THE SEBORRHEIC DERMATITIS, A REVIEW. / LA DERMATITIS SEBORREICA, REVISION

La Dermatitis Seborreica y sus alternativas terapeuticas, Revision . !

  

The seborrheic Dermatitis and Therapheutic alternatives, a Review. !

 

DERMATITIS SEBORREICA MEJILLAS  

PUBLICADO 2017 ACTUALIZADO 2023

 

EDITORIAL ESPAÑOL
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Hola amigos de la red, DERMAGIC EXPRESS de nuevo, hoy con el interesante tema: LA DERMATITIS SEBORREICA, una enfermedad no tan severa pero muy frecuente hoy en dia en la población, tanto niños como adultos, hombres y mujeres. 

La enfermedad afecta principalmente la cara, el cuero cabelludo, y también tórax anterior y posterior menos frecuentemente. Caracterizada por ser placas eritematosas y descamativas con prurito, es de evolución crónica y representa un verdadero reto su tratamiento, debido a hecho de que es frecuente su recaída aun con las mejores opciones.

En el cuero cabelludo la descamación producida por la DERMATITIS SEBORREICA es conocida con el nombre vulgar de "CASPA", quizá una de las causas mas frecuentes de la consulta dermatologica.

La enfermedad es causada por una hipersecreción de las glándulas sebáceas, luz solar, temperatura corporal y ESTRESS cotidiano. Relacionada con al HONGO PITYROSPORUM, (MALASSEZIA). 

DERMATITIS SEBORREICA DE LA CARA

Como dato histórico desde que se estableció la relacion entre esta enfermedad y el hongo antes mencionado, comenzaron a usarse los ANTIMICOTICOS vía oral y tópica en el tratamiento de esta patología con relativo margen de éxito. Esto comenzó en los años 80, específicamente 1.985 el ITRACONAZOLE, en los 90, se comienza a usar el METRONIDAZOLE en gel topico, en los años 2.000 aparece el PIMECROLIMUS Y TACROLIMUS como opción tópica terapéutica, los cuales años después se descubrieron que el uso prolongado de los mismos puede producir cáncer y la FDA les obligó a colocar una severa advertencia en el empaque.

En los años 50 y 60 comenzaron a utilizarse LOS ESTEROIDES TOPICOS, EL AZUFRE y LA SULFACETAMIDA, vigentes hoy día.   

DERMATITIS SEBORREICA SEVERA DEL CUERO CABELLUDO

Hoy dia 2.017 les presento en esa amplia revisión las MEJORES ALTERNATIVAS TERAPEUTICAS que han sido descritas en el tratamiento de esta enfermedad: 

1.) CORTICOSTEROIDES TOPICOS.
2.) UREA.
3.) ACIDO SALICILICO.
4.) PROPILEN-GLICOL.
5.) PIRITIONATO DE ZINC.
6.) BIOTINA.
7.) KETOCONAZOL.
8.) FLUCONAZOL.
9.) SERTACONAZOL.
10.) ITRACONAZOL.
11.) DITRANOL.
12.) SUCCINADO DE LITIO.
13.) VITAMINA-COMPLEJO B.
14.) PEROXIDO DE BENZOILO.
15.) SULFURO DE SELENIO.
16.) SULFACETAMIDA.
17.) TACROLIMUS.  (Hoy día 2023 estos medicamentos TACROLIMUS Y PIMECROLIMUS tienen una advertencia severa por la FDA de que su uso prolongado puede inducir cáncer)
18.) PIMECROLIMUS.
19.) METRONIDAZOL.
20.) TERBINAFINA.
21.) ALQUITRAN DE PINO.
22.) ALQUITRAN DE HULLA.
23.) GLICERINA.
24.) TACALCITOL.
25.) FOTOTERAPIA.
26.) AZUFRE.
27.) BIFONAZOL.
28.) CICLOPIROXOLAMINA.
29.) L - DOPA. 

Probablemente existan  otras mas, LAS MAS UTILIZADAS de todas estas, hoy dia son EL ITRACONAZOLE, METRONIDAZOLE, PIMECROLIMUS, TACROLIMUS, SERTACONAZOLE, KETOCONAZOLE, TERBINAFINE, BIFONAZOLE y ESTEROIDES TOPICOS, pero cualquiera de las mencionadas puede ser utilizada. 

