Last update: January 27, 2006

Here's a selection of scientific journal abstracts about seborrheic dermatitis. These are very useful for getting a better understanding of SD.

1: HIV Med. 2004 Jan; 5(1): 50-4.
Oral candidiasis and seborrheic dermatitis in HIV-infected patients on highly active antiretroviral therapy.
Dunic I, Vesic S, Jevtovic DJ.
Institute of Dermatovenereology Institute for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia & Montenegro.
BACKGROUND: Mucocutaneous manifestations such as oral candidiasis (OC) and seborrheic dermatitis (SD) are very common HIV-related opportunistic events and are usually initial markers of immunodeficiency. AIM: The purpose of this study was to evaluate the efficacy of highly active antiretroviral therapy (HAART) in the regression of HIV-associated OC and SD. METHODS: In a prospective study, 120 HIV-infected patients with OC and SD were divided into two groups: HAART-treated patients (group 1, n=76) and non-HAART-treated patients (group 2, n=44). Non-HAART-treated patients were given antimicrobial therapy. Study subjects were matched for sex, age, risk, and stage of HIV infection. The results were analysed by chi2 test and the Kaplan-Meier method. RESULTS: At baseline, OC was evident in 59 (77.7%) of the HAART-treated patients and in 34 (77.3%) of the non-HAART-treated patients, while SD was present in 19 (25.0%) of the HAART-treated patients and in 17 (38.6%) of the non-HAART-treated patients. After a median follow-up period of 22 months, regression of OC and SD occurred in 49 (83.1%) and 16 (84.2%) of the HAART-treated patients, respectively. In the control group, regression of OC and SD occurred in only five (14.7%) and seven (41.2%) patients, respectively, during the same period. CONCLUSIONS: HAART showed greater efficacy than standard antimicrobial therapy for the treatment of OC and SD in HIV-infected patients.
PMID: 14731170 [PubMed - in process]

2: Int J Dermatol. 2004 Jan; 43(1): 63-6.
Itraconazole in the treatment of seborrheic dermatitis: a new treatment modality.
Baysal V, Yildirim M, Ozcanli C, Ceyhan AM.
Department of Dermatology, School of Medicine, University of Suleyman Demirel, Isparta, Turkey.
BACKGROUND: Due to the high rate of recurrence, seborrheic dermatitis (SD) represents a therapeutic problem. AIM: To evaluate the role of oral itraconazole in the treatment of SD. PATIENTS AND METHODS: Thirty-two patients with SD were enrolled in the study. All topical and oral treatments were stopped. The patients applied 1% hydrocortisone cream twice daily for 1 month. In addition, they took itraconazole, 200 mg/day, during the first week of the first month and then hydrocortisone cream was stopped and itraconazole (200 mg/day) was given on the first 2 days of the following 11 months. The patients were followed for 2 months without medicine. The severity score was measured at the initial evaluation, and at the first, 12th, and 14th months. RESULTS: Twenty-eight patients completed the study. There was a statistically significant decrease in the mean severity score at the first, 12th, and 14th months. On the final evaluation at the 12th month, 19 of the 28 patients showed a complete improvement, and three patients showed a slight improvement. CONCLUSIONS: This study indicates that itraconazole plays an important role in the treatment of SD.
PMID: 14693026 [PubMed - in process]

3: Int J Dermatol. 2004 Jan; 43(1): 6-11.
Seasonal variation of dermatologic disease in the USA: a study of office visits from 1990 to 1998.
Hancox JG, Sheridan SC, Feldman SR, Fleischer AB.
Bristol Myers-Squibb Center for Dermatology Research and the Department of Dermatology, Wake Forest University School of Medicine, and Department of Geography, Kent State University, Winston-Salem, North Carolina.
BACKGROUND: Seasonal variation has been demonstrated in many diseases, including certain skin diseases. OBJECTIVE: To determine whether there is seasonal variation in dermatologic office visits in the USA. METHODS: Data on dermatologic office visits were obtained from representative visits to outpatient physicians in the USA from the National Ambulatory Medical Care Survey from 1990 to 1998. Office visit seasonality was examined for all skin conditions, and individually for the 15 most commonly diagnosed conditions. RESULTS: Office visits for skin conditions were seasonal (P = 0.002). The magnitude of variation can be roughly expressed by the following scheme: actinic keratosis (P = 0.0001) > acne (P = 0.0001) > folliculitis (P = 0.002) > dyschromia (P = 0.01) > seborrheic keratosis (P = 0.04) > psoriasis (P = 0.07) > seborrheic dermatitis (P = 0.09). Visits for skin cancer, not otherwise specified (skin cancer NOS), atopic dermatitis, cysts, common wart, wart, not otherwise specified (wart NOS), rosacea, contact dermatitis, and benign tumors showed no significant seasonal variations or trends. CONCLUSIONS: Dermatologic office visits are seasonal, with visits for individual diseases varying in their magnitude of seasonality. This seasonal variation may be a result of biological and nonbiological variables.
PMID: 14693014 [PubMed - in process]

4: Pathol Biol (Paris). 2003 Jul; 51(5): 275-8.
[Normal and pathologic sebaceous function. Research in a shallow milieu?]
[Article in French]
Saint-Leger D.
L'Oreal R&D, 41, rue Martre, 92117 Clichy, France. [email protected]
Modern therapeutic approaches allow to control sebaceous secretion but knowledge about the sebaceous gland and its precise function within the pilosebaceous unit is still insufficient. Steroid hormones are the principal albeit not exclusive regulators of the sebaceous glands. Three phases may be distinguished in sebaceous physiology: secretion-production, stocking in the follicular reservoir, and excretion. Human "native" intracellular sebum, before secretion, is composed of squalene, waxes, and triglycerides. Once secreted, the sebum is colonised by various xenobiots whose development is controlled by several defensive humoral mechanisms and by the contact with ambient oxygen. Oxygen and micro-organisms transform "native" sebum, lysis of triglycerides to fatty acids being the most pronounced activity. Certain components of this complex mixture of molecules present in the sebum are clearly cytotoxic or irritant, provoking reactive follicular hyperkeratosis and comedone formation--the first step to acne. Some lipophilic organisms like Malassezia yeast may be highly antigenic and induce chronic inflammatory reactions like in seborrhoeic dermatitis. Demodex is an inrafollicular parasite feeding on sebum that frequently causes blepharitis. Sebum is also a vehicle transporting and transmitting several endogenous and exogenous molecules, including potential regulatory factors of hair follicles. Recent development of in vitro cultures of functional sebocytes should help to better understand several aspects of the sebaceous gland's biology.
PMID: 14567194 [PubMed - indexed for MEDLINE]

5: Dermatol Clin. 2003 Jul; 21(3): 401-12.
Seborrheic dermatitis.
Gupta AK, Bluhm R, Cooper EA, Summerbell RC, Batra R.
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook Site), University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada. [email protected]
Seborrheic dermatitis is present in 1% to 3% of immunocompetent adults, and is more prevalent in men than in women. Seborrheic dermatitis may be seen in conjunction with other skin diseases, such as rosacea, blepharitis or ocular rosacea, and acne vulgaris. Malassezia yeasts have been associated with seborrheic dermatitis. Abnormal or inflammatory immune system reactions to these yeasts may be related to development of seborrheic dermatitis. Treatment modalities for seborrheic dermatitis include keratolytic agents, corticosteroids, and more recently, antifungal agents. Antifungal agents do not carry a risk of skin atrophy or telangiectasia with prolonged use, and it is more prudent to consider antifungals than corticosteroid preparations. The wide range of antifungal formulations available (creams, shampoos, or oral) provides safe, effective, and flexible treatment options for seborrheic dermatitis.
PMID: 12956195 [PubMed - indexed for MEDLINE]

6: Dermatol Online J. 2003 Aug; 9(3): 13.
Topical pimecrolimus in the treatment of seborrheic dermatitis.
Brownell I, Quan LT, Hsu S.
Department of Dermatology, Baylor College of Medicine, Houston, TX, USA.
Seborrheic dermatitis is a chronic inflammatory disease that mainly affects seborrheic areas of skin. An inflammatory response to the yeast Pityrosporum ovale has been thought to be important in the etiology of the condition. Therefore, topical antifungals and corticosteroids have been the mainstay of treatment. The recent development of topical macrolactam immunomodulators has offered a useful, safe alternative to corticosteroids in the treatment of various inflammatory skin disorders. We report successful treatment of seborrheic dermatitis with pimecrolimus.
PMID: 12952760 [PubMed - indexed for MEDLINE]

7: Drugs R D. 2003; 4(5): 323-5.
Ketoconazole foam--connetics: connetics ketoconazole foam.
[No authors listed]
Connetics Corporation (USA) is developing a foam formulation of 2% ketoconazole [Extina] for the treatment of mycoses and dermatological indications, particularly seborrhoeic dermatitis. The product utilises Connetics' proprietary foam drug delivery technology, VersaFoam, and is currently awaiting registration in the US for the treatment of seborrhoeic dermatitis.Ketoconazole is a common antifungal used for the treatment of broad-spectrum mycoses, including Candida spp. Ketoconazole binds to fungal cytochrome P450 enzymes and inhibits cells from producing ergosterol, the main component of the cell wall. In late 2001, the initiation of clinical trials was delayed after Connetics decided to reformulate the foam to eliminate a particular ingredient derived from cows. In its 2001 Annual Report, Connetics stated that although the ingredient is acceptable in US products, the company felt that it was prudent to reformulate the product before beginning clinical trials. Connetics has already completed a pilot study comparing Extina with Nizoral in 50 patients with seborrhoeic dermatitis. The trial, while not sized for efficacy, did show strong efficacy trends in favour of Extina. This outcome was anticipated based on the advantages seen in skin permeation studies, which demonstrated that Extina penetrated the skin twice as effectively as Nizoral cream. The skin permeation studies were conducted by Connetics' Center for Skin Biology. Complete results from the skin permeation and pilot efficacy studies were to be submitted for publication in the second half of 2002. Results were also presented in March 2003 at the 61st Annual Meeting of the American Academy of Dermatology (AAD-2003). In July 2002, Connetics estimated the US market for topical antifungals to be worth approximately $US700 million annually.
PMID: 12952504 [PubMed - in process]

8: Int J Dermatol. 2003 Sep; 42 Suppl 1: 19-22.
Ciclopirox gel for seborrheic dermatitis of the scalp.
Aly R, Katz HI, Kempers SE, Lookingbill DP, Lowe N, Menter A, Morman M, Savin RC, Wortzman M.
Department of Dermatology, University of California San Francisco, San Francisco, CA, USA.
BACKGROUND: Seborrheic dermatitis is a common inflammatory skin disorder that usually occurs in patients with pre-existing seborrhea. The etiology of seborrheic dermatitis is uncertain. Typically, sites dense with sebaceous glands support growth of the lipophilic yeast Malassezia furfur. Ciclopirox (Loprox) gel is a hydroxypyridone, broad-spectrum antifungal agent proven effective against the yeast M. furfur. OBJECTIVE: A multicenter, randomized, double-blind, vehicle controlled study of 178 subjects evaluated the efficacy of ciclopirox gel in treating seborrheic dermatitis of the scalp. METHODS: One hundred and seventy-eight subjects were randomized to apply either ciclopirox gel 0.77% twice daily, or vehicle twice daily for 28 days. Subjects' signs and symptoms of severity (erythema, scaling, pruritus and burning) were rated on a scale of 0-3 (none to severe); for inclusion, a minimum score of 4, for the sum of the individual ratings was required. Efficacy evaluations were performed at baseline, days 4, 8, 15, 22, 29, and at end-point (final visit, up to day 33). The primary efficacy variable was clinical response assessed by a global improvement, based on a scale of 0-5 (100% clearance to flare of treatment area). Changes in signs/symptoms severity scores within the target lesion were also evaluated. RESULTS: Global evaluation scores demonstrated that significantly more ciclopirox-treated subjects achieved over 75% improvement compared with vehicle at days 22, 29, and endpoint (P < 0.01). Change-from-baseline mean score for total signs and symptoms was significantly greater in ciclopirox subjects compared with vehicle subjects at the same time points as above (P < 0.001), as well as day 15 (P < 0.01). Twenty-nine percent of subjects rated ciclopirox as having excellent cosmetic acceptability. There were only mild adverse events, with the most common being burning sensation in 13% of ciclopirox subjects and 9% of vehicle subjects. CONCLUSION: Ciclopirox gel is effective and safe in the treatment of seborrheic dermatitis of the scalp.
PMID: 12895183 [PubMed - in process]

9: Int J Dermatol. 2003 Aug; 42(8): 632-5.
Is topical metronidazole effective in seborrheic dermatitis? A double-blind study.
Koca R, Altinyazar HC, Esturk E.
Department of Dermatology, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey. [email protected]
BACKGROUND: Seborrheic dermatitis is a common, chronic, papulosquamous dermatosis. Although several types of treatment have been developed, repetitive treatment courses are often necessary. AIM: To perform a randomized, placebo-controlled, double-blind clinical study with metronidazole 0.75% gel in patients with mild to moderate seborrheic dermatitis of the face. METHODS: Eighty-four patients (52 males and 32 females) with seborrheic dermatitis were enrolled in the study. Patients were randomly allocated to the application of metronidazole 0.75% gel or placebo to their facial lesions, twice daily for 8 weeks. Patients were scored with regard to the severity of the lesions at the initial evaluation and every 2 weeks for 2 months. All patients were evaluated for a final assessment of improvement at the end of the study. RESULTS: At baseline, both treatment groups were comparable in terms of demographic data and lesion severity score. Seventy-eight patients (48 males and 30 females), 48 (62%) in the metronidazole group and 30 (38%) in the placebo group, completed the study. Two patients in the metronidazole group and four patients in the placebo group left the study. There was no statistically significant difference in the change in the mean severity score between the two groups at the end of the study (P > 0.05). At the final evaluation of the response at 8 weeks, no statistically significant difference was found between the treatment groups (P > 0.05). Metronidazole gel was generally tolerated well during the study. CONCLUSIONS: Metronidazole 0.75% gel and placebo show similar efficacy in the treatment of seborrheic dermatitis.
PMID: 12890109 [PubMed - in process]

10: Curr Med Res Opin. 2003; 19(4): 342-5.
Efficacy of betamethasone valerate 0.1% thermophobic foam in seborrhoeic dermatitis of the scalp: an open-label, multicentre, prospective trial on 180 patients.
Milani M, Antonio Di Molfetta S, Gramazio R, Fiorella C, Frisario C, Fuzio E, Marzocca V, Zurilli M, Di Turi G, Felice G.
R&D Mipharm, Milan, Italy. [email protected]
BACKGROUND: Seborrhoeic dermatitis (SD) is a common chronic inflammatory disease of the skin. Topical steroid creams and/or antifungal agents are commonly used in SD, but no resolutive therapies have been available up to now. Furthermore, little data have been available regarding clinical outcomes after cessation of topical treatments. A new formulation of betamethasone valerate 0.1% in a thermophobic, low-residue, foam vehicle (Bettamousse) (BVM) has become available for the topical treatment of scalp dermatoses. No data have been published hitherto regarding efficacy, safety and patient acceptability of this new formulation for the treatment of SD of the scalp. Study aim: To assess in an open-label, prospective, multicentre trial, the efficacy, safety and patient acceptability of BVM, as compared to baseline, in SD subjects with scalp involvement. PATIENTS AND METHODS: A total of 180 patients with moderate-to-severe SD of the scalp were enrolled in the trial. Efficacy was evaluated by analysing SD lesions for erythema, scaling and itching using a five-point grading score (0 = lesion completely cured; 1 = mild; 2 = moderate; 3 = severe and 4 = very severe lesion). The clinical global (sum) score was obtained adding the score of each item. Efficacy and safety were assessed at baseline, after 4 weeks of active treatment, followed by an 8-week follow-up period with no treatment. RESULTS: In comparison with baseline, BVM significantly improved SD lesions. The sum score was reduced from 6.3 +/- 1.8 to 1.4 +/- 1.4 at the end of the active treatment period, (p < 0.0001) and to 1.7 +/- 1.8 at the end of the 8-week follow-up period (p < 0.0001). After active treatment, 93% of the patients had a sum score of </=3). At the end of 8-week of follow-up, 88% of patients maintained a sum score </=3. In addition, 85% of patients considered BVM foam to be a better topical formulation both in terms of efficacy and acceptability compared with previous treatments used. CONCLUSION: BVM is an effective and well-tolerated topical treatment of scalp SD. Its clinical effect is also maintained after a 2-month wash-out period.
PMID: 12841928 [PubMed - indexed for MEDLINE]

11: J Am Acad Dermatol. 2003 Jul; 49(1): 145-7.
An open pilot study using tacrolimus ointment in the treatment of seborrheic dermatitis.
Meshkinpour A, Sun J, Weinstein G.
University of California, Irvine, USA.
Seborrheic dermatitis is generally treated with topical steroids, antifungals, or both. This pilot study was undertaken to examine the possibility of tacrolimus as a useful therapy for seborrheic dermatitis. In a single-center, open-label study, 18 consecutive patients with seborrheic dermatitis were treated with 0.1% tacrolimus for a total of 28 days or until complete clearance occurred, if sooner. Of the patients, 11 (61%) showed 100% clearance of their seborrheic dermatitis; the remaining 7 patients showed 70% to 99% clearance. The most common side effects were mild local burning and irritation.
PMID: 12833030 [PubMed - indexed for MEDLINE]

12: Br J Dermatol. 2003 Jun; 148(6): 1242-4.
Tacrolimus 0.1% ointment for seborrhoeic dermatitis: an open-label pilot study.
Braza TJ, DiCarlo JB, Soon SL, McCall CO.
Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA.
BACKGROUND: As a topical immunosuppressant, tacrolimus ointment may be beneficial in the treatment of seborrhoeic dermatitis, while avoiding adverse effects related to long-term use of topical corticosteroids. OBJECTIVES: To determine the safety and efficacy of topical tacrolimus 0.1% ointment in the treatment of seborrhoeic dermatitis. METHODS: Sixteen subjects (15 men and one woman) were enrolled in a 6-week, open-label, uncontrolled trial of daily topical tacrolimus 0.1% ointment. Following a 2-week washout period for subjects using conventional therapy for seborrhoeic dermatitis, study medication was applied nightly to affected areas until clinical clearance occurred, and then for 7 days thereafter. Lesional extent and severity were assessed at baseline (day 0), at week 2 and at week 6 using the following parameters: (i). clinical assessment of erythema and scaling using a 0-3 scale; (ii). investigator global assessment; (iii). subject global assessment using a 0-6 scale; and (iv). serial photography. RESULTS: Thirteen of 16 (81%) subjects completed the study protocol; three subjects were lost to follow-up at week 6. Relative to the mean baseline value, the mean lesional erythema scores improved by 66.1% and 70.9% at weeks 2 and 6, respectively. Compared with baseline, the mean scaling scores improved by 63.7% at week 2 and 87.8% at week 6. These observations were statistically significant (P < 0.05, Wilcoxon two-sample test). Mean investigator global assessment scores improved by 76.6% at week 2 and 82.7% at week 6, relative to the mean baseline value. Mean subject global assessment scores also improved, by 69.4% at week 2 and 83.5% at week 6, relative to the mean baseline value. Other than transient application site pruritus/burning in two subjects, no serious adverse events were observed. CONCLUSIONS: This pilot study suggests that topical tacrolimus 0.1% ointment is efficacious in the short-term treatment of seborrhoeic dermatitis. Further controlled trials are warranted, to determine its efficacy and safety for this common condition.
PMID: 12828755 [PubMed - indexed for MEDLINE]

13: Br J Dermatol. 2003 Jun; 148(6): 1230-6.
Lithium gluconate 8% vs ketoconazole 2% in the treatment of seborrhoeic dermatitis: a multicentre, randomized study.
Dreno B, Chosidow O, Revuz J, Moyse D; THE STUDY INVESTIGATOR GROUP.
Clinique Dermatologique, CHU Nantes, Hotel Dieu, BP 1005, 44305 Nantes cedex, France. [email protected]
BACKGROUND: Lithium significantly improved seborrhoeic dermatitis symptoms in comparison with placebo. Objectives This randomized controlled trial was designed to show a non-inferiority of 15% (primary end-point) of lithium gluconate 8% ointment compared with ketoconazole 2% emulsion. METHODS: The study population comprised out-patients who had facial seborrhoeic dermatitis for at least 2 months, with moderate to severe erythema and desquamation at inclusion. The primary end-point was complete remission, defined as the disappearance of both erythema and desquamation. The non-inferiority of lithium was assessed on the 95% confidence interval (CI) of the difference between treatments. RESULTS: The intent-to-treat analysis (ITT) involved 288 patients and the per protocol (PP) analysis 269 patients. Treatment groups were comparable at baseline on age, sex, disease duration and symptoms. For the main criterion, the success rate was 52.0% (lithium) vs. 30.1% (ketoconazole) in the ITT population and 53.2% (lithium) vs. 30.7% (ketoconazole) in the PP population. The non-inferiority of lithium was demonstrated with differences of 21.9% (95% CI 10.0-33.7%) and 22.5% (95% CI 10.2-34.8%), respectively, in the ITT and PP population. As the lower limit of the 95% CI was > 0, the superiority of lithium was shown. Lithium also showed better results on other symptoms: burning and dryness. Adverse events were reported by 26.3% (lithium) and 25% (ketoconazole) of patients. CONCLUSIONS: Lithium was 22% more effective than ketoconazole in giving complete remission of seborrhoeic dermatitis, with comparable safety.
PMID: 12828753 [PubMed - indexed for MEDLINE]

14: Nippon Ishinkin Gakkai Zasshi. 2003; 44(2): 77-80.
[Seborrheic dermatitis--clinical diagnosis and therapeutic value of different drugs]
Sei Y.
Department of Dermatology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku Yokohama 227-8501, Japan.
Seborrheic dermatitis (SD) is a disease characterized by erythema and accompanied by greasy scale in the seborrheic region. The mechanism by which the disease occurs is still unknown. The genus Malassezia is involved in aggravating SD. Objective diagnosis of SD has yet been established. Atopic dermatitis and psoriasis or contact dermatitis are often confused with SD. One method to differentiate SD from other skin diseases is direct microscopic examination. Mild corticosteroids are effective in treatment of this condition, although, many cases recur within a few days. Antifungal agents are also effective in the treatment of SD by reducing the number of spores, which results in prolongation of the time to recurrence. It is my recommendation that antifungal agents be the first choice of therapy.
PMID: 12748587 [PubMed - indexed for MEDLINE]

15: Med Hypotheses. 2003 Jun; 60(6): 907-11.
Seborrheic dermatitis, increased sebum excretion, and Parkinson's disease: a survey of (im)possible links.
Mastrolonardo M, Diaferio A, Logroscino G.
Department of Dermatology, Azienda ospedaliero-universitaria 'Ospedali Riuniti', Foggia, Italy. [email protected]
The concept of skin as a mirror of parkinsonism, dates back at the beginning of the last century. Since then, much evidence has been accumulated supporting a causal association between the neurological disturbance and changes detectable on areas of the integument with the richest sebaceous gland supply, namely seborrheic dermatitis and/or seborrhea. However, the many persisting sources of perplexity weighing on some general aspects of the skin condition itself (lack of standardized diagnostic criteria, high variability of estimates of prevalence, and controversies on etiology and pathomechanisms) must have to date hampered assessment of the real nature, and significance (if any) of the links observed. The three major pathogenical pathways so far conceived in this context will be critically reviewed on the basis of evidences provided in the literature.
PMID: 12699724 [PubMed - indexed for MEDLINE]

16: J Pak Med Assoc. 2002 Nov; 52(11): 504-6.
Correlation of the density of yeast Malassezia with the clinical severity of seborrhoeic dermatitis.
Zaidi Z, Wahid Z, Cochinwala R, Soomro M, Qureishi A.
Department of Dermatology, Dow Medical College and Civil Hospital, Karachi.
OBJECTIVE: To correlate the density of the yeast Malassezia with the clinical seventy of seborrhoeic dermatitis. METHOD: Fifty patients and twenty control subjects were selected for the study. The patients were evaluated both clinically for the severity of seborrhoeic dermatitis and microscopically for the presence of the yeast Malassezia. RESULTS: Out of 50 patients Malassezia was present in 41 patients (82%). On microscopic evaluation it was found that patients with mild seborrhoeic dermatiis had a density of 2+ (more than 5 but less than 10 yeast cells per high power field (hpf). Patients with moderate seborrhoeic dermatitis had a density of 3+ (more than 10 but less than 20 yeast cells per hpf) and patients with severe seborrhoeic dermatitis had a density of 4+ (more than 20 yeast cells per hpf). Of the 20 normal subjects only 8 (40%) had Malassezia and they had a density of 1+ (5 or fewer yeast cells per hpf). The results show a strong correlation of the yeast Malassezia to the severity of seborrhoeic dermatitis (p value < 0.05). CONCLUSION: Malassezia increases in proportion with the severity of seborrhoeic dermatitis; an antifungal agent should therefore be used in the treatment of seborrhoeic dermatitis.
PMID: 12585368 [PubMed - indexed for MEDLINE]

17: Infection. 2002 Dec; 30(6): 373-6.
Ciclopiroxolamine cream for treating seborrheic dermatitis: a double-blind parallel group comparison.
Unholzer A, Varigos G, Nicholls D, Schinzel S, Nietsch KH, Ulbricht H, Korting HC.
Clinic for Dermatology and Allergology, Ludwig-Maximilians University, Munich, Germany.
BACKGROUND: The aim of this study was to compare the efficacy and tolerability of topically applied ciclopiroxolamine cream with that of the corresponding vehicle in patients with seborrheic dermatitis of the face. PATIENTS AND METHODS: The study was conducted as a multicenter prospective, randomized, double-blind parallel group comparison at 14 centers in Australia and New Zealand. 189 patients with clinically diagnosed seborrheic dermatitis participated in the study. Each patient applied ciclopiroxolamine 1% cream or the corresponding vehicle twice daily as a thin film to the affected skin areas and to clinically unaffected skin areas surrounding the lesions for 29 days. RESULTS: The rate of treatment success was significantly higher with ciclopiroxolamine than with vehicle (73.9 vs 53.6%; p = 0.003). Treatment with ciclopiroxolamine reduced the sum score of the clinical signs of seborrheic dermatitis to a greater extent than the vehicle (p </= 0.001). CONCLUSION: This study confirms that topical treatment with ciclopiroxolamine is effective and well tolerated in patients with seborrheic dermatitis.
PMID: 12478328 [PubMed - indexed for MEDLINE]

18: Skin Pharmacol Appl Skin Physiol. 2002 Nov-Dec; 15(6): 434-41.
A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis.
Pierard-Franchimont C, Goffin V, Decroix J, Pierard GE.
Department of Dermatopathology, University Medical Center Sart Tilman, B-4000 Liege, Belgium.
Ketoconazole (KET) and zinc pyrithione (ZPT) are compounds active against the Malassezia spp. yeasts, which are believed to play a major role in dandruff and seborrheic dermatitis. We compared the efficacy and safety of KET 2% and ZPT 1% in shampoo formulations for the alleviation of severe dandruff and seborrheic dermatitis. This open randomized, parallel-group trial began with a 2-week run-in phase during which subjects applied a neutral non-antidandruff shampoo. It was followed by a 4-week randomized treatment phase and a subsequent 4-week follow-up phase without treatment. Shampooing during the treatment period was carried out twice weekly for the KET group and at least twice weekly for the ZPT group in accordance with the label instructions. A total of 343 subjects were recruited to enter the trial. Of the 331 eligible volunteers, 171 were randomized to KET 2% and 160 to ZPT 1%. Clinical assessments were performed. Beneficial effects were evidenced for both medicated shampoos, but the effect was significantly better for KET 2%, which achieved a 73% improvement in the total dandruff severity score compared with 67% for ZPT 1% at week 4 (p < 0.02). The recurrence rate of the disease was also significantly lower following KET 2% treatment than following ZPT 1% treatment. As a consequence, the overall clearing of the skin condition at the end of treatment and follow-up phase was in favor of the KET 2% formulation (p = 0.004). Side effects were minimal. It is concluded that after a 4-week treatment, KET 2% shampoo was significantly superior to ZPT 1% shampoo in the treatment of subjects with severe dandruff or seborrheic dermatitis of the scalp. It is our assumption that this difference is noticeable for the patient and as a consequence relevant. Both formulations were well tolerated. Copyright 2002 S. Karger AG, Basel
PMID: 12476017 [PubMed - indexed for MEDLINE]

19: Eur J Dermatol. 2002 Nov-Dec; 12(6): 549-52.
Lithium gluconate in the treatment of seborrhoeic dermatitis: a multicenter, randomised, double-blind study versus placebo.
Dreno B, Moyse D.
CHU Nantes, Clinique Dermatologique, Hotel-Dieu, BP 1005, 44035 Nantes Cedex, France. [email protected]
Seborrhoeic dermatitis is a frequent and chronic dermatitis of the face for which the 2 main treatments used are topical antifungals and corticosteroids. The aim of this study was to investigate the effect of topical lithium gluconate in the treatment of this affection. One hundred and twenty-nine patients with a facial seborrhoeic dermatitis for at least two months and presenting erythema and desquamation of moderate to severe intensity, were randomised to either lithium gluconate ointment dosed at 8% or placebo. The products were applied twice a day for eight weeks. The primary endpoint was to obtain a complete remission. One hundred and twenty-three patients were valid for efficacy analysis. Lithium gluconate ointment was significantly more effective than placebo, with a complete clinical remission after 4 and 8 weeks respectively of 11.3% and 29.1% of the patients in the lithium group, and 5.1% and 3.8% respectively in the placebo group. This study confirms the effectiveness of 8% lithium gluconate ointment in the treatment of seborrhoeic dermatitis.
PMID: 12459525 [PubMed - indexed for MEDLINE]

20: J Am Acad Dermatol. 2002 Dec; 47(6): 852-5.
Treatment of dandruff with 5% tea tree oil shampoo.
Satchell AC, Saurajen A, Bell C, Barnetson RS.
Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
BACKGROUND: Dandruff appears to be related to the yeast Pityrosporum ovale. Tea tree oil has antifungal properties with activity against P ovale and may be useful in the treatment of dandruff. OBJECTIVE: We conducted a randomized, single-blind, parallel-group study to investigate the efficacy and tolerability of 5% tea tree oil and placebo in patients with mild to moderate dandruff. METHODS: One hundred twenty-six male and female patients, aged 14 years and older, were randomly assigned to receive either 5% tea tree oil shampoo or placebo, which was used daily for 4 weeks. The dandruff was scored on a quadrant-area-severity scale and by patient self-assessment scores of scaliness, itchiness, and greasiness. RESULTS: The 5% tea tree oil shampoo group showed a 41% improvement in the quadrant-area-severity score compared with 11% in the placebo group (P <.001). Statistically significant improvements were also observed in the total area of involvement score, the total severity score, and the itchiness and greasiness components of the patients' self-assessments. The scaliness component of patient self-assessment improved but was not statistically significant. There were no adverse effects. CONCLUSION: Five percent tea tree oil appears to effective and well tolerated in the treatment of dandruff.
PMID: 12451368 [PubMed - indexed for MEDLINE]

21: Skin Therapy Lett. 2002; 7 Suppl 1: 4-8.
Itraconazole (Sporanox) for seborrheic dermatitis.
Gupta AK, Bluhm R.
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site) and the University of Toronto, Toronto, Canada.
Seborrheic dermatitis is a common superficial dermatosis, characterized by red, flaking areas of the skin, which may in some cases be covered with yellowish flakes. The most commonly affected areas are the nasolabial folds, ears, eyebrows, scalp and chest. While seborrheic dermatitis may be easy to recognize clinically, the variability of the lesions in both appearance and location may complicate the diagnosis. Seborrheic dermatitis has been described as resembling psoriasis (in which case, the condition may be called "sebopsoriasis") and, when affecting the eyes or ears, has also been described as blepharitis and otitis, respectively. Seborrheic dermatitis tends to be chronic, though seasonal variation is common, with lesions worsening in the dry, winter months.
PMID: 12432423 [PubMed - in process]

22: Cutis. 2002 Oct; 70(4): 207-8.
Pimecrolimus: a new treatment for seborrheic dermatitis.
Crutchfield CE 3rd.
University of Minnesota, USA. [email protected]
Seborrheic dermatitis is a chronic recurrent inflammatory skin condition that mainly affects areas containing sebaceous glands. I present a case of a novel effective topical nonsteroidal treatment (pimecrolimus 1.0% cream) for facial seborrheic dermatitis. Pimecrolimus is a member of a new class of nonsteroidal agents- macrolactam immunomodulators.
PMID: 12403310 [PubMed - indexed for MEDLINE]

23: Australas J Dermatol. 2002 Aug; 43(3): 186-9.
Efficacy, cutaneous tolerance and cosmetic acceptability of desonide 0.05% lotion (Desowen) versus vehicle in the short-term treatment of facial atopic or seborrhoeic dermatitis.
Freeman S, Howard A, Foley P, Rosen R, Wood G, See JA, Gray S.
Skin and Cancer Foundation Australia, Darlinghurst, New South Wales, Australia. [email protected]
The differences between topical corticosteroids are based mainly on their potency, safety and patient acceptability. The aim of this study was to evaluate a mild- to mid-potent topical corticosteroid, desonide 0.05%, on these three parameters in an Australian cohort of patients with facial seborrhoeic or atopic dermatitis. Eighty-one adult patients were randomized to receive desonide 0.05% lotion or its vehicle, applied twice daily for 3 weeks under double-blind conditions. In the active treatment group, 88% of patients had their skin condition cleared or almost cleared and only two patients experienced cutaneous adverse events (rash and pruritus). The acceptability of the lotion was high; 95% of patients stated they would use this topical corticosteroid again. These data support the short-term use of desonide 0.05% lotion as a suitable agent for the short-term treatment of facial dermatitis.
PMID: 12121395 [PubMed - indexed for MEDLINE]

24: Dermatology. 2002; 204(4): 344-7.
A double-blind placebo-controlled study of ketoconazole + desonide gel combination in the treatment of facial seborrheic dermatitis.
Pierard-Franchimont C, Pierard GE.
Department of Dermatopathology, University Medical Center of Liege, Belgium. [email protected]
BACKGROUND: The pathobiology of seborrheic dermatitis is rooted in a peculiar inflammatory reaction to Malassezia spp. Both topical corticosteroids and antifungals are routinely used with success, either singly or in combination. OBJECTIVE: To assess the effect of a new combination therapy in this condition. METHODS: Eighteen patients with facial seborrheic dermatitis were treated in a pilot double-blind trial with an anhydrous gel containing the combination of 2% ketoconazole and 0.05% desonide (n = 9) or the unmedicated gel (n = 9). The products were applied once daily for 3 consecutive weeks. Disease severity was assessed at the start and weekly during treatment, as well as 2, 4 and 8 weeks after the end of treatment or at the time of recurrence. The overall clinical assessments were performed using a visual analogue scale. Objective measurements included squamometry X after harvesting the stratum corneum and the erythema index yielded by narrow-band reflectance spectrophotometry. Data were evaluated in an intent-to-treat analysis. RESULTS: The combination therapy yielded reductions in the overall clinical symptom severity of 49, 84 and 92% after 1, 2 and 3 weeks of treatment, respectively. The corresponding improvements with the placebo gel were significantly smaller (p < 0.01), reaching 23, 29 and 42% at successive 1-week intervals. At the end of the 3-week treatment, the clinical signs had completely subsided in 6/9 patients treated with the medicated gel and in only 1/9 patients using the placebo gel. Thus, the clinical response rate was significantly faster (p < 0.01) with the combination therapy than with the vehicle. Differences between the treatment groups using objective noninvasive assessments were also significantly (p < 0.01) in favor of the combination therapy. The squamometry X measurements showed 47, 67 and 74% improvements with the combination gel after 1, 2 and 3 weeks, respectively. The corresponding values with the placebo gel were 34, 46 and 53%, respectively. The erythema index was almost completely reduced to normal at week 2 of treatment in contrast with about 50% reduction with the unmedicated vehicle. None of the patients reported any side effects. CONCLUSION: The combination of ketoconazole with desonide in an anhydrous gel is well tolerated and proves to be significantly more effective than the vehicle for treating facial seborrheic dermatitis. The fast response to treatment and the limited additional improvement between weeks 2 and 3 of the treatment suggest that this combination product may be efficacious with once daily applications for 2 weeks. These data call for expanded studies comparing each single compound, the vehicle and the combination therapy. Copyright 2002 S. Karger AG, Basel
PMID: 12077544 [PubMed - indexed for MEDLINE]

25: J Dermatolog Treat. 2002 Jun; 13(2): 51-60.
A randomised, single-blind, single-centre clinical trial to evaluate comparative clinical efficacy of shampoos containing ciclopirox olamine (1.5%) and salicylic acid (3%), or ketoconazole (2%, Nizoral) for the treatment of dandruff/seborrhoeic dermatitis.
Squire RA, Goode K.
PPD Development, Chelmsford, Essex, UK.
BACKGROUND: The association between seborrhoeic dermatitis and dandruff and the yeast Malassezia furfur is well recognized. Symptoms include scalp itchiness and scaling. Due to its antimycotic activity, ciclopirox olamine is established as an effective treatment for these scalp conditions. Salicylic acid has keratolytic properties and aids in the removal of scales. OBJECTIVE: To compare the therapeutic efficacy of a shampoo containing 1.5% ciclopirox olamine and 3% salicylic acid (CPO/SA) with Nizoral (2.0% ketoconazole shampoo) in a study involving 154 subjects with dandruff - 70 of whom also had seborrhoeic dermatitis of the scalp. Nizoral is currently a registered treatment for dandruff and seborrhoeic dermatitis. METHODS: The shampoos were used three times week for 4 weeks, with 2-week washout and follow-up periods. Clinical and self-assessments were made throughout treatment and after follow-up (day 43). Within and between-treatment assessments of signs and symptoms were analysed. RESULTS: In the two groups, seborrhoeic dermatitis and dandruff improved significantly throughout treatment, with lower clinical and self-assessment scores at both the end of treatment (day 29) and follow-up (day 43). Only the subjects treated with CPO/SA shampoo showed a significant reduction in the itching of seborrhoeic dermatitis at these times. CONCLUSION: The study demonstrated that both CPO/SA and Nizoral were safe and effective in the treatment of dandruff and seborrhoeic dermatitis.
PMID: 12060502 [PubMed - indexed for MEDLINE]

26: Nippon Ishinkin Gakkai Zasshi. 2002; 43(2): 65-8.
[Identification of causative species in malassezia-associated dermatoses]
[Article in Japanese]
Nakabayashi A.
Department of Dermatology, Showa University Fujigaoka Hospital, l-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan.
The Tween test was used to identify Malassezia species isolated from patients with pityriasis versicolor and seborrhoeic dermatitis, and suckling infants with seborrhoeic dermatitis. The most common species isolated from cases of pityriasis versicolor was M. globosa (55%), and this species was surmised to be the principal causative organism of this disease. In both adult and suckling infant cases of seborrhoeic dermatitis, M. globosa and M. furfur were isolated at high incidences compared with the healthy control subjects, indicating the possibility that one or both of these species are the causative organisms of these diseases. In addition, scales were collected from lesions of pityriasis versicolor for use as the template, and the involved Malassezia species were identified by the PCR method using the DNA sequences of nuclear ribosomal internal transcribed spacer l. The most commonly detected species was M. globosa, found in 97% of the cases, and this was followed in frequency by M. restricta (79%) and M. sympodialis (68%). It was also elucidated that multiple Malassezia species can be detected in the same specimen.
PMID: 12040361 [PubMed - indexed for MEDLINE]

27: Nippon Ishinkin Gakkai Zasshi. 2001; 42(4): 218-20.
[Relationship between Malassezia Yeast and Infantile Seborrhoeic Dermatitis]
[Article in Japanese]
Nakabayashi A, Sei Y.
Department of Dermatology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama 227-8501, Japan.
We examined 52 patients with infantile seborrhoeic dermatitis (ISD) and 47 healthy 1-month-old infants. Yeast cells on the right side of the face were counted by direct microscopic examination, and isolates from the left side of the face were identified by Tween test. Yeast cells were more numerous patients with ISD than in the healthy infants. M. furfur and M. globosa were isolated from ISD patients at significantly higher rates than from healthy infants.
PMID: 11704750 [PubMed - indexed for MEDLINE]

28: Schweiz Rundsch Med Prax. 2001 Aug 16; 90(33): 1346-9.
[Clinical effectiveness and tolerance of climbazole containing dandruff shampoo in patients with seborrheic scalp eczema]
[Article in German]
Wigger-Alberti W, Kluge K, Elsner P.
Klinik fur Dermatologie und dermatologische Allergologie, Friedrich-Schiller-Universitat, Jena.
Pityrosporum ovale appears to play an important role in the pathogenesis of dandruff as a symptom of seborrheic dermatitis. Climbazole is an antimycotic agent with a high in vitro and in vivo efficacy against P. ovale. In the presented work we investigated the efficacy and safety of a climbazole 0.65% shampoo on seborrheic dermatitis of 30 volunteers. Subjects were diagnosed as having moderate to severe seborrheic dermatitis of the scalp. After a 1-week washout and a 4-week treatment the clinical evaluation showed a successful reduction of dandruff, skin redness and itching in 80% of the volunteers and a mild improvement in 20% of the volunteers. The cosmetic acceptability was very good by the majority. It is concluded that the formulation tested is effective in the treatment of moderate to severe dandruff.
PMID: 11534318 [PubMed - indexed for MEDLINE]

29: Minerva Ginecol. 2000 Dec; 52(12 Suppl 1): 54-8.
Is seborrhoeic dermatitis a clinical marker of HIV disease?
Ippolito F, Passi S, Di Carlo A.
Istituto Dermovenereologico S. Gallicano, IRCCS, Via S. Gallicano, 25/A, 00153 Roma.
The Authors have conducted a cohort study on a group of subjects HIV positive, asymptomatic, (group A, according to CDC criteria) who presented Seborrhoeic dermatitis (SD), to evaluate if this cutaneous finding could be considered a marker of the HIV disease. Previously the Authors had shown that healthy subjects affected by SD showed at blood level an imbalance in the ratio of PL-PUFA (fundamental components of cell walls) to the antioxidants Vitamin E (Vit E) and gluthathion peroxidase (GSH-Px); furthermore the Authors reported SD as being constantly present in AIDS patients, in which they found more severe biochemical changes. On these bases they enrolled 72 HIV positive individuals that presented at STD-AIDS Unit of the S Gallicano Institute in the years 1994-1995 and followed them, until the 1998. They were all asymptomatic and were divided at the beginning in two subgroups, respectively with and without SD. Records were made regularly of their clinical, laboratory and biochemical data. The results highlighted the fact that SD-HIV positive individuals had severe biochemical alterations and a worse clinical evolution (higher incidence of opportunistic events). These data confirm on the hand the SD as a cutaneous marker of HIV disease not only, but also its presence could indicate the possibility of a worse progression of the disease. Finally the Authors suggest the possibility of a dietary pharmacological treatment, associated, or not, with antiretroviral therapy, to the aim to improve cell membrane defences and thereby cell immunity itself.
PMID: 11526689 [PubMed - indexed for MEDLINE]

30: Eur J Med Res. 2001 Jul 30; 6(7): 306-8.
Therapeutic and prophylactic effects of crude honey on chronic seborrheic dermatitis and dandruff.
Al-Waili NS.
Dubai Specialised Medical Centre and Medical Research Labs, P.O.Box 19964, Dubai, United Arab Emirates. [email protected]
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.
PMID: 11485891 [PubMed - indexed for MEDLINE]

31: Med Mycol. 2001 Jun; 39(3): 243-51.
Quantitative culture of Malassezia species from different body sites of individuals with or without dermatoses.
Gupta AK, Kohli Y, Summerbell RC, Faergemann J.
Department of Medicine, Women's College Hospital, University of Toronto, Canada. [email protected]
Quantitative cultures were obtained using contact plates to determine whether the quantity and composition of Malassezia species at a given anatomic site in normal individuals differs from that of patients with various cutaneous dermatoses. The sample included 20 clinically healthy individuals (without any dermatosis) and 110 patients with dermatoses (including 31 with atopic dermatitis [AD], 28 with psoriasis [PS], 28 with seborrheic dermatitis [SD] and 23 with pityriasis versicolor [PV]). Contact plates filled with special culture medium were used to obtain a quantitative culture from five body sites (scalp, forehead, arm, trunk and leg) of every individual. The number of cfu were recorded for every plate that grew Malassezia yeasts, and 3-5 colonies were isolated for identification to species level using microscopic, physiological and molecular characteristics. The mean cfu counts observed among patients with AD, PS and SD was significantly lower than normal control subjects (P < 0.05). The mean cfu counts from PV patients was not different from that of healthy control subjects. Overall, for all conditions considered together, the mean cfu counts in lesional sites were significantly lower than in non-lesional sites (P <0.05). Furthermore, the mean cfu counts from lesional sites in patients with AD and PS were significantly lower than the corresponding value in patients with PV (P <0.05). Six Malassezia species were recovered from the different dermatoses. Malassezia sympodialis was the most common species associated with AD and PV patients and healthy control subjects, while M. globosa was most frequently isolated from PS and SD patients. More than one Malassezia species was recovered at any given anatomic site from both controls as well as individuals with dermatoses. M. globosa was equally likely to be recovered from scalp, forehead and trunk, but less likely to derive from arms and legs. M. restricta and M. slooffiae were recovered more frequently from the upper body (scalp and forehead) than from the lower body. Among normal individuals and for patients with AD and PV, M. sympodialis was significantly more likely to affect the forehead than the legs.
PMID: 11446527 [PubMed - indexed for MEDLINE]

32: Br J Dermatol. 2001 May; 144(5): 1033-7.
Randomized, placebo-controlled, double-blind study on clinical efficacy of ciclopiroxolamine 1% cream in facial seborrhoeic dermatitis.
Dupuy P, Maurette C, Amoric JC, Chosidow O; Study Investigator Group.
Pierre-Fabre Research Institute, Allee Camille Soula, BP 74, Vigoulet, 31322 Castanet Tolosan Cedex, France. [email protected]
BACKGROUND: Antifungal agents are beneficial in the treatment of seborrhoeic dermatitis. OBJECTIVES: To perform a randomized, vehicle-controlled, double-blind clinical study with an antifungal ciclopiroxolamine (CIC) 1% cream in patients with mild-to-moderate seborrhoeic dermatitis of the face. METHODS: One hundred and twenty-nine patients were enrolled, 57 patients in the CIC group and 72 patients in the vehicle group, and comprised the study population for efficacy (intent-to-treat analysis) and safety. Patients were randomly allocated to apply either the CIC cream or the vehicle on their facial lesions, twice daily for a maximum of 28 days (initial phase), followed by a once daily application of the test products for another 28 days (maintenance phase). Test lesions were defined as lesions localized in the nasolabial folds and/or the eyebrow. The main efficacy parameter (end-point) was the proportion of patients who achieved complete disappearance of erythema and scaling (treatment responders) at the end of the initial phase (28 days or less) and of the maintenance phase (28 days). RESULTS: At baseline, both treatment groups were comparable in terms of demographic data and lesional status. At the end of the initial phase, responders to treatment were higher with CIC (25 patients, 44%) than with the vehicle (11 patients, 15%) (P < 0.001, Fisher exact test). At the end of the maintenance phase, responders in both groups were even higher, comprising 27 patients (63%, n = 43) in the CIC group and 15 patients (34%, n = 44) in the vehicle group (P < 0.007, intergroup analysis). The local tolerance was good in the two groups, except for a higher rate of lesional exacerbation in the vehicle group. No drug-related systemic adverse event was observed during the study. CONCLUSIONS: CIC administered in a cream demonstrated a good therapeutic value in mild-to-moderate seborrhoeic dermatitis of the face.
PMID: 11359393 [PubMed - indexed for MEDLINE]

33: J Invest Dermatol. 2001 May; 116(5): 769-73.
The effects of Malassezia yeasts on cytokine production by human keratinocytes.
Watanabe S, Kano R, Sato H, Nakamura Y, Hasegawa A.
Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan. [email protected]
Yeasts of Malassezia, members of the microbiologic flora of the skin, cause pityriasis versicolor and have also been implicated in the pathogenesis of other superficial dermatoses; the most important ones are seborrheic dermatitis, folliculitis, and atopic dermatitis. The mechanisms by which the yeasts cause these dermatoses however, are not yet clear, and there have been no studies on the interaction between fungi and keratinocytes, especially the effects of fungi on the production of cytokines by human keratinocytes. Recently, the genus Malassezia has been expanded to seven species based on molecular data. In this study, we estimated the effects of Malassezia yeasts on cytokine (interleukins 1beta, 6, and 8, monocyte chemotactic protein-1, and tumor necrosis factor-alpha) production by human keratinocytes in order to examine whether the pathogenicity of the respective Malassezia yeasts is different from each other and to elucidate the mechanism by which Malassezia yeasts cause the dermatoses with different clinical and pathologic manifestations. Variable levels of interleukin 6 and 8, and tumor necrosis factor-alpha in the supernatants in response to Malassezia yeasts (except M. furfur) increased from 1 to 24 h co-culture, but the monocyte chemotactic protein-1 was undetectable. Furthermore, cytokine levels in the supernatants were undetectable 1-24 h after the keratinocytes were harvested with only supernatants of Malassezia. These results indicate that Malassezia stimulates cytokine production by keratinocytes, the cytokine production needs the presence of Malassezia, and there are differences in ability to induce cytokine production by human keratinocytes among Malassezia yeasts. These differences may reflect the different inflammatory responses in Malassezia-associated dermatoses, resulting in different clinical and pathologic manifestations.
PMID: 11348468 [PubMed - indexed for MEDLINE]

34: Dermatology. 2001; 202(2): 171-6.
Effect of ketoconazole 1% and 2% shampoos on severe dandruff and seborrhoeic dermatitis: clinical, squamometric and mycological assessments.
Pierard-Franchimont C, Pierard GE, Arrese JE, De Doncker P.
Department of Dermatopathology, University of Liege, Belgium.
Ketoconazole (KET) is active to control dandruff and seborrhoeic dermatitis. Objective assessments comparing the 1% and 2% shampoo formulations are scant. This open, randomized parallel-group trial was carried out to differentiate the effectiveness of KET 1% and 2% in severe dandruff and seborrhoeic dermatitis. A total of 66 patients with severe dandruff or seborrhoeic dermatitis were randomized to each of the two groups. A 2-week run-in phase was followed by a 4-week treatment phase, in turn followed by a 4-week follow-up. The efficacy of treatments was evaluated by combining squamometry X, Malassezia spp. counts and clinical assessments. After 2 and 4 weeks of treatment, KET 2% was significantly superior over KET 1% (p < 0.001) for decreasing both in flakiness and Malassezia density from baseline. The same trend was observed in the mean change from baseline in the overall dandruff severity score. Only 6 mild adverse events were reported. During follow-up KET 2% showed a trend to fewer relapses than KET 1%. KET 2% had superior efficacy compared to KET 1% in the treatment of severe dandruff and scalp seborrhoeic dermatitis. Biometrological evaluations were correlated with the clinical improvements and therefore useful to incorporate in future dandruff studies. Copyright 2001 S. Karger AG, Basel.
PMID: 11306850 [PubMed - indexed for MEDLINE]

35: Br J Dermatol. 2001 Apr; 144(4): 854-7.
Evaluation of the efficacy and tolerability of oral terbinafine (Daskil) in patients with seborrhoeic dermatitis. A multicentre, randomized, investigator-blinded, placebo-controlled trial.
Scaparro E, Quadri G, Virno G, Orifici C, Milani M.
Dermatological Outpatients Departments of Genoa, Savona, Ventimiglia, La Spezia and Milan, Italy.
BACKGROUND: Previous uncontrolled trials have suggested that oral terbinafine, an antimycotic allylamine compound, could be useful in the treatment of seborrhoeic dermatitis. OBJECTIVES: To investigate in a placebo-controlled trial the clinical efficacy of oral terbinafine (Daskil(R), Mipharm, Milan, Italy) in patients with moderate to severe seborrhoeic dermatitis. METHODS: Sixty outpatients (mean +/- SD age 37 +/- 11 years; 32 men and 28 women) with moderate to severe seborrhoeic dermatitis were enrolled in a multicentre, randomized, placebo-controlled, investigator-blinded, parallel-group, 12-week study. After a 2-week wash-out period, enrolled patients were randomized to treatment with oral terbinafine 250 mg daily (n = 30) or placebo (moisturizing ointment) (n = 30) applied twice daily for 4 weeks (weeks 0-4). Patients were followed up for an additional 8 weeks after completion of treatment and were clinically evaluated at weeks 0, 2, 4 and 12 by an investigator unaware of the patient's type of treatment. The primary end-point of the study was clinical evaluation of erythema, scaling and itching, each scored on a 0-3 scale. A global clinical score, representing the sum of each evaluated symptom, was also calculated. RESULTS: Demographic and clinical data were equally balanced between the placebo and terbinafine groups. All enrolled patients concluded the study. At baseline, the mean +/- SD global clinical score was 7.4 +/- 1.3 in the placebo group and 7.7 +/- 1.0 in the terbinafine-treated group. At weeks 4 and 12 the mean +/- SD global clinical score in the placebo group was 5.9 +/- 1.7 and 6.3 +/- 1.2, respectively, which was not significantly different from baseline. As compared with baseline values and the placebo group, terbinafine treatment significantly (P < 0.0001, Tukey-Kramer test) reduced the mean +/- SD global clinical score (to 1.0 +/- 1.1 at week 4, and 1.2 +/- 1.4 at week 12), as well as the individual erythema, scaling and itching scores. No serious adverse events were recorded during the study in either group. CONCLUSIONS: This is the first controlled trial that has shown oral terbinafine to be effective in the treatment of moderate to severe seborrhoeic dermatitis. Clinical improvement following 4 weeks treatment with terbinafine was maintained 8 weeks after completing treatment.
PMID: 11298548 [PubMed - indexed for MEDLINE]

36: Br J Dermatol. 2001 Mar; 144(3): 549-56.
Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry.
Faergemann J, Bergbrant IM, Dohse M, Scott A, Westgate G.
Department of Dermatology, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden. [email protected]
BACKGROUND: The fact that Pityrosporum ovale plays a part in seborrhoeic dermatitis is well established but the mechanism of this relationship has not been established. OBJECTIVES: To compare the number and type of inflammatory cells and mediators in skin biopsies from normal and lesional skin from the trunk and scalp in patients with seborrhoeic dermatitis, Pityrosporum (Malassezia) folliculitis and in normal skin from healthy controls. METHODS: The skin biopsies were stained using the labelled Streptavidin-biotin METHOD: The following markers were studied: CD4, CD8, CD68, HLA-DR, NK1, CD16, C1q, C3c, IgG, CD54 (ICAM-1), interleukin (IL) -1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-10, IL-12, tumour necrosis factor-alpha and interferon-gamma. RESULTS: HLA-DR+ cells were seen in the highest number, and were higher in lesional skin compared with normal skin from both patients and healthy volunteers. ICAM-1 expression was also increased in lesional skin. C1q and the interleukins showed an increased cellular and intercellular staining in patients compared with healthy controls and the intercellular staining was often more intense in lesions compared with non-lesional skin. Staining was often more intense when Malassezia (Pityrosporum ovale) yeast cells were present. CONCLUSIONS: An increase in NK1+ and CD16+ cells in combination with complement activation indicates that an irritant non-immunogenic stimulation of the immune system is important. The result with the interleukins showed both an increase in the production of inflammatory interleukins as well as in the regulatory interleukins for both TH1 and TH2 cells. Similarities to the immune response described for Candida albicans infections indicate the role of Malassezia in the skin response in seborrhoeic dermatitis and Pityrosporum folliculitis.
PMID: 11260013 [PubMed - indexed for MEDLINE]

37: Dermatology. 2001; 202(1): 35-7.
Topical metronidazole in seborrheic dermatitis--a double-blind study.
Parsad D, Pandhi R, Negi KS, Kumar B.
Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. [email protected]
OBJECTIVE: To evaluate the role of topical metronidazole gel in the treatment of seborrheic dermatitis. METHODS: Forty-four patients with seborrheic dermatitis were enrolled in the study. All topical treatments were stopped for at least 2 weeks before the patients were allocated at random to receive either metronidazole 1% gel or placebo for 8 weeks. The severity score was measured at the initial evaluation, and the patients were followed up at 2-week intervals for 8 weeks. A global evaluation of improvement was done at 8 weeks. RESULTS: Thirty-eight patients completed the study; 21 patients in the metronidazole group and 17 patients in the placebo group could be evaluated. There was a statistically significant decrease of the mean score even at week 2; the difference became highly significant at 8 weeks (p < 0.001). On the final evaluation at 8 weeks, 14 patients in the metronidazole group showed marked improvement to complete clearance as compared to only 2 patients having moderate improvement in the placebo group (p < 0.001). CONCLUSION: The present trial has demonstrated the effectiveness of topical 1% metronidazole gel in seborrheic dermatitis.
PMID: 11244226 [PubMed - indexed for MEDLINE]

38: Dermatology. 2000; 201(4): 332-6.
New strategies in dandruff treatment: growth control of Malassezia ovalis.
Baroni A, De Rosa R, De Rosa A, Donnarumma G, Catalanotti P.
Istituto di Clinica Dermosifilopatica, Facolta di Medicina e Chirurgia, Seconda Universita di Napoli, Italia. [email protected]
BACKGROUND: Cutaneous infections induced by Malassezia ovalis (Pityrosporum ovale) represent a therapeutic problem due to the high rate of recurrence. OBJECTIVE: We studied feasible strategies to control the growth of M. ovalis, compatible with topical use in cosmetic formulations. Studies were performed on the effects of pH, ionic strength, cinnamic acid and related compounds on mycotic growth. METHODS: M. ovalis was cultivated in modified Sabouraud agar. The effects of pH, ionic strength and cinnamic acid and related compounds on mycotic growth were studied by the membrane filter method. RESULTS: In vitro growth of M. ovalis is strongly affected by pH and ionic strength. pH 4.5 induced a growth inhibition of about 95% and 1 M NaCl, at the optimal growth pH, reduced cell growth by over 90%. Cinnamic acid showed an inhibitory effect of 50% at 0.005 g/dl; 30 min incubation with cinnamic acid 0.5 g/dl had a mycocidic effect. CONCLUSION: These results suggest the use of cosmetic compositions containing cinnamic acid or buffered acidic lotions and shampoos in the treatment of M. ovalis infections of the scalp, eventually in addition or alternative to antimycotic drugs or in maintenance therapy. Cosmetic formulations with high ionic strength or skin irritant derivatives such as cinnamaldehyde cannot be proposed for practical use. Copyright 2000 S. Karger AG, Basel
PMID: 11146344 [PubMed - indexed for MEDLINE]

39: Med Mycol. 2000 Oct; 38(5): 337-41.
Identification of Malassezia species isolated from patients with seborrhoeic dermatitis, atopic dermatitis, pityriasis versicolor and normal subjects.
Nakabayashi A, Sei Y, Guillot J.
Department of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan. [email protected]
We identified Malassezia species isolated from 42 patients with seborrhoeic dermatitis, 17 patients with atopic dermatitis, 22 patients with pityriasis versicolor, 35 normal subjects and 73 healthy medical students. Regarding the prevalence of Malassezia species in the 35 normal subjects, the frequency of isolation of Malassezia globosa was 22%, M. sympodialis 10% and M. furfur 3%. M. slooffiae, M. pachydermatis, M. restricta and M. obtusa were infrequently isolated from normal skin. Two different species were isolated coincidentally from seven samples. In the patients with atopic dermatitis, M. furfur was isolated more frequently from lesional skin (21%) than non-lesional skin (11%). However, there was no statistical significance. Therefore, this result, by itself, is insufficient to prove that M. furfur should be considered to be an exacerbating factor of atopic dermatitis. In seborrhoeic dermatitis, M. furfur (35%) and M. globosa (22%) were isolated from lesional skin on the face at significantly high rates in comparison with the normal subjects. Therefore, M. furfur and/or M. globosa may be pathogens of seborrhoeic dermatitis. M. globosa was isolated at a frequency of 55% from lesional skin of pityriasis versicolor, while all other species were below 10%. These data suggest that the pathogenic species of pityriasis versicolor is M. globosa.
PMID: 11092380 [PubMed - indexed for MEDLINE]

40: Br J Dermatol. 2000 Nov; 143(5): 964-8.
Narrow-band ultraviolet B (ATL-01) phototherapy is an effective and safe treatment option for patients with severe seborrhoeic dermatitis.
Pirkhammer D, Seeber A, Honigsmann H, Tanew A.
Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, University of Vienna Medical School, Wahringer Gurtel 18-20, A-1090 Vienna, Austria. [email protected]
BACKGROUND: Seborrhoeic dermatitis is a common papulosquamous dermatosis affecting 2-10% of the adult population. Current treatment options are limited and not always satisfactory. Objectives We aimed to investigate the efficacy of narrow-band ultraviolet (UV) B (TL-01) phototherapy as an alternative treatment for seborrhoeic dermatitis. METHODS: Eighteen patients with severe disease were enrolled in an open prospective study. Treatment was given three times weekly until complete clearing or to a maximum of 8 weeks. A clinical score assessing erythema, scaling, infiltration and pruritus was performed at baseline and every 2 weeks thereafter. Additionally, the patients were asked to rate the intensity of pruritus on a visual analogue scale. After completion of the study the patients were followed up to determine the median time interval until recurrence. RESULTS: All patients responded favourably to treatment, with six showing complete clearance and 12 marked improvement. The median clinical score decreased from 7.5 (range 4-8) at baseline to 0.5 (range 0-3) after 8 weeks of treatment (P = 0.005). The median pruritus score decreased from 4.5 (range 0-8) at baseline to 0 (range 0-3) at week 8 (P = 0.008). Relapses occurred in all patients after a median of 21 days (range 12-40). No side-effects of treatment were observed except occasional episodes of a moderate erythemal response. CONCLUSIONS: Narrow-band UVB phototherapy appears to be a very effective and safe treatment option for patients with severe seborrhoeic dermatitis.
PMID: 11069503 [PubMed - indexed for MEDLINE]

41: Eur J Dermatol. 2000 Oct-Nov; 10(7): 528-32.
Four cases of sebopsoriasis or seborrheic dermatitis of the face and scalp successfully treated with 1a-24 (R)-dihydroxycholecalciferol (tacalcitol) cream.
Nakayama J.
Department of Dermatology, Fukuoka University School of Medicine, Fukuoka 814-0180, Japan.
A 71-year-old woman visited our clinic due to the presence of widespread scaly erythema on her face, scalp, and lower extremities. She was tentatively diagnosed as having seborrheic dermatitis but the symptoms were difficult to distinguish from psoriasis vulgaris. As a result, she was diagnosed as having sebopsoriasis. She was treated topically with an active vitamin D3 compound, 1a-24 (R)-dihydroxycholecalciferol D3 (tacalcitol) cream. She applied tacalcitol cream twice daily for 4 weeks, and her facial eruptions thus cleared up completely. No recurrence was observed for 2 months thereafter, even though the use of tacalcitol cream was stopped. To investigate whether or not tacalcitol cream is generally effective for the treatment of such seborrheic dermatitis-like eruptions, three more patients were treated with tacalcitol cream. All patients exhibited scaly erythematous macules on the face and/or scalp, and their eruptions improved rapidly with tacalcitol cream. Tacalcitol cream was thus found to be effective and useful for the treatment of both sebopsoriasis and even seborrheic dermatitis of the face and scalp.
PMID: 11056423 [PubMed - indexed for MEDLINE]

42: Dermatology. 2000; 201(2): 146-7.
High prevalence of seborrhoeic dermatitis on the face and scalp in mountain guides.
Moehrle M, Dennenmoser B, Schlagenhauff B, Thomma S, Garbe C.
Department of Dermatology, University of Tubingen, Germany. [email protected]
BACKGROUND: High incidence rates of seborrhoeic dermatitis (SD) have been reported in HIV-infected individuals, indicating immunosuppression to be involved in the pathogenesis. OBJECTIVE: To establish the prevalence of SD in mountain guides who have a high occupational exposure to solar UV radiation. PATIENTS AND METHODS: In November 1999, 283 mountain guides were physically examined on the face and scalp for symptoms of SD in Austria (n = 75), Switzerland (n = 123) and Germany (n = 85); they were 21.3-93.1 years of age (median age 41.4 years). RESULTS: Forty-six of 283 (16. 3%) mountain guides when examined clinically were found to have SD. The median age of mountain guides with SD was 41.2 years. There were similar incidence rates in all three countries. CONCLUSION: SD affects mountain guides in a clearly higher percentage as the general population. We suggest UV-induced immunosuppression due to occupational sun exposure as a pathogenetic factor. Copyright 2000 S. Karger AG, Basel
PMID: 11053918 [PubMed - indexed for MEDLINE]

43: Mycopathologia. 1999; 147(2): 63-5.
The antifungal action of dandruff shampoos.
Bulmer AC, Bulmer GS.
J.F. Cotton Hospital, Dermatology Section, Manila, Philippines.
The disease commonly known as "dandruff" is caused by numerous host factors in conjunction with the normal flora yeast Malassezia furfur (Pityrosporum ovale). Indeed, clinical studies have shown that administration of antifungal agents correlates with an improved clinical condition. Almost all commercially available hair shampoos publicize that they contain some form of antifungal agent(s). However, few studies have been published in which antifungal activity of commercially available hair shampoos have been contrasted experimentally. In this study six commercially available shampoos (in the Philippines) were assessed for antifungal activity against a human (dandruff) isolate of M. furfur: (a) Head & Shoulders (Proctor & Gamble); (b) Gard Violet (Colgate-Palmolive); (c) Nizoral 1% (Janssen); (d) Nizoral 2% (Janssen); (e) Pantene Blue (Proctor & Gamble); and (f) Selsun Blue (Abbott). The results demonstrated that all six of the assayed hair shampoos have some antifungal effect on the test yeast. However, there was consider variation in potency of antifungal activity. Nizoral 1% and Nizoral 2% shampoo preparations were the most effective. The 1% Nizoral shampoo was consistently 10X better at killing yeast cells than the next closest rival shampoo. The 2% Nizoral shampoo was 10X better than the Nizoral 1% product and 100 times better than any of the other products assayed. The study demonstrated that shampoos containing a proven antifungal compound were the most effective in controlling the causative yeast.
PMID: 10967964 [PubMed - indexed for MEDLINE]

44: Am Fam Physician. 2000 May 1; 61(9): 2703-10, 2713-4.
Treatment of seborrheic dermatitis.
Johnson BA, Nunley JR.
Division of General Medicine, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond 23298-0230, USA.
Seborrheic dermatitis is a chronic inflammatory disorder affecting areas of the head and trunk where sebaceous glands are most prominent. Lipophilic yeasts of the Malassezia genus, as well as genetic, environmental and general health factors, contribute to this disorder. Scalp seborrhea varies from mild dandruff to dense, diffuse, adherent scale. Facial and trunk seborrhea is characterized by powdery or greasy scale in skin folds and along hair margins. Treatment options include application of selenium sulfide, pyrithione zinc or ketoconazole-containing shampoos, topical ketoconazole cream or terbinafine solution, topical sodium sulfacetamide and topical corticosteroids.
PMID: 10821151 [PubMed - indexed for MEDLINE]

45: Clin Exp Dermatol. 1999 Sep; 24(5): 402-6.
Cell-mediated immunity to Malassezia furfur in patients with seborrhoeic dermatitis and pityriasis versicolor.
Bergbrant IM, Andersson B, Faergemann J.
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Goteborg, Sweden.
The lymphocyte transformation response to Malassezia furfur, Candida albicans, phytohaemagglutinin, concanavlin A and tuberculin purified protein derivative of 12 patients with pityriasis versicolor, 15 patients with seborrhoeic dermatitis and matched controls, was studied. Patients with pityriasis versicolor showed a significantly lower response to M. furfur than patients with seborrhoeic dermatitis and controls.
PMID: 10564332 [PubMed - indexed for MEDLINE]

46: J Dermatol. 1999 Sep; 26(9): 558-61.
Malassezia spp carriage in patients with seborrheic dermatitis.
Pechere M, Krischer J, Remondat C, Bertrand C, Trellu L, Saurat JH.
Department of Dermatology, Geneva University Hospital, Switzerland.
The role of Malassezia spp in seborrheic dermatitis (SD) is controversial. To compare the cutaneous density and the cultural characteristics of Malassezia in persons with or without SD, quantitative cultures were obtained by stripping the forehead with a tape placed on Leeming and Notman medium. Plates were incubated at 37 degrees C in a plastic bag, and colonies were counted after 14 days. High yeast density was defined as > 100 colony forming units (CFU)/tape. Volunteers were divided into four groups depending on their HIV serology [HIV (+) versus HIV (-) or unknown] and their clinical status (with or without SD). 126/129 cultures were positive (97.7%). Malassezia spp density was low on clinically normal skin in all HIV (-) persons (40/40) but was high in 8/34 (24%) HIV (+) persons without SD (p < 0.001). In SD patients, high densities were found in 10/22 (45%) HIV (+) and in 17/33 (52%) HIV (-) persons. The strains could be divided into three basic groups on the basis of their cultural characteristics. Colony morphology type A predominated on normal skin (72%), and morphology type C predominated on persons with SD (78%). High yeast density can be present without skin symptoms. The pathogenicity of Malassezia seems more likely to be determined by the subtype present on the skin rather than by its density.
PMID: 10535248 [PubMed - indexed for MEDLINE]

47: Skin Pharmacol Appl Skin Physiol. 1999 Jan-Apr; 12(1-2): 28-33.
The effect of isotretinoin on biotinidase activity.
Schulpis KH, Georgala S, Papakonstantinou ED, Michas T, Karikas GA.
Institute of Child Health, Aghia Sophia Children's Hospital, Athens, Greece.
BACKGROUND: Among the reaction and effects of isotretinoin, mucocutaneous reactions, xerosis and erythema of the skin as well as elevation of liver enzymes and lipids except high density lipoprotein have been reported. OBJECTIVE: Since biotinidase is mainly produced in the liver and partial biotinidase deficiency causes dermatological manifestations, seborrheic dermatitis, alopecia etc., isotretinoin side effects in relation to biotinidase activity were studied. METHODS: Forty-two (n = 42) patients with severe cystic acne had liver function tests, lipid estimations, serum biotin as well as biotinidase activity evaluations before (value 1) and on the 30th day (value 2) of treatment with isotretinoin monotherapy (Roaccutane 0.5 mg/kg/24 h). The same laboratory tests were evaluated in 50 controls only once. Moreover, the effect of isotretinoin on a known plasma biotinidase activity was evaluated after incubation in vitro with various concentrations of the drug. RESULTS: A statistically significant elevation of liver enzymes and lipids, except high density lipoprotein, was observed at the end of this study. On the contrary, biotinidase activity was found to be significantly decreased as compared to the initial values (value 1 = 4.70 +/- 0.89 nmol/min/l, value 2 = 2.50 +/- 0.8 nmol/min/l, p < 0.001) and to controls (5.2 +/- 0.9 nmol/min/l vs. value 2 = 2.50 +/- 0.8 nmol/min/l, p < 0.001). Additionally, biotin levels showed no significant alterations and the in vitro incubation of the enzyme with various concentrations of the drug exhibited no effect on its activity. CONCLUSION: It is suggested that isotretinoin isomers-metabolites act in the liver, resulting in low biotinidase activity.
PMID: 10325581 [PubMed - indexed for MEDLINE]

48: Nippon Ishinkin Gakkai Zasshi. 1999; 40(2): 63-7.
[Cutaneous immune and inflammatory reactions to Malassezia furfur]
[Article in Japanese]
Terui T, Kudo K, Tagami H.
Department of Dermatology, Tohoku University School of Medicine Seiryo-machi 1-1, Aoba-ku, Sendai 980-8574, Japan.
Initiation and aggravation of several inflammatory skin diseases are associated with Malassezia furfur. These are divided into at least two groups. In one group including tinea versicolor and Malassezia folliculitis, the growth of Malassezia furfur directly triggers the development of the cutaneous lesions. In another group including atopic dermatitis, seborrheic dermatitis, and psoriasis, cutaneous lesions already developed by other mechanisms are aggravated by the growth of Malassezia furfur. Recent progress of molecular biology techniques revealed that Malassezia furfur is divided into at least seven species. Since their clinical and histological findings are quite diverse, their differences cannot be explained solely by the difference in antigenicity of each Malassezia. Instead, the cutaneous defense mechanisms against Malassezia furfur must be considered. In this article, we reviewed the mechanisms at three levels: 1) barrier functions of the uppermost layer of the skin, the stratum corneum, 2) cytokine production by epidermal keratinocytes, and 3) immune and inflammatory responses by infiltrating neutrophils and T cells.
PMID: 10234075 [PubMed - indexed for MEDLINE]

49: Br J Dermatol. 1998 Aug; 139(2): 254-63.
Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast.
Parry ME, Sharpe GR.
Dermatology Unit, Department of Medicine, University of Liverpool, Liverpool L69 3GA, U.K.
The immune response of patients with seborrhoeic dermatitis and healthy age- and sex-matched controls was examined to test the hypothesis that an inadequate or inappropriate immune response to Malassezia yeast leads to seborrhoeic dermatitis. Antibody responses were examined using enzyme-linked immunosorbent assays (ELISAs) and Western blots and lymphocyte responses using lymphocyte proliferation assays. The level of IgG and IgM specific for whole yeast cells or extracted proteins of two isolates of M. furfur was tested in ELISA. A wide range of antibody levels was found but the patient and control groups were indistinguishable (n = 19), and the groups could not be distinguished by the pattern of Malassezia proteins recognized by their sera in Western blots. The average affinity of the subjects' antibodies specific for Malassezia cells or proteins was measured using ammonium thiocyanate dissociation. Most of the sera had moderate affinities corresponding to 50% dissociation at thiocyanate concentrations of 0.5-1.0 mol/L. There was no difference between patients and matched controls. The proliferation of the patients' lymphocytes in response to a number of M. furfur cell preparations was measured: whole cells, cytoplasmic proteins, cell walls, soluble molecules extracted from the cell walls using sonication, and a commercial preparation. There was a wide range of responses between individuals, but there was no difference between the three groups: patients with seborrhoeic dermatitis (n = 16), healthy controls (n = 16) and a group suffering from other inflammatory skin conditions (n = 15). The results do not support the hypothesis that an inadequate immune response to Malassezia yeast could lead to seborrhoeic dermatitis. Other possible pathological mechanisms include toxin production or lipase activity.
PMID: 9767239 [PubMed - indexed for MEDLINE]

50: Dermatology. 1998; 196(1): 140-7.
Oral retinoids in the treatment of seborrhoea and acne.
Orfanos CE, Zouboulis CC.
Department of Dermatology, University Medical Center Benjamin Franklin, Free University of Berlin, Germany.
Isotretinoin is an extremely effective drug if given systemically in severe forms of seborrhoea and acne, being the only retinoid with potent sebostatic properties. Its unique activity on the sebaceous gland still remains unclear since isotretinoin barely binds to cellular retinoic-acid-binding proteins and to retinoic acid receptors. Its bioavailability is approximately 25% and can be increased by food 1.5-2 times; after 30 min, the drug is detectable in the blood and maximal concentrations are reached 2-4 h after oral intake. The major metabolites of isotretinoin in blood are 4-hydroxy- and 4-oxo-isotretinoin, while several glucuronides are detectable in the bile. 4-Oxo-isotretinoin is present in plasma in a 2- to 4-fold higher concentration 6 h after a single dose. Steady-state concentrations appear after 1 week. The half-life elimination rate of the parent compound ranges from 7 to 37 h while that of some metabolites does so from 11 to 50 h. Isotretinoin crosses the placenta and is recognized as a strong teratogenic compound. About 10-30% of the drug is metabolized via its isomer tretinoin. Excretion of isotretinoin occurs after conjugation with the faeces or after metabolization with the urine. The epidermal levels of isotretinoin are rather low and no progressive accumulation, either in serum or in the skin, is found. After discontinuation of therapy, isotretinoin disappears from serum and skin within 2-4 weeks. Isotretinoin is the most effective drug in reducing sebaceous gland size (up to 90%) by decreasing proliferation of basal sebocytes, suppressing sebum production and inhibiting sebocyte differentiation in vivo. The molecular basis for its antisebotrophic activity has not been fully elucidated. Isotretinoin also exhibits anti-inflammatory activities. Systemic isotretinoin is today the regimen of choice in severe seborrhoea, since it reduces sebocyte lipid synthesis by 75% with daily doses as low as 0.1 mg/kg after 4 weeks. Patients who have received oral isotretinoin therapy for seborrhoea do not usually experience a relapse for months or years. In severe acne, a 6- to 12-month treatment with isotretinoin 1 mg/kg/day reduced to 0.5 or 0.2 mg/kg/day according to the response is recommended (cumulative dose of > 120 mg/kg). Contraception is essential during isotretinoin treatment in women of childbearing age 1 month before, during and for 3 months after discontinuation of treatment.
PMID: 9557249 [PubMed - indexed for MEDLINE]

51: Mycopathologia. 1997; 139(2): 79-85.
Humoral immune response to Malassezia furfur in patients with pityriasis versicolor and seborrheic dermatitis.
Silva V, Fischman O, de Camargo ZP.
Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo (UNIFESP), Brasil.
Humoral immune responses against exoantigen components of oval, elliptic and round yeast forms of Malassezia furfur were analysed by ELISA and Western blotting assays, using sera from patients with pityriasis versicolor (PV), seborrheic dermatitis (SD) and healthy adults (HA), as control. Sera from patients with SD showed IgG anti-oval M. furfur titers ranging from 1/400 to 1/6400 showing geometric mean (GM) of 1/1472, higher than those obtained with sera from patients with PV (1/200 to 1/6400, GM = 1/1239). Both patient groups showed mean titres statistically superior (P < 0.05) than those obtained form HA (GM = 1/229). Similar data were also obtained with the elliptic and round antigens. However, the anti-oval IgG mean titers from patients' sera were much higher than those obtained with elliptic or round antigenic components (p < 0.05) Anti-M furfur IgM titers obtained from patient's sera with PV against all three exoantigens were statistically superior (p < 0.05) than HA group. Patients with SD showed IgM titers statistically superior (p < 0.05) only to oval yeasts of M. furfur. The IgA mean titers from patients' groups against the different morphological antigens were shown be slightly higher than those HA group. By Western blot, using rabbit anti-sera, the different antigenic components of M.furfur showed a close relationship mainly between oval and elliptic yeast cells antigens. The 70 kDa component of the M. furfur exoantigen of oval morphology was recognized by 84% of the PV patients' sera. On the other hand, SD patients' sera recognized 3 principal components of 70 kDa (100%), 65 kDa (67%) and 84 kDa (53%). These components may be considered immunological markers for PV and SD. Twenty-five percent of HA sera recognized the components of 65, 70 and 94 kDa. This investigation shows that M. furfur antigens can sensitize the host, mainly the oval yeast form of M. furfur with a very important specific IgG response in patients with SD and PV.
PMID: 9549101 [PubMed - indexed for MEDLINE]

52: Clin Exp Dermatol. 1997 Sep; 22(5): 216-9.
Topical lithium succinate ointment (Efalith) in the treatment of AIDS-related seborrhoeic dermatitis.
Langtry JA, Rowland Payne CM, Staughton RC, Stewart JC, Horrobin DF.
Department of Dermatology, Westminster Hospital, London, UK.
A randomised, double-blind, placebo-controlled trial with lithium succinate ointment was conducted in patients with AIDS-associated facial seborrhoeic dermatitis. Twice daily applications of the ointment brought about a rapid (2.5 days) and highly significant (P = 0.007) improvement in the severity of the condition. Lithium succinate ointment is well tolerated and can be a useful treatment for seborrhoeic dermatitis in this group of patients.
PMID: 9536541 [PubMed - indexed for MEDLINE]

53: Pediatr Dermatol. 1997 Nov-Dec; 14(6): 423-5.
Malassezia furfur in infantile seborrheic dermatitis.
Tollesson A, Frithz A, Stenlund K.
Karolinska Institute, Department of Dermatology, Stockholm, Sweden.
Malassezia furfur is important in the pathogenesis of a number of dermatologic diseases including seborrheic dermatitis in adults. It has also recently been suggested that M. furfur might be the etiologic agent in infantile seborrheic dermatitis (ISD). We studied the presence of M. furfur in 21 children with the clinical diagnosis of infantile seborrheic dermatitis. Laboratory analyses showed aberrant patterns of essential fatty acids (EFA) in serum characterized by elevated levels of 18:1w9 and 20:2w6. Samples for M. furfur were taken from the foreheads and chests of children with infantile seborrheic dermatitis at the time of diagnosis, directly after treatment to complete healing, and after 1 year with no signs of infantile seborrheic dermatitis. All the patients were treated topically with borage oil containing 25% gammalinolenic acid (GLA). No reduced growth of M. furfur was seen on contact plates prepared with borage oil. The growth of M. furfur seems not to be related to the clinical symptoms in ISD.
PMID: 9436835 [PubMed - indexed for MEDLINE]

54: Br J Dermatol. 1996 Jun; 134 Suppl 46: 12-5: discussion 38.
Pityrosporum ovale (Malassezia furfur) as the causative agent of seborrhoeic dermatitis: new treatment options.
Faergemann J, Jones JC, Hettler O, Loria Y.
Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Several studies indicate that Pityrosporum ovale plays an important role in seborrhoeic dermatitis. Many of these are treatment studies which describe the effectiveness of antimycotics, paralleled by a reduction in the number of P. ovale colonies and then recolonization, leading to a recurrence of seborrhoeic dermatitis. In this study 20 patients with seborrhoeic dermatitis of the scalp were treated with terbinafine (Lamisil) 1% solution once daily for 4 weeks. Eleven of 18 patients (61%) were cured and they were still free of lesions 2 weeks after stopping treatment. No side-effects related to treatment were seen. There was also a significant reduction in the number of P. ovale colonies. This may explain both the good clinical effect and the observation that all patients who were cleared of P. ovale were still free of lesions 2 weeks after stopping treatment.
PMID: 8763461 [PubMed - indexed for MEDLINE]

55: Skin Pharmacol. 1996; 9(6): 388-94.
Antifungal activity of the essential oil of Melaleuca alternifolia (tea tree oil) against pathogenic fungi in vitro.
Nenoff P, Haustein UF, Brandt W.
Department of Dermatology, University of Leipzig, Germany.
The in vitro antifungal activity of tea oil, the essential oil of Melaleuca alternifolia, has been evaluated against 26 strains of various dermatophyte species, 54 yeasts, among them 32 strains of Candida albicans and other Candida sp. as well as 22 different Malassezia furfur strains. Minimum inhibitory concentrations (MIC) of tea tree oil were measured by agar dilution technique. Tea tree oil was found to be able to inhibit growth of all clinical fungal isolates. For the investigated dermatophytes MIC values from 1,112.5 to 4,450.0 micrograms/ml with a geometric mean of 1,431.5 micrograms/ml were demonstrated. Both C. albicans strains and the other strains belonging to the genus Candida and Trichosporon appeared to be slightly less susceptible to tea tree oil in vitro. However, their MIC values, which varied from 2,225.0 to 4,450.0 micrograms/ml (geometric mean 4,080 micrograms/ml), indicated moderate susceptibility to the essential oil of M. alternifolia. The lipophilic yeast M. furfur seemed to be most susceptible to tea tree oil. MIC values between 556.2 and 4,450.0 micrograms/ml (geometric mean 1,261.5 micrograms/ml) were found against the tested M. furfur strains. However, when calculated as percentage tea tree oil of the agar, the above-mentioned concentrations correspond to 0.5-0.44% tea tree oil content. These values are far below the usual relatively high therapeutic concentrations of the agent; approximately 5-10% solution or even the concentrated essential oil are used for external treatment. In comparison with tea tree oil, in vitro susceptibility against miconazole, an established topical antifungal, was tested. As expected, very low MIC values for miconazole were found for dermatophytes (geometric mean 0.2 microgram/ml), yeasts (geometric mean 1.0 microgram/ml), and M. furfur (geometric mean 2.34 micrograms/ml). It is suggested that the in vivo effect of tea tree oil ointment in the therapy of fungal infections of the skin and mucous membranes as well as in the treatment of dandruff, a mild form of seborrheic dermatitis, may be at least partly due to an antifungal activity of tea tree oil.
PMID: 9055360 [PubMed - indexed for MEDLINE]

56: Br J Dermatol. 1995 Mar; 132(3): 441-5.
Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial.
Peter RU, Richarz-Barthauer U.
Department of Dermatology, University of Munich, Germany.
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.
PMID: 7718463 [PubMed - indexed for MEDLINE]

57: Curr Top Med Mycol. 1995; 6: 95-112.
Seborrhoeic dermatitis and Pityrosporum yeasts.
Bergbrant IM.
Department of Dermatology, University of Gothenburg, Sahlgrenska Hospital, Gotborg, Sweden.
The connection between P. ovale and seborrhoeic dermatitis has been clearly demonstrated in a number of treatment studies but we still do not know how P. ovale induces skin lesions. An enhanced growth of P. ovale cannot be the cause, because a number of studies with quantitative determinations of P. ovale have not been able to show any difference in the number of yeast cells between patients and healthy controls. The number of P. ovale is probably only important for the individuals who are susceptible to seborrhoeic dermatitis. An abnormal immune response to P. ovale could be another explanation. Sohnle et al. have shown that P. ovale can activate complement by both the classical and the alternative pathway. A defective cell-mediated immunity to P. ovale in patients with seborrhoeic dermatitis has been demonstrated by Wikler et al. In patients with AIDS, who are known to have a diminished T-cell function, a high incidence of seborrhoeic dermatitis has been found. Activation of the alternative complement pathway by P. ovale, which does not require T-cell function, could be an explanation for the inflammatory response. I also believe that the skin lipids are important in the pathogenesis. An improvement of seborrhoeic dermatitis has been demonstrated after treatment with drugs that reduce the sebum excretion. Pityrosporum has lipase activity and may generate free fatty acids, which could also contribute to the inflammatory response. There are a number of factors which are probably important in the pathogenesis of seborrhoeic dermatitis, that is, the number of P. ovale, P. ovale lipase activity, skin lipids, immune function, heredity, atmospheric humidity and emotional state. A reduction in the number of P. ovale in patients suffering from seborrhoeic dermatitis and being treated with antimycotic treatment is, at the present state of knowledge, the best way to treat the disease.
PMID: 8724243 [PubMed - indexed for MEDLINE]

58: Dermatology. 1995; 191(4): 311-4.
The antifungal activity of a coal tar gel on Malassezia furfur in vitro.
Nenoff P, Haustein UF, Fiedler A.
Department of Dermatology, University of Leipzig, Germany.
OBJECTIVE: Seborrhoeic dermatitis is associated with Malassezia furfur, but the exact role of this lipophilic yeast is still unclear. The in vitro antifungal activity of a coal tar gel, the base of the gel and coal tar (Stantar) itself has been evaluated against 54 different M. furfur strains, isolated from patients suffering from dandruff, seborrhoeic dermatitis and pityriasis versicolor. METHODS: Minimum inhibitory concentrations (MICs) of the tested agents were measured by the agar dilution technique. RESULTS: The coal tar gel was found to be able to inhibit growth of 52 out of 54 investigated M. furfur isolates in vitro at MIC values between 625 and 10,000 micrograms/ml-corresponding to 3-5 micrograms/ml coal tar. However, the gel base also appears to be a less potent inhibitor of in vitro growth of M. furfur. In addition, it could be demonstrated that coal tar alone has an antifungal potential on M. furfur in vitro. MIC values from 250 to 5,000 micrograms/ml for coal tar were found. Presumably, both coal tar as the active ingredient and the gel base contribute to the in vitro activity of the coal tar gel against M. furfur. CONCLUSIONS: It is suggested that the effect of coal tar gel ointment in dandruff and seborrhoeic dermatitis therapy in vivo may be at least partly due to an antifungal activity of the coal tar but also of the gel base.
PMID: 8573928 [PubMed - indexed for MEDLINE]

59: Dermatology. 1995; 190(1): 48-50.
In vitro activity of lithium succinate against Malassezia furfur.
Nenoff P, Haustein UF, Munzberger C.
Department of Dermatology, University of Leipzig, Germany.
OBJECTIVE: The in vitro antifungal activity of lithium succinate has been evaluated against 46 different Malassezia furfur strains, isolated from patients suffering from dandruff, seborrheic dermatitis, and pityriasis versicolor. METHODS: Minimum inhibitory concentrations of lithium succinate were measured by the agar dilution technique. RESULTS: Lithium succinate was found to be able to inhibit growth of all investigated M. furfur isolates in vitro but at much higher concentrations than those which are normally used for susceptibility testing. Minimum inhibitory concentrations between 1,250 and 10,000 micrograms/ml were determined. When compared to the 8% lithium succinate ointment, the investigated concentrations are even far below this 8% value. CONCLUSIONS: It is suggested that the effect of lithium succinate ointment in seborrheic dermatitis therapy in vivo may be at least partly due to an antifungal activity of the agent.
PMID: 7894097 [PubMed - indexed for MEDLINE]

60: Hautarzt. 1994 Jul; 45(7): 464-7.
[Effect of anti-seborrhea substances against Pityrosporum ovale in vitro]
[Article in German]
Nenoff P, Haustein UF.
Klinik und Poliklinik fur Hautkrankheiten, Universitat Leipzig.
Thirty strains of the lipophilic yeast Pityrosporum ovale were isolated from patients suffering from seborrhoeic dermatitis and dandruff and tested for susceptibility both to some classic antifungal agents and to several primarily non-antimycotic drugs. Minimal inhibitory concentrations (MIC) of altogether eleven agents were measured by the agar dilution technique. As expected, the tested imidazoles showed a good inhibition of growth of Pityrosporum. The most effective agents were ketoconazole (MIC 0.1 microgram/ml) and itraconazole (MIC 0.05 microgram/ml for some strains). MIC for fluconazole, clotrimazole and tioconazole were also low, indicating a good inhibition of Pityrosporum. In contrast, the range of MIC for bifonazole was moderate to high (for some strains 12.5-25 micrograms/ml). For zinc pyrithion a very good in vitro efficacy (MIC 0.78-1.56 micrograms/ml) was dedicated. The MIC for selenium disulphide was 1.56-3.13 micrograms/ml. The antipsoriatic drugs dithranol and liquor carbonis detergens also inhibited growth of all Pityrosporum ovale strains investigated but only at higher concentrations.
PMID: 7928340 [PubMed - indexed for MEDLINE]

61: Mycoses. 1994 Jun-Jul; 37(5-6): 217-9.
Adherence of Malassezia furfur to human stratum corneum cells in vitro: a study of healthy individuals and patients with seborrhoeic dermatitis.
Bergbrant IM, Faergemann J.
Department of Dermatology and Venereology, Sahlgrenska University Hospital, Goteborg, Sweden.
The role of Malassezia furfur adherence to human stratum corneum cells in vitro was studied. The adherence assay was performed with one strain of M. furfur and stratum corneum cells from 30 healthy individuals and from 28 patients with seborrhoeic dermatitis. Stratum corneum cells from patients with seborrhoeic dermatitis contained significantly lower numbers of adherent M. furfur cells than cells from healthy individuals. No correlation was found with sex or age. The adherence assay was also performed with stratum corneum cells from one healthy individual and M. furfur strains from 15 patients with seborrhoeic dermatitis and 13 healthy controls. Malassezia furfur strains from patients with seborrhoeic dermatitis showed the same in vitro capacity for adherence to stratum corneum cells as strains from healthy individuals. This in vitro study does not indicate that M. furfur adherence to human stratum corneum cells is of importance in the pathogenesis of seborrhoeic dermatitis.
PMID: 7898520 [PubMed - indexed for MEDLINE]

62: J Dermatol. 1994 May; 21(5): 334-40.
Seborrhoeic dermatitis: treatment with anti-mycotic agents.
Sei Y, Hamaguchi T, Ninomiya J, Nakabayashi A, Takiuchi I.
Department of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan.
In order to elucidate the effectiveness of anti-mycotics in treating seborrhoeic dermatitis, an attempt was made to isolate Malassezia from seborrhoeic lesions of patients of seborrhoeic dermatitis. The results revealed that, in male patients, 46/49 cases were positive for Malassezia furfur on the face and 30/48 cases were positive for M. furfur on the scalp. In female patients, 7/13 cases were positive for M. furfur on the face, and 6/17 cases were positive for M. furfur on the scalp. Anti-mycotic agents were excellent in 50% and good in 31% of the spore-positive cases, yielding an overall efficacy rate of 81%. In contrast, the treatment of the face with vehicle alone showed only one excellent result out of 8 cases. Although clinical improvement was rapid on the side treated with a topical corticosteroid in the half-side-test, numerous fungal elements remained. While the improvement with anti-mycotic agents was slower than that with the corticosteroid, clinical improvement became evident by the third week of administration and fungal elements disappeared.
PMID: 8051320 [PubMed - indexed for MEDLINE]

63: J Am Acad Dermatol. 1993 Dec; 29(6): 1008-12.
A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff.
Danby FW, Maddin WS, Margesson LJ, Rosenthal D.
Division of Dermatology, Queen's University, Kingston, Ontario, Canada.
BACKGROUND: Ketoconazole is highly effective against the yeast Pityrosporum ovale, an organism believed to be involved in the pathogenesis of dandruff. OBJECTIVE: Our purpose was to evaluate the safety and effectiveness of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo and placebo shampoo in patients with moderate to severe dandruff. METHODS: Features assessed included adherent and loose dandruff scores, presence or absence of irritation, itching, yeast cells, and global improvement rating by the investigator. RESULTS: A total of 246 patients were included. Mean total adherent dandruff score declined throughout the treatment period with both ketoconazole 2% and selenium sulfide 2.5% shampoos significantly better than placebo at all visits. Ketoconazole was statistically superior to selenium sulfide at day 8 only (p = 0.0026). Both medicated shampoos were significantly better than placebo for reducing irritation and itching. Of the nine adverse experiences reported during the treatment phase, all involved patients treated with selenium sulfide 2.5% shampoo. CONCLUSION: Both ketoconazole 2% shampoo and selenium sulfide 2.5% shampoo are effective in the treatment of moderate to severe dandruff; however, ketoconazole 2% shampoo appears to be better tolerated.
PMID: 8245236 [PubMed - indexed for MEDLINE]

64: J Am Acad Dermatol. 1993 Jun; 28(6): 957-61.
Essential fatty acids in infantile seborrheic dermatitis.
Tollesson A, Frithz A, Berg A, Karlman G.
Department of Dermatology, Karolinska Institutet, Stockholm, Sweden.
BACKGROUND: In infantile seborrheic dermatitis (ISD) several different pathogenetic mechanisms have been proposed. OBJECTIVE: The purpose of the study was to investigate the importance of essential fatty acids (EFAs) and their metabolites in the origin of ISD. METHODS: The serum EFA patterns of 30 children with ISD, 1 to 6 months of age, were studied for 2 to 5 months. Blood samples were obtained at the time of diagnosis and after spontaneous recovery. Control samples were taken from age-matched healthy children. RESULTS: In children with active dermatitis levels of EFA 18:1w9 were increased and levels of 18:2w6 were decreased, whereas 20:4w6 levels remained normal. The rare fatty acid 20:2w6 was found in significant amounts in 20 patients, but at only barely detectable levels in the controls. All deviant values but the levels of 20:2w6 were normal at the time of recovery. Breast milk samples were obtained at the time of diagnosis from the patients' mothers and from a control group consisting of healthy nursing mothers. The EFA patterns were identical. The differences in EFA pattern between children with ISD and those free of skin disease were significant. The normalization of the deviation in ISD paralleled the recovery at any age it occurred. CONCLUSION: The laboratory findings suggest a transient impaired function of the enzyme delta-6-desaturase. The altered EFA pattern in ISD may be important in the pathogenesis of the disease.
PMID: 8496460 [PubMed - indexed for MEDLINE]

65: Mycoses. 1993 May-Jun; 36(5-6): 207-10.
In vitro comparison of antifungal effects of a coal tar gel and a ketoconazole gel on Malassezia furfur.
Wright MC, Hevert F, Rozman T.
Basotherm GmbH, Biberach, Germany.
Malassezia furfur seems to be a major pathogenetic factor in seborrhoeic dermatitis, a frequent human skin disease. To estimate the antifungal properties of a coal tar gel (5 mg ml-1 coal tar) which is used in the treatment of seborrhoeic dermatitis of the scalp, we compared its effects on the in vitro growth of M. furfur with those of a ketoconazole gel (20 mg ml-1 ketoconazole). None of the gels was fungicidal within incubation times up to 20 min. During a single application, both gels remain on the skin for only 5 min. Fungicidal effects are consequently unlikely to play a substantial therapeutic role. Fungistatic effects were observed with both gels. In cultures inoculated with 1 x 10(3) cells ml-1, a 1:49 152 dilution of the ketoconazole gel and a 1:768 dilution of the coal tar gel still showed inhibitory effects. At inoculum densities of 1 x 10(5) ml-1, both gels were fungistatic only in dilutions of a maximum of 1:40. Our results suggest that under clinical treatment conditions the fungistatic activities of both preparations should be comparable.
PMID: 8264719 [PubMed - indexed for MEDLINE]

66: Acta Derm Venereol. 1993 Feb; 73(1): 18-20.
Transepidermal water loss and water content in the stratum corneum in infantile seborrhoeic dermatitis.
Tollesson A, Frithz A.
Karolinska Institutet, Department of Dermatology, Sodersjukhuset, Stockholm, Sweden.
Thirty-seven patients with clinically diagnosed infantile seborrhoeic dermatitis (ISD) were studied in an attempt to establish the significance of transepidermal water loss (TEWL) and water content in the stratum corneum, in active disease and after recovery. All the patients were treated daily with topically applied borage oil (containing 24% gamma-linolenic acid). With this regimen they were completely free from all skin symptoms within 3-4 weeks. Analyses of essential fatty acids in serum showed aberrations as previously described, with elevated levels of 18:1w9 and 20:2w6. TEWL and water content were recorded at the time of diagnosis and after treatment from the right forearm in skin that was free from symptoms and not treated with borage oil. Twenty-five healthy children in an age-matched group without skin disorders were used as controls. Significant differences in TEWL between patients and controls were found before treatment. After treatment no significant differences were found. There were no significant differences between controls and patients regarding water content in the stratum corneum. Gamma-linolenic acid is suggested to be of importance in maintaining normal TEWL and also in promoting recovery in patients suffering from ISD.
PMID: 8095744 [PubMed - indexed for MEDLINE]

67: Acta Derm Venereol. 1992 Nov; 72(6): 432-5.
A dose-response study of irritant reactions to sodium lauryl sulphate in patients with seborrhoeic dermatitis and atopic eczema.
Cowley NC, Farr PM.
Department of Dermatology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
The susceptibility of the skin of patients with seborrhoeic dermatitis to surfactant irritation was investigated and compared to that of a group of normal subjects and patients with a history of atopic eczema. Responses to six concentrations of sodium lauryl sulphate (SLS), applied to forearm skin, were assessed clinically and measured by laser Doppler flowmetry. Analysis of dose-response curves showed statistically significant increased susceptibility to SLS-induced irritation in patients with seborrhoeic dermatitis and atopic eczema compared with normal subjects. Increased susceptibility to chemical irritation may be important in the pathogenesis of seborrhoeic dermatitis.
PMID: 1362835 [PubMed - indexed for MEDLINE]

68: J Am Acad Dermatol. 1992 Mar; 26(3 Pt 2): 452-7.
A double-blind, placebo-controlled, multicenter trial of lithium succinate ointment in the treatment of seborrheic dermatitis.
Efalith Multicenter Trial Group.
[No authors listed]
BACKGROUND: Seborrheic dermatitis, an inflammatory dermatosis that principally affects sebaceous areas, may be related to the presence of the yeast Pityrosporum ovale. Topical therapy with corticosteroids, although in general effective, may be associated with several unwanted effects. The development of alternative non-steroid-based therapies may enable patients to avoid the use of topical steroids and help elucidate the pathogenesis of the disease. OBJECTIVE: This study aimed to assess the efficacy and safety of an ointment containing 8% lithium succinate in the treatment of seborrheic dermatitis. METHODS: The study consisted of a multicenter placebo-controlled clinical trial in 227 adult patients. RESULTS: Lithium succinate ointment was significantly more effective than placebo in treating all the symptoms of seborrheic dermatitis. No specific unwanted effects were associated with its use. Relapse was slow when treatment was stopped. CONCLUSION: The effectiveness of lithium succinate ointment in the treatment of seborrheic dermatitis adds to the evidence implicating P. ovale in the pathogenesis of that condition.
PMID: 1532964 [PubMed - indexed for MEDLINE]

69: Dermatology. 1992; 184(3): 194-7.
Comment in: Dermatology. 1993;187(2):149-50.
Use of topical lithium succinate in the treatment of seborrhoeic dermatitis.
Cuelenaere C, De Bersaques J, Kint A.
Department of Dermatology, University Hospital, Ghent, Belgium.
Twenty-one patients with seborrhoeic dermatitis were included in an open trial of lithium succinate ointment (LSO) for a total duration of 8 weeks. The same clinician made assessments of the severity of redness, scaling, greasiness and overall clinical impression of the condition every 2 weeks. Because the results appeared to be satisfactory, we decided to perform a double-blind, placebo-controlled trial of LSO. Thirty patients with seborrhoeic dermatitis were included. The results also demonstrated the beneficial effect of LSO. A significantly higher number of patients treated with LSO showed remission or marked improvement compared with placebo. The main adverse events demonstrated consisted of minor transient skin irritation and/or stinging sensation. Studying the in vivo inhibitory effect of LSO on the growth of Pityrosporum revealed that Pityrosporum did not significantly have its growth inhibited by lithium. Topical lithium succinate appears to be a safe and an effective treatment for seborrhoeic dermatitis. The product presumably acts as an anti-inflammatory agent.
PMID: 1392111 [PubMed - indexed for MEDLINE]

70: Dermatology. 1992; 184(4): 275-80.
Comparative study of ketoconazole 2% foaming gel and betamethasone dipropionate 0.05% lotion in the treatment of seborrhoeic dermatitis in adults.
Ortonne JP, Lacour JP, Vitetta A, Le Fichoux Y.
Department of Dermatology, Hopital Pasteur, Nice, France.
Sixty-two patients with seborrhoeic dermatitis were treated topically with a 2% ketoconazole foaming gel or with a 0.05% betamethasone dipropionate lotion in a single-blind study for 4 months. Changes in the number of Pityrosporum ovale were scored by a mycologist. The investigator rated the severity of erythema, scaling and itching of the patients' scalp, eyelashes, nasolabial folds and thorax. In addition, both the investigator and the patients evaluated the treatments globally. At the end of treatment, the response rate for ketoconazole 2% foaming gel was significantly higher than that for betamethasone dipropionate 0.05% lotion according to the global evaluation by the physician (89 vs. 62%, p less than 0.05) and the patient (89 vs. 65%, p less than 0.05). Ketoconazole was also superior to betamethasone with reference to the evolution of the symptoms, irrespective of their localization. This efficacy manifested itself by a significant reduction of the number of P. ovale on the scalp in the ketoconazole group (p less than 0.001) compared to the betamethasone group, in which the count was hardly changed during therapy. The treatment was also better tolerated in the ketoconazole group (5 vs. 16 patients with side-effects, p less than 0.001). It is concluded that ketoconazole 2% foaming gel offers an excellent alternative to local corticosteroids in the treatment of seborrhoeic dermatitis.
PMID: 1386766 [PubMed - indexed for MEDLINE]

71: Int J Dermatol. 1991 Nov; 30(11): 806-9.
Ketoconazole 2% emulsion in the treatment of seborrheic dermatitis.
Pierard GE, Pierard-Franchimont C, Van Cutsem J, Rurangirwa A, Hoppenbrouwers ML, Schrooten P.
Department of Dermatopathology, CHU du Sart Tilman, Liege, Belgium.
Fifty patients (42 men, 8 women) with seborrheic dermatitis were included in the trial. Ketoconazole 2% emulsion or the same emulsion without active drug was applied b.i.d. for 4 weeks. Two patients dropped out in the ketoconazole group and nine in the placebo group. Pityrosporum ovale was cultured from all patients at the start and from six out of 23 in the ketoconazole group versus nine out of 16 in the placebo group at week 4. The overall assessment showed a significantly better response to treatment for the ketoconazole emulsion (72%) than for the placebo (32%).
PMID: 1836780 [PubMed - indexed for MEDLINE]

72: Clin Exp Dermatol. 1991 Sep; 16(5): 331-8.
An immunological study in patients with seborrhoeic dermatitis.
Bergbrant IM, Johansson S, Robbins D, Scheynius A, Faergemann J, Soderstrom T.
Department of Dermatology, University of Gothenburg, Sahlgrenska Hospital.
The humoral and cellular immune-status was studied in 30 patients with seborrhoeic dermatitis. Increased frequencies of natural killer cells were found in 46% of patients. Furthermore, subnormal mitogen stimulation responses were demonstrated in 13 patients, whereas two individuals were found to have very high numbers of activated T lymphocytes in peripheral blood. Higher-than-normal total serum IgG and IgA was observed in 14 and 11 patients, respectively. For nine of 12 patients with skin lesions, dermal perivascular cell infiltrates were seen. The majority of the infiltrating cells reacted with anti-CD4 antibodies. HLA-DR-expressing keratinocytes were found in two biopsies. The study suggests that patients with seborrhoeic dermatitis may have depressed T-cell function. This could have a bearing on their susceptibility to the Pityrosporum ovale-associated dermatitis. The very high frequencies of activated T cells observed in the peripheral blood of two otherwise healthy seborrhoeic individuals suggests that intermittent systemic immune activation may occur. Seborrhoeic dermatitis is a common skin disease. It can be diagnosed by its characteristic red to yellow-brown lesions covered with greasy scales distributed in areas with a high number of sebaceous glands, such as the scalp, face and upper trunk. There is an association between seborrhoeic dermatitis and the lipophilic yeast Pityrosporum ovale but its exact aetiological role is not known. The yeast is a member of the normal cutaneous flora but also the aetiological agent of pityriasis versicolor and Pityrosporum folliculitis. P. ovale can activate complement via the direct and alternative pathways. This may play some part in the induction of inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 1838969 [PubMed - indexed for MEDLINE]

73: Arzneimittelforschung. 1991 Aug; 41(8): 852-4.
[Treatment of seborrhoeic eczema with ketoconazole in comparison with an active agent-free cream]
[Article in German]
Peter RU, Korting HC.
Dermatologische Klinik und Poliklinik, Ludwig-Maximilians-Universitat, Munchen.
Both systemic and topical application of ketoconazole (CAS 65277-42-1) have been found effective in seborrhoeic dermatitis. The topical application of 2% ketoconazole in a cream base in particular has so far only once been compared to the application of the vehicle. Statistical analysis, however, has only been descriptive. In the present trial including 60 patients 2% ketoconazole cream (Nizoral) and a bland cream have been compared in a randomised, controlled fashion. Both erythema and scaling were found markedly more reduced in the verum group (p = 0.003 and p = 0.006, resp.). Hence the topical application of 2% ketoconazole cream can be considered as rational treatment of seborrhoeic dermatitis the more so as the application of the drug was well tolerated.
PMID: 1838256 [PubMed - indexed for MEDLINE]

74: J Dermatol Sci. 1991 May; 2(3): 171-8.
Blood levels of vitamin E, polyunsaturated fatty acids of phospholipids, lipoperoxides and glutathione peroxidase in patients affected with seborrheic dermatitis.
Passi S, Morrone A, De Luca C, Picardo M, Ippolito F.
Istituto Dermatologico San Gallicano, Rome, Italy.
Plasma levels of vitamin E (Vit E) and polyunsaturated fatty acids of phospholipids (PUFA-PL) as well as erythrocyte glutathione peroxidase (GSH-Px) activity are significantly lower (P less than 0.001) in patients with seborrheic dermatitis (SD). both HIV seropositive or HIV sero-negative, than in control subjects. No differences are found between HIV sero-positive and sero-negative individuals with SD. The deficiency of PUFA-PL (mainly C20: 3 n-6, C20: 4 n-6 and C22: 6 n-3) which is accompanied by a significant increase of saturated palmitic and stearic acids (P less than 0.001), does not appear to be associated with an active lipoperoxidative process in the plasma. The significant blood deficiency of Vit E, GSH-Px, and particularly of PUFA-PL, may play a pathogenetic role in seborrheic dermatitis.
PMID: 1831657 [PubMed - indexed for MEDLINE]

75: Acta Derm Venereol Suppl (Stockh). 1991; 167: 1-36.
Seborrhoeic dermatitis and Pityrosporum ovale: cultural, immunological and clinical studies.
Bergbrant IM.
Department of Dermatology, University of Goteborg, Sweden.
Seborrhoeic dermatitis is a common skin disease mainly affecting the scalp and face. The etiology of seborrhoeic dermatitis is unknown but a connection with the lipophilic yeast Pityrosporum ovale has been found in a number of treatment studies. P. ovale belongs to the normal cutaneous flora but is also an opportunistic pathogen. The purpose of these studies was to examine how the density of P. ovale changes with age, to determine the number of P. ovale in seborrhoeic dermatitis compared to controls, to study the immunological functions in patients with seborrhoeic dermatitis, to evaluate different methods of detecting antibodies against P. ovale and to describe how the patients experience their disease. The number of P. ovale on clinically normal skin decreases with increasing age. In patients with seborrhoeic dermatitis, the number of P. ovale in lesional skin was not increased compared to healthy skin in the patients or in healthy controls. A reduction of the skin surface lipids was seen in elderly healthy individuals. The lipid content on the skin in patients with seborrhoeic dermatitis was higher than in controls (p = 0.0001). Serum IgG antibodies against P. ovale measured with indirect immunofluorescence decreased parallel to increasing age in healthy individuals and no difference was found between patients with seborrhoeic dermatitis and healthy controls. ELISA with a P. ovale protein extract was the only method that demonstrated a difference in immune response between patients and controls when this method was compared with four other assays (p = 0.03). Immunological screening was done in 30 patients with seborrhoeic dermatitis. No major abnormalities in the humoral and local immune system were found but T-cell and NK-cell aberrations were found in several patients with seborrhoeic dermatitis. One-third of the patients had low lymphocyte stimulations with Concanavalin-A and phytohaemagglutinin and almost half of the patients had high frequencies of circulating natural killer-cells. In a questionnaire answered by 431 patients with seborrhoeic dermatitis, we found indications that hereditary, the season, mental stress and the work environment influence the disease. The investigations suggest that the number of P. ovale in seborrhoeic dermatitis is of minor importance. How each individual reacts to P. ovale and the amount of skin surface lipids are probably of greater importance in the development of seborrhoeic dermatitis.
PMID: 1839943 [PubMed - indexed for MEDLINE]

76: Semin Dermatol. 1990 Dec; 9(4): 262-8.
The role of Pityrosporum ovale in seborrheic dermatitis.
Bergbrant IM, Faergemann J.
Department of Dermatology, University of Gothenburg, Sahlgren's Hospital, Sweden.
This paper discusses the relation between the lipophilic dimorphic yeast Pityrosporum ovale and seborrheic dermatitis. A review of studies concerning the microbiology in seborrheic dermatitis and immune reactions to P ovale are given. In our own studies with quantitative cultures, no significant difference was found in the number of P ovale in patients compared with controls, or between healthy and lesional skin in the patient group. IgG serum antibodies against P ovale cells estimated with indirect immunofluorescence did not show any difference between patients and controls, but a significant difference was found when a P ovale protein extract and ELISA were used. Immunological investigation on serum samples were done on 30 patients with seborrheic dermatitis. Defects were found in their T-cell function. The number of P ovale is of importance in those individuals who are susceptible to seborrheic dermatitis and the development of the disease depends on the way their immune system reacts to the antigens derived from P ovale.
PMID: 2149500 [PubMed - indexed for MEDLINE]

77: Acta Derm Venereol. 1990; 70(5): 432-4.
Patients with mood depression have a high prevalence of seborrhoeic dermatitis.
Maietta G, Fornaro P, Rongioletti F, Rebora A.
Department of Dermatology, University of Genoa, Italy.
Prevalence and severity of seborrhoeic dermatitis were studied in 150 patients with psychiatric disorders, including schizophrenia, mood disorders, anxiety and organic mental illness. As a control group, we examined 150 patients waiting for surgery and regarded as obviously anxious. Thirty-eight psychiatric patients were found to have seborrhoeic dermatitis, versus 13 in the surgery group. This statistically significant difference was entirely ascribable to patients with depression.
PMID: 1980980 [PubMed - indexed for MEDLINE]

78: Br J Dermatol. 1989 Sep; 121(3): 353-7.
A double-blind trial of treatment of seborrhoeic dermatitis with 2% ketoconazole cream compared with 1% hydrocortisone cream.
Katsambas A, Antoniou C, Frangouli E, Avgerinou G, Michailidis D, Stratigos J.
A. Sygros Hospital for Diseases of the Skin, University of Athens, Greece.
Fifty patients with seborrhoeic dermatitis were treated with 2% ketoconazole cream (n = 24) or with 1% hydrocortisone cream (n = 26) for 4 weeks in a double-blind comparative study. These twice daily applications resulted in 87.2% symptomatic improvement for hydrocortisone vs. 81.6% for ketoconazole. The number of P. ovale yeasts was significantly reduced after the application of ketoconazole compared with hydrocortisone. The incidence of side-effects was low in both groups.
PMID: 2529893 [PubMed - indexed for MEDLINE]

79: Drugs. 1989 Aug; 38(2): 204-25.
Bifonazole. A review of its antimicrobial activity and therapeutic use in superficial mycoses.
Lackner TE, Clissold SP.
Jewish Hospital of St Louis, Missouri.
Bifonazole is a substituted imidazole antifungal agent structurally related to other drugs in this group. It possesses a broad spectrum of activity in vitro against dermatophytes, moulds, yeasts, dimorphic fungi and some Gram-positive bacteria. Both non-comparative and comparative clinical trials have clearly demonstrated the efficacy and safety of various formulations of bifonazole 1% (cream, gel, solution and powder) applied once daily in the treatment of superficial fungal infections of the skin such as dermatophytoses, cutaneous candidiasis and pityriasis versicolor. In comparative studies bifonazole was significantly superior to placebo and at least as effective as alternative imidazole antifungal drugs including clotrimazole, econazole, miconazole, oxiconazole and sulconazole. Preliminary studies in other superficial skin and nail infections/dermatoses suggest that bifonazole may be useful for treating onychomycoses (in a combination cream; bifonazole 1% plus urea 40%), otomycoses, erythrasma, sebopsoriasis, seborrhoeic dermatitis and rosacea. However, controlled trials are needed in each of these clinical settings to assess accurately its relative place in therapy. Thus, bifonazole is an effective and well-tolerated treatment for superficial fungal infections of the skin. Compared with the majority of topical antifungal drugs, which need to be applied at least twice daily, bifonazole offers the convenience of once daily administration, which may improve patient compliance.
PMID: 2670516 [PubMed - indexed for MEDLINE]

80: Pediatr Dermatol. 1989 Mar; 6(1): 16-20.
Pityrosporum ovale in infantile seborrheic dermatitis.
Ruiz-Maldonado R, Lopez-Matinez R, Perez Chavarria EL, Rocio Castanon L, Tamayo L.
Department of Dermatology, Instituto Nacional de Pediatria, Mexico City.
The presence of Pityrosporum ovale was investigated in four groups of infants age 1 to 24 months, 15 with infantile seborrheic dermatitis, 15 with infantile atopic dermatitis, 15 with other infantile dermatoses, and 15 healthy infants. Samples were taken from the scalp, face, presternal area, and inguinal area. Pityrosporum ovale was detected by smears and/or cultures in 73% of infants with seborrheic dermatitis, 33% with atopic dermatitis, 33% with other dermatoses, and 53% of healthy infants. The percentages of positive smears and/or cultures from four body sites in each patient group were 42% for seborrheic dermatitis, 20% for atopic dermatitis, 20% for other infantile dermatoses, and 23% for healthy infants. The majority of infants with positive cultures or positive direct examination for P. ovale were between 1 and 8 months of age. The organism was isolated in 28% of samples taken from the scalp, 32% from the face, 30% from the presternal area, and 15% from the inguinal area. Patients with infantile seborrheic dermatitis were treated with 2% topical ketoconazole cream for two weeks. Eleven of these children were clinically cleared and 13 became mycologically negative. Pityrosporum ovale was significantly more frequent in infants with seborrheic dermatitis than in those with atopic dermatitis, in other infantile dermatoses, or in healthy infants, both in the total number of infants with positive smears and/or cultures and in the number of positive samples per body area (P less than 0.05).
PMID: 2523039 [PubMed - indexed for MEDLINE]

81: Contact Dermatitis. 1988 Sep; 19(3): 195-201.
The role of contact allergy in the spectrum of adverse effects caused by cosmetics and toiletries.
de Groot AC, Beverdam EG, Ayong CT, Coenraads PJ, Nater JP.
Department of Dermatology, Carolus & Willem-Alexander Hospital, 's-Hertogenbosch, The Netherlands.
Of 982 female clients of beauticians interviewed, 254 (25.9%) claimed to have experienced adverse reactions to cosmetics and toiletries in the preceding 5 years. Most reactions were caused by skin-care products (36.6%), followed by personal cleanliness products (29.5%), eye cosmetics (24.0%), deodorants and antiperspirants (12.6%), and facial make-up products (8.3%). 150 women were patch tested. In the European standard series, only a few positive reactions were seen to possible cosmetic allergens: fragrance mix (n = 3), wool alcohols (n = 3), formaldehyde (n = 2), balsam of Peru (n = 1), and colophony (n = 1). In the cosmetic series, only Kathon CG elicited positive patch test reactions (n = 3). Cosmetic allergy was considered to be "proven" in 3 patients (2.0%), and "possible" in 7 (4.7%). It is concluded that contact allergy is responsible for a minority (less than 10%) of all reactions to cosmetics and toiletries. The majority of reactions are due to irritation from personal cleanliness products such as soaps, shampoos, bath foams and from deodorants, or worsening of pre-existing dermatoses such as seborrhoeic dermatitis and acne.
PMID: 3191681 [PubMed - indexed for MEDLINE]

82: Cutis. 1988 Aug; 42(2): 146.
Short-term treatment of dandruff with a combination of propylene glycol solution and shampoo.
Faergemann J.
Department of Dermatology, University of Gothenburg, Sahlgren's Hospital, Sweden.
Many studies now indicate an association between the lipophilic dimorphic yeast Pityrosporon ovale and dandruff. Propylene glycol has been proved effective in the treatment of pityriasis versicolor, Pityrosporon folliculitis, and seborrheic dermatitis. The patients in this study found treatment with a combination of propylene glycol, ethanol, and water, used with a shampoo, to be effective, easy to use, and cosmetically attractive. No side effects were observed by the patients.
PMID: 2970946 [PubMed - indexed for MEDLINE]

83: Cutis. 1988 Jul; 42(1): 69-71.
Propylene glycol in the treatment of seborrheic dermatitis of the scalp: a double-blind study.
Faergemann J.
Department of Dermatology, University of Gothenburg, Sahlgren's Hospital, Goteborg, Sweden.
Thirty-nine patients with seborrheic dermatitis of the scalp were treated in a double-blind controlled study with a solution containing either 15 percent propylene glycol, 50 percent ethanol, and 35 percent water, or a solution containing 50 percent ethanol and 50 percent water. Two patients did not return for follow-up. Sixteen of eighteen (89 percent) in the group treated with propylene glycol showed healing, compared to six of nineteen (32 percent) in the other group. In twenty patients quantitative cultures for Pityrosporum orbiculare were taken. The number of organisms was reduced significantly after treatment with the propylene-glycol-containing solution but not in the other group. This propylene-glycol-containing solution was easy to apply, cosmetically attractive, and may be an alternative to corticosteroids for the treatment of seborrheic dermatitis of the scalp.
PMID: 2974411 [PubMed - indexed for MEDLINE]

84: J Am Acad Dermatol. 1988 Mar; 18(3): 553-8.
Comment in: J Am Acad Dermatol. 1990 Jul;23(1):154-6.
Sulfur revisited.
Lin AN, Reimer RJ, Carter DM.
Laboratory for Investigative Dermatology, Rockefeller University, New York, NY 10021.
Sulfur is a time-honored therapeutic agent useful in a variety of dermatologic disorders. Its keratolytic action is due to formation of hydrogen sulfide through a reaction that depends upon direct interaction between sulfur particles and keratinocytes. The smaller the particle size, the greater the degree of such interaction and the greater the therapeutic efficacy. When applied topically, sulfur induces various histologic changes, including hyperkeratosis, acanthosis, and dilatation of dermal vasculature. One study showed that sulfur was comedogenic when applied onto human and rabbit skin, findings that were not reproduced in other studies. About 1% of topically applied sulfur is systemically absorbed. Adverse effects from topically applied sulfur are uncommon and are mainly limited to the skin. In infants, however, fatal outcome after extensive application has been reported.
PMID: 2450900 [PubMed - indexed for MEDLINE]

85: Br J Dermatol. 1986 Jun; 114(6): 695-700.
Seborrhoeic dermatitis and Pityrosporum orbiculare: treatment of seborrhoeic dermatitis of the scalp with miconazole-hydrocortisone (Daktacort), miconazole and hydrocortisone.
Faergemann J.
Seventy patients (36 males and 34 females) with seborrhoeic dermatitis of the scalp were treated in a double-blind controlled study, for a maximum of 6 weeks, with 2% miconazole base and 1% hydrocortisone (Daktacort), 2% miconazole base, or 1% hydrocortisone. Patients who were cured were treated with the same formulation prophylactically twice monthly for 3 months or until recurrence. Nineteen of 21 patients were cured in the Daktacort group, 15 of 22 in the miconazole group and 17 of 24 in the hydrocortisone group. The number of cultured Pityrosporum orbiculare was significantly lower in all groups after treatment, but in the hydrocortisone group was still significantly higher than in the two other groups. After 3 months of prophylactic treatment, both Daktacort (16 of 19 patients clear) and miconazole (10 of 15 patients clear) were significantly better than hydrocortisone (3 of 17 patients clear) (P less than 0.01). The numbers of P. orbiculare remained low in the Daktacort and miconazole groups and also significantly lower than in the hydrocortisone-treated group (P less than 0.01). In patients with recurrence, the numbers returned to pre-treatment levels. This study demonstrates the aetiological significance of the Pityrosporum yeasts in seborrhoeic dermatitis. Both Daktacort and miconazole were effective in treatment and as prophylactic agents.
PMID: 2941051 [PubMed - indexed for MEDLINE]

86: Med Cutan Ibero Lat Am. 1986; 14(2): 133-7.
[Clinical trial of a topical preparation containing urea, sunflower oil, evening primrose oil, wheat germ oil and sodium pyruvate, in several hyperkeratotic skin conditions]
[Article in Spanish]
Ferrando J.
A topical clinical trial with preparations containing urea and sodium pyruvate has been made. It was used for diverse hyperkeratotic skin conditions (psoriasis, xerosis, pityriasis rubra pilaris, stuccokeratosis, seborrheic dermatitis, stasis dermatitis, pityriasis lichenoides chronica). A month later a clinical improvement was evident in all cases except in pityriasis lichenoides.
PMID: 3528709 [PubMed - indexed for MEDLINE]

87: Br J Dermatol. 1985 Apr; 112(4): 415-22.
The effects of a shampoo containing zinc pyrithione on the control of dandruff.
Marks R, Pearse AD, Walker AP.
Thirty-two subjects who suffered from dandruff participated in a study in which one-half of the head was washed with a shampoo containing 1% zinc pyrithione (ZPT) and the other half was washed with the same shampoo without ZPT. Four groups, eight subjects per group, were shampooed one, three, six or nine times (shampoo frequency twice per week). Clinical dandruff gradings of each half of the head were made 4 days after the last shampoo in each group, when scalp biopsy samples were also taken from each half of the head. Measurements of labelling index (LI), mean epidermal thickness (MET), and assessment of the numbers of PAS- and Gram-positive micro-organisms were made on the biopsy samples. There was a progressive reduction in dandruff on the sides of the head treated with the ZPT shampoo, the differences relative to the placebo-treated areas being statistically significant after three, six and nine washes. There were no significant differences in LI between treatment groups and the MET was shown to vary according to the treatment and the number of washes. There was a significant reduction in the number of PAS-positive micro-organisms (but not Gram-positive micro-organisms) on the ZPT-treated areas.
PMID: 3158327 [PubMed - indexed for MEDLINE]

88: Br Med J (Clin Res Ed). 1983 Apr 9; 286(6372): 1169-70.
Seborrhoea is not a feature of seborrhoeic dermatitis.
Burton JL, Pye RJ.
The sebum excretion rate from forehead skin was measured in 44 patients with classic seborrhoeic dermatitis and 200 control subjects. The mean excretion rate was normal in the 29 men with seborrhoeic dermatitis and significantly reduced in the 15 women with the disease. This study showed that seborrhoeic dermatitis is not usually associated with seborrhoea, and therefore "dermatitis of the sebaceous areas" may be a more accurate term.
PMID: 6220754 [PubMed - indexed for MEDLINE]

89: Cutis. 1983 Feb; 31(2): 203-4.
The use of halcinonide solution, 0.1 percent, in the treatment of eczematous diseases.
Lynfield YL.
Halcinonide solution, 0.1 percent, was used to treat sixty-six patients with eczematous dermatoses. The majority of the responses were excellent, with the condition clearing completely in eight patients within the first week. The total mean amount of medication used by each patient for twice a day application for one or two weeks was less than 24 ml.
PMID: 6219862 [PubMed - indexed for MEDLINE]

90: Acta Derm Venereol. 1983; 63(4): 335-9.
Seborrhoeic dermatitis of the face induced by PUVA treatment.
Tegner E.
Seborrhoeic dermatitis of the face was observed in 28 of 347 patients treated with PUVA for psoriasis. The facial lesions appeared after discontinuation of PUVA, and had not been present at the start of PUVA treatment. They were prevented by masking the face during irradiation.
PMID: 6195866 [PubMed - indexed for MEDLINE]

91: N Z Med J. 1982 Oct 27; 95(718): 738-40.
Locoid vs betnovate lotion in the treatment of seborrhoeic and atopic dermatitis of the scalp.
Turnbull BC.
In a randomised, double-blind clinical trial, the relative efficacy of Locoid scalp lotion and Betnovate scalp application was assessed in the treatment of 30 patients, 15 in each treatment group, suffering from seborrhoeic or atopic dermatitis of the scalp. Both therapies produced a statistically significant improvement and clearance of the lesions by the end of the four weeks of treatment. Slight differences were observed in favour of Betnovate with respect to global efficacy but this difference was not statistically significant. Side-effects were not spontaneously complained of by any of the 30 patients but six admitted experiencing a stinging or burning sensation (four with Locoid and two with Betnovate) when asked specifically as to the occurrence of these side-effects.
PMID: 6216427 [PubMed - indexed for MEDLINE]

92: J Am Acad Dermatol. 1981 Apr; 4(4): 417-22.
Complications of topical hydrocortisone.
Guin JD.
Chronic and uninterrupted application of 1% hydrocortisone was followed by complications in six patients. Three developed a rosacea-like eruption for the first time and one also had perioral dermatitis. All of these responded to treatment and remained clear. Another patient had a severe exacerbation of rosacea following use and withdrawal of 1% hydrocortisone cream. Two female adults developed atrophy and telangiectasia of the eyelids following long-term application of 1% hydrocortisone cream. The severity of the complications reported was generally less than that found following use of more potent topical corticosteroids. However, the complications experienced by these patients would suggest that therapy with any effective topical corticosteroid should be intermittent. Particular care should be used in susceptible individuals and in vulnerable areas such as the eyelids.
PMID: 6453138 [PubMed - indexed for MEDLINE]

93: Am Fam Physician. 1981 Feb; 23(2): 171-4.
Possible side effects of topical steroids.
Morman MR.
When used properly in controlled situations, topical corticosteroids provide dramatic relief in distressing disorders such as eczema, psoriasis and seborrheic dermatitis. The fluorinated preparations are associated with a variety of side effects, including acne, striae, premature aging of the skin, hypertrichosis, perioral dermatitis, glaucoma and even adrenal suppression. Except for the severe, acute dermatoses, a nonfluorinated steroid is the better choice because of the relative lack of side effects and lower cost.
PMID: 6450525 [PubMed - indexed for MEDLINE]

94: Clin Ther. 1980; 3(4): 229-33.
General dermatologic use of hydroxamic acid.
Solano E.
Fifty clinic patients with mild to moderately severe dermatoses were treated for three weeks with bufexamac, a hydroxamic acid compound with anti-inflammatory properties. Half the patients had either contact or seborrheic dermatitis; the remaining 25 were distributed among five other diagnostic categories. Evaluation and grading of signs and symptoms were done at initial visit; changes resulting from topical treatment with bufexamac cream were monitored at weekly intervals. Forty-three (86%) patients had a good or very good response; seven were treatment failures. In terms of weighted response scores, those of patients with seborrheic, contact, or solar dermatitis were above the median for all scores, with lesser intensity of efficacy in the remaining diagnostic groups. Clinical cures were noted in 20 patients by week 2, in 17 by week 3, and six by the fourth or fifth week. No side effects were reported.
PMID: 7273060 [PubMed - indexed for MEDLINE]

95: Schweiz Med Wochenschr. 1978 Oct 21; 108(42): 1640-2.
[Treatment of acne and seborrhea using antiandrogens]
[Article in German]
Keller PJ, Fetz A, Schar A, Floersheim Y.
57 women suffering from seborrhea and acne were treated with low doses of estrogens and antiandrogens. A cyclic regimen comprising 21 tablets of 0.05 mg ethinylestradiol and 2 mg cyproterone acetate was used. Results were very favourable: within 6 months, 51 patients were healed or significantly improved. There were only minor side effects, and none of the women conceived. It is concluded that this combination not only provides very effective therapy but might also be the contraceptive of choice for women with skin problems.
PMID: 151916 [PubMed - indexed for MEDLINE]

96: Int J Vitam Nutr Res. 1977; 47(2): 107-18.
Biotin in man's nutrition and therapy -- a review.
Bonjour JP.
The literature on biotin in human nutrition and therapy has been reviewed. The influence of the diet on biotin excretion and the intestinal synthesis of biotin is discussed. Biotin deficiency symptoms are occasionally seen, especially in infants where the deficiency is manifested as seborrhoeic dermatitis. Nevertheless, low urinary excretion and low circulating biotin levels can be found in certain sections of the population.

97: Z Hautkr. 1976 Jul 15; 51(14): 580-2.
[Clinical trial with benzoyl peroxide shampoo in seborrhea oleosa]
[Article in German]
Schmid U.
The effectiveness of Shampoo containing benzoyl peroxide against oily hair and dandruff has been studied in a clinical trial. The shampoo has proved a precious therpeutic adjunct for these conditions. The probable mechanism of action is summarized on the basis of references.
PMID: 134521 [PubMed - indexed for MEDLINE]

98: Med J Aust. 1976 Apr 17; 1(16): 584-5.
Oral use of biotin in seborrhoeic dermatitis of infancy: a controlled trial.
Keipert JA.
A double-blind cross-over trial of biotin given by mouth in the treatment of seborrhoeic dermatitis of infancy did not show a statistically significant advantage of biotin over placebo.
PMID: 132601 [PubMed - indexed for MEDLINE]

99: Arch Dis Child. 1975 Nov; 50(11): 871-4.
Generalized seborrhoeic dermatitis. Clinical and therapeutic data of 25 patients.
Messaritakis J, Kattamis C, Karabula C, Matsaniotis N.
Twenty-five infants with generalized seborrhoeic dermatitis have been studied with reference to the provision of optimum treatment. Leucocyte counts and chest x-ray examination are recommended in every case. Irrespective of clinical findings, antibiotics should be given to patients with overt bacterial infection and those with leucocytosis, shift to the left, and toxic granulation. One group of infants was treated with vitamin B complex plus biotin given slowly intravenously over 24 hours; a second group was given only biotin intravenously over 2-3 hours; and a third group only biotin over 1-2 minutes. A fourth group was treated with both biotin and antibiotics for confirmed or suspected superimposed bacterial infection. The results were excellent in all groups. Skin lesions improved within 4-8 days and cleared completely within 15-30 days. Intravenous administration of biotin is recommended as less painful and less dangerous than multiple intramuscular injections. PMID: 129036 [PubMed - indexed for MEDLINE]

Legal Disclaimer

Copyright© M.Churchill 2005 -- All Rights Reserved