Cannabinoids.
Rietcheck Hope R,Maghfour Jalal,Rundle Chandler W,Husayn Sameeha S,Presley Colby L,Sillau Stefan H,Liu Ying,Leehey Maureen A,Dunnick Cory A,Dellavalle Robert P
Dermatology (Basel, Switzerland)
Parkinson's disease (PD) is a neurodegenerative disorder associated with multiple comorbidities, including seborrheic dermatitis (SD), which develops in more than half of PD patients. SD in patients with PD can be severe and frequently intractable by traditional topical therapy. Cannabinoids possess anti-inflammatory and neuromodulatory properties working within the intrinsic endocannabinoid system, the activation of which may alleviate the motor symptoms of PD. The effect of cannabinoids on SD is unknown. Here we explore the pathophysiological mechanisms and possible therapeutic role of oral cannabinoids in PD patients with SD, and review speculative mechanisms underlying the association of PD and SD. Current data supporting the use of cannabinoids in both PD and SD, as well as oral cannabinoid safety and tolerability, are presented. Cannabinoids may provide the possibility of simultaneous treatment of both SD and PD. Specific SD studies and additional safety data on oral cannabinoids are needed.
Serum Levels of 25-Hydroxyvitamin D in Patients with Seborrheic Dermatitis: A Case-Control Study.
Rahimi Siavash,Nemati Negar,Shafaei-Tonekaboni Seyedeh Sareh
Dermatology research and practice
Several autoimmune papulosquamous skin conditions such as psoriasis, systemic lupus erythematous, and lichen planus have been associated with vitamin D deficiency or correlated with serum vitamin D level. This study was aimed at comparing the 25-hydroxyvitamin D (25(OH)D) status in patients with facial or scalp seborrheic dermatitis with healthy subjects. This case-control study included 289 patients (118 with psoriasis and 171 sex- and age-matched control subjects) from the outpatient clinic of two hospital dermatology departments in the west of Mazandaran province, Iran. All patients and control subjects were studied during one season to avoid seasonal variations in vitamin D levels. Serum mean ± standard deviation of 25(OH)D levels were signiﬁcantly lower in seborrheic dermatitis patients than in control subjects (20.71 ± 8.16 vs. 23.91 ± 7.78, = 0.007). Serum 25(OH)D levels were negatively associated with the risk of developing seborrheic dermatitis (odds ratio (OR): 0.898, 95% confidence interval (Cl): 0.840-0.960, = 0.002). Also, vitamin D under 30 ng/ml was associated with OR: 4.22 (95% Cl: 1.077-16.534, = 0.039) for seborrheic dermatitis. The severity of scalp disease was significantly associated with serum 25(OH)D level ( = 0.003). Cases with severe scalp scores had significantly lower serum 25(OH)D level compared to moderate OR score ( = 0.036). A similar trend was not seen in the facial disease. The 25(OH)D values are signiﬁcantly lower in seborrheic dermatitis patients than in healthy subjects. Furthermore, the scalp disease severity was associated with lower serum 25(OH)D level. Our results may suggest that vitamin D may play a role in the pathogenesis of seborrheic dermatitis.
Composition of cutaneous bacterial microbiome in seborrheic dermatitis patients: A cross-sectional study.
Sanders Martijn G H,Nijsten Tamar,Verlouw Joost,Kraaij Robert,Pardo Luba M
BACKGROUND:Seborrheic dermatitis (SD) is a chronic inflammatory skin disease with a multifactorial aetiology. Malassezia yeasts have been associated with the disease but the role of bacterial composition in SD has not been thoroughly investigated. OBJECTIVES:To profile the bacterial microbiome of SD patients and compare this with the microbiome of individuals with no inflammatory skin disease (controls). METHODS:This was a cross sectional study embedded in a population-based study. Skin swabs were taken from naso-labial fold from patients with seborrheic dermatitis (lesional skin: n = 22; non-lesional skin SD: n = 75) and controls (n = 465). Sample collection began in 2016 at the research facility and is still ongoing. Shannon and Chao1 α- diversity metrics were calculated per group. Associations between the microbiome composition of cases and controls was calculated using multivariate statistics (permANOVA) and univariate statistics. RESULTS:We found an increased α-diversity between SD lesional cases versus controls (Shannon diversity: Kruskal-Wallis rank sum: Chi-squared: 19.06; global p-value = 7.7x10-5). Multivariate statistical analysis showed significant associations in microbiome composition when comparing lesional SD skin to controls (p-value = 0.03;R2 = 0.1%). Seven out of 13 amplicon sequence variants (ASVs) that were significantly different between controls and lesional cases were members of the genus Staphylococcus, most of which showed increased composition in lesional cases, and were closely related to S. capitis S. caprae and S. epidermidis. CONCLUSION:Microbiome composition differs in patients with seborrheic dermatitis and individuals without diseases. Differences were mainly found in the genus Staphylococcus.