En estas 100 referencias bibliográficas aprenderás el origen y las alternativas terapéuticas de la DERMATITIS SEBORREICA, en el adjunto varias fotos de la enfermedad. 

A adia de Hoy 2023, no se han inventado nuevas cremas o lociones de las ya conocidas, quedando como GRANDES opciones LA FORMULACION MAGISTRAL para estos casos, como champús preparados a base de azufre, acido salicílico y lociones capilares también preparadas, INTERCALADAS con productos comerciales ya conocidos.

La dermatitis seborreica en muchos casos es recalcitrante, difícil de tratar pues recaen mucho los pacientes una vez presentan mejoría, el exceso de grasa en la cara y el estrés son GRANDES factores desencadenantes y de recaídas.

Saludos a todos. 

Dr. José Lapenta.

Dr.  José M. Lapenta.

  

EDITORIAL ENGLISH
===================
Hello friends of the network, DERMAGIC EXPRESS again, today with the interesting topic: SEBORRHEIC DERMATITIS, a disease not so severe but very frequent today in the population, both children and adults, men and women. 

The disease mainly affects the face, the scalp, and also anterior and posterior thorax less frequently. Characterized as erythematous and desquamative plaques with pruritus. The evolution is chronic and represents a real challenge for its treatment, due to the fact that is frequent its relapse even with the best options.

In the scalp the desquamation produced by SEBORRHEIC DERMATITIS is known by the vulgar name of "DANDRUFF", perhaps one of the most frequent causes of the dermatological consultation.

The disease is caused by a hypersecretion of sebaceous glands, sunlight, body temperature and everyday STRESS. Related to the FUNGUS PITYROSPORUM, (MALASSEZIA).

As a historical fact since the relationship between this disease and the aforementioned fungus was established, ANTIFUNGAL began to be administered via oral and topical treatment of this pathology with a relative margin of success. This began in the 1980s, specifically 1,985 ITRACONAZOLE, in the 90's, METRONIDAZOLE is started using topical gel, in the year 2,000 PIMECROLIMUS AND TACROLIMUS appeared as a topical therapeutic option, which years later were discovered that prolonged use of them can cause cancer and the FDA forced them to place a severe warning on the packaging.
 
 In the 1950s and 1960s, TOPIC STEROIDS, SULFUR and SULFACETAMIDE began to be used, and remain a therapeutic alternative.

Today, 2,017 I present to you in this broad review the BEST THERAPEUTIC ALTERNATIVES that have been described in the treatment of this disease:

1.) TOPICAL CORTICOSTEROIDS.
2.) UREA.
3.) SALIYLIC ACID.
4.) PROPYLENE-GLYCOL.
5.) PYRITHIONE ZINC.
6.) BIOTIN.
7.) KETOCONAZOLE.
8.) FLUCONAZOLE.
9.) SERTACONAZOLE.
10.) ITRACONAZOLE.
11.) DITHRANOL.
12.) LITHIUM SUCCINATE.
13.) VITAMIN-COMPLEX B.
14.) BENZOYL PEROXIDE.
15.) SELENIUM SULFIDE.
16.) SULFACETAMIDE.
17.) TACROLIMUS. (Today 2023 these drugs TACROLIMUS AND PIMECROLIMUS have a severe warning from the FDA that their prolonged use can induce cancer)
18.) PIMECROLIMUS.
19.) METRONIDAZOLE.
20.) TERBINAFINE.
21.) PINE TAR.
22.) COAL TAR.
23.) GLYCERINE.
24.) TACALCITOL.
25.) PHOTOTHERAPY.
26.) SULFUR.
27.) BIFONAZOLE.
28.) CYCLOPYROXOLAMINE.
29.) L-DOPA.

Probably there are other more, THE MOST USED of all these, today are ITRACONAZOLE, METRONIDAZOLE, PIMECROLIMUS, TACROLIMUS, SERTACONAZOLE, KETOCONAZOLE, TERBINAFINE, BIFONAZOLE and TOPICAL STEROIDS but any of the aforementioned can be used.

In these 100 bibliographic