Seborrheic Dermatitis in Skin of Color: Clinical Considerations

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.

Novel inhibitor against Malassezia globosa LIP1 (SMG1), a potential anti-dandruff target.

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.

[The influence of macromolecular excipients on the process of mass transfer at the boundary phase from a model anti-dandruff preparation into the external compartment under in vitro conditions]. / Wplyw wielkoczasteczkowych substancji pomocniczych na proces wymiany masy na granicy faz z modelowego preparatu przeciwlupiezowego do kompartmentu zewnetrznego w warunkach in vitro.

AIM OF THE STUDY: The aim of the research was the application assessment of a model preparation--anti-dandruff emulsion. The experiments was conducted under in vitro conditions using of a model system of human skin, which are cellulose dialysis membranes with a standardized pore size. The behaviour of the preparation on the dialysis membrane was analyzed, and the degree of film formation performing the function of a protective barrier was evaluated after gentle rinsing with tepid water without cleaning agents. It was checked whether the product layer remaining on the membrane product layer does not block diffusion and penetration processes. Additionally, an attempt to assess the character of the layer with the use of a hydrophilic marker was made. MATERIALS AND METHODS: Model anti-dandruff emulsion, Servapor Dialysis Tubing 100 dialysis membranes with a wall thickness d = 0.1 mm and a declared pore diameter phi = 25 A degrees, sodium chloride, purified water--assessment of the residue level of the analyzed preparation on the dialysis membrane. Examination on the marker diffusion through the dialysis membrane covered with the model anti-dandruff preparation, Approximation of the obtained results. RESULTS: The first phase of the experiment was the preparation of dialysis membranes for the adsorption process of a model anti-dandruff preparation, then its adsorption, rinsing with tepid water and the measurement of residue level of the product on the membrane control. It has been observed that the mass of the membrane on which the preparation was applied increased in relation to the membrane from a control sample. The mass increase of the membrane in a research sample is accompanied with the increase of its thickness caused by the adsorbed amount of the product and water on the membrane. The diffusion through the membrane in a control sample turned out to be slightly slower what may indicate the character of the membrane residue of the model anti-dandruff preparation. CONCLUSIONS; The technology of model anti-dandruff emulsion enables the formation of a layer forming a specific protective barrier on the surface of the dialysis membrane. The presence of the layer of model anti-dandruff emulsion on the membrane is confirmed by mean values of mass and thickness increase of the dialysis membrane. The hydrophobic diffusion layer is of a variable character. The properly applied emulsion under "in vivo" conditions might fill voids of the corneal layer of epidermis creating a structure of a film character performing the function of a protective barrier. On the basis of the in vitro assessment, the therapeutic effectiveness under in vivo conditions may be concluded.

Diagnosis and management of common dermatoses in children: atopic, seborrheic, and contact dermatitis.

Atopic, seborrheic, and contact dermatitis can significantly reduce the quality of life of patients and their families. Although differing in specific aspects of their epidemiology, etiology, and pathobiology, all 3 dermatoses are common in the pediatric population, and they share a common treatment approach. Although effective and widely used to manage exacerbations of pediatric dermatitis, the use of topical corticosteroid remains a concern for some physicians and parents because of its potential for systemic absorption and adverse events associated with prolonged use. Newer additions to the dermatitis treatment algorithm, such as the topical calcineurin inhibitors, may provide an effective steroid-sparing treatment option. Adjuvant treatments, such as antihistamines, antifungals, and antibiotics, also can provide benefit in appropriate circumstances. As there is no cure for dermatitis, a comprehensive, multipronged management strategy of preventive measures, such as trigger avoidance and periodic pharmacologic treatment, will provide patients and caregivers with the best opportunity to successfully control the disease.

Treatment and prophylaxis of seborrheic dermatitis of the scalp with antipityrosporal 1% ciclopirox shampoo.

OBJECTIVE: To demonstrate the efficacy, safety, and tolerance of ciclopirox shampoo for treatment and prophylaxis of seborrheic dermatitis of the scalp. DESIGN: Multicenter, randomized, double-blind, vehicle-controlled study. After treatment with ciclopirox shampoo once or twice weekly or vehicle for 4 weeks (study segment A), responders were randomized to a 12-week prophylactic study arm (segment B). SETTING: Forty-five medical centers in Germany (n = 19), France (n = 15), the United Kingdom (n = 8), and Austria (n = 3). Patients A total of 1000 patients with stable or exacerbating seborrheic dermatitis of the scalp. Interventions A total of 949 patients were randomized to receive ciclopirox treatment once or twice weekly or vehicle for 4 weeks. Thereafter, 428 responders received either ciclopirox prophylaxis once weekly or every 2 weeks or vehicle for 3 months. MAIN OUTCOME MEASURES: Primary and secondary: response of "effectively treated" and "cured," with investigators and patients rating acceptability and tolerance. RESULTS: Ciclopirox twice and once weekly produced response rates of 57.9% and 45.4%, respectively, compared with 31.6% for vehicle. Relapses occurred in 14.7% of patients using prophylactic ciclopirox once weekly, 22.1% of those in the prophylactic group shampooing once every 2 weeks, and 35.5% in the vehicle group. The few adverse events were evenly distributed among groups. Local tolerance and cosmetic acceptability were "good" in more than 85% of subjects. CONCLUSIONS: Seborrheic dermatitis of the scalp responds well to 1% ciclopirox shampoo once or twice weekly for 4 weeks. A low relapse rate is maintained by once-weekly shampooing or shampooing once every 2 weeks. These treatments are safe and well-tolerated.

Isolation of llama antibody fragments for prevention of dandruff by phage display in shampoo.

As part of research exploring the feasibility of using antibody fragments to inhibit the growth of organisms implicated in dandruff, we isolated antibody fragments that bind to a cell surface protein of Malassezia furfur in the presence of shampoo. We found that phage display of llama single-domain antibody fragments (VHHs) can be extended to very harsh conditions, such as the presence of shampoo containing nonionic and anionic surfactants. We selected several VHHs that bind to the cell wall protein Malf1 of M. furfur, a fungus implicated in causing dandruff. In addition to high stability in the presence of shampoo, these VHHs are also stable under other denaturing conditions, such as high urea concentrations. Many of the stable VHHs were found to contain arginine at position 44. Replacement of the native amino acid at position 44 with arginine in the most stable VHH that lacked this arginine resulted in a dramatic further increase in the stability. The combination of the unique properties of VHHs together with applied phage display and protein engineering is a powerful method for obtaining highly stable VHHs that can be used in a wide range of applications.

The hair strand test - a new method for testing antifungal effects of antidandruff preparations.

Seborrheic dermatitis and its minimal variant, dandruff (pityriasis simplex capillitii), are among the most frequent diseases caused by Malassezia (M.) yeasts. Treatment studies have shown that antimycotics achieve clinical improvement, while recolonization leads to recurrent symptoms. Among the antimycotics used are azoles, hydroxypyridones, and various agents such as zinc pyrithione, tar, and selenium disulfide. However, comparative efficacy studies in vitro should not only consider the minimal inhibitory concentrations against Malassezia yeasts but also the bioavailability of the individual substances with regard to hair and scalp. By means of a new method, the hair strand test, hairs from ten volunteers were subjected to standardized 5-min incubation with different shampoo formulations. Thereafter they were rinsed with running water for 1 min and dried. Two hundred each of these hairs (length 1 cm) were given into a medium (olive oil on selective agar for pathogenic fungi) inoculated with M. sympodialis or M. globosa (5 x 10(3) CFU/microl), and the influence on growth was semiquantitatively determined over a period of up to 18 days. According to preliminary results, 1% climbazole proved to be particularly effective. The hair strand test, which can also be performed ex vivo, is a new method to find out whether antimycotic agents bind differently to the hair substance and, via a depot effect, may influence the growth of Malassezia yeasts and thus affect dandruff. This allows conclusions about the efficacy of antidandruff formulations.

Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff.

Honey has antibacterial, antifungal and antioxidants activities and has high nutrient value. In this study we investigated the potential use of topical application of crude honey in the management of seborrheic dermatitis and dandruff. Thirty patients with chronic seborrheic dermatitis of scalp, face and front of chest were entered for study. Twenty patients were males and 10 were females, their ages ranged between 15 and 60 years. The patients had scaling, itching and hair loss. The lesions were scaling macules, papules and dry white plaques with crust and fissures. The patients were asked to apply diluted crude honey (90% honey diluted in warm water) every other day on the lesions with gentle rubbing for 2-3 mins. Honey was left for 3 hr before gentle rinsing with warm water. The patients were followed daily for itching, scaling, hair loss and the lesions were examined. Treatment was continued for 4 weeks. The improved patients were included in a prophylactic phase, lasting six months. Half patients were treated with the topical honey once weekly and the other half served as control. All the patients responded markedly with application of honey. Itching was relieved and scaling was disappeared within one week. Skin lesions were healed and disappeared completely within 2 weeks. In addition, patients showed subjective improvement in hair loss. None of the patients ( 15 patients) treated with honey application once weekly for six months showed relapse while the 12/15 patients who had no prophylactic treatment with honey experienced a relapse of the lesions 2-4 months after stopping treatment. It might be concluded that crude honey could markedly improve seborrheic dermatitis and associated hair loss and prevent relapse when applied weekly.

Effect of a desogestrel-containing oral contraceptive on the skin.

OBJECTIVE: This pilot study evaluated the effects of a desogestrel-containing oral contraceptive (DSG-OC) on facial seborrhea (oiliness), acne and related factors in otherwise healthy women with moderate facial acne vulgaris. METHODS: In this double-blind, placebo-controlled study, 41 women received DSG-OC (50/100/150 microg desogestrel plus 35/30/30 microg ethinylestradiol given in a 7/7/7 day regimen) and 41 received placebo for six cycles. Seborrhea and skin assessments, and hormone analyses were performed regularly. RESULTS: Analyses of sebum output (measured using Sebutape) indicated that the effect of DSG-OC on the skin varied with facial area. Compared with placebo, DSG-OC had a statistically significant effect on the cheeks (60% relative reduction in sebum output; p = 0.02), and a non-significant effect on the forehead (30% relative reduction in sebum output). Acne lesion counts did not differ significantly between groups. Both patient and investigator assessments of skin condition (visual analog scale) indicated significant improvements with DSG-OC compared with placebo. The reduced sebum output with DSG-OC is associated with a three-fold increase in sex hormone binding globulin, as well as an expected decrease in free testosterone and other androgens that were found in this group. CONCLUSION: These results suggest that DSG-OC reduces facial oiliness and may be a useful contraceptive choice for women with this problem.

Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial.

Pityrosporum ovale appears to play an important role in the pathogenesis of seborrhoeic dermatitis. Ketoconazole is an antimycotic agent with a high in vitro and in vivo efficacy against P. ovale. We performed a multicentre study to investigate the efficacy of ketoconazole 2% shampoo in the treatment and prophylaxis of seborrhoeic dermatitis and dandruff. Five hundred and seventy-five patients presenting with moderate to severe seborrhoeic dermatitis and dandruff of the scalp were treated with 2% ketoconazole shampoo twice weekly for 2-4 weeks, producing an excellent response in 88%. Of those patients who responded, 312 were included in a prophylactic phase, lasting 6 months. These patients were treated with the active preparation (shampoo containing 2% ketoconazole) once-weekly, once every other week, alternating with placebo (shampoo without ketoconazole), or with placebo only once-weekly. Forty-eight (47%) patients in the placebo group experienced a relapse of seborrhoeic dermatitis, compared with 23 (19%) patients in the active treatment group, and 31 (31%) patients in the active/placebo group. The medication was well tolerated in all three groups. We conclude that ketoconazole 2% shampoo is highly effective, not only in clearing scalp seborrhoeic dermatitis and dandruff, but also in preventing relapse of the disease when used prophylactically once weekly.

[Evaluation of the fungicidal-fungistatic activity of various preparations for the cure and prevention of seborrheic dermatitis]. / Valutazione dell'attività fungistatica-fungicida di alcuni preparati per la cura e la prevenzione della dermatite seborroica.

Fungistatic and fungicide activity of 4 preparations available on the market for the prevention and treatment of infection due to P. ovale has been defined. P. ovale is a microorganism which complicates phlogosis of seborrhoeic dermatitis. The advantages of the presence of a limited antifungal activity are considered.

[Problems of skin protection in clean rooms]. / Probleme des Hautschutzes in Reinräumen.

The high standard of quality of microelectronic products can be achieved only under clean room conditions. With people working in clean rooms - protective clothing notwithstanding - the incidence of skin flaking is high, and this can cause electronic faults. Even components of normal skin-care agents can be the cause of electronic short circuits. Common skin-care agents have been investigated by emission spectral analysis. Two products virtually free from inorganic substances (and hence ions) were tested in the clean rooms. Use of these skin cosmetics can lead to a considerable reduction in skin flaking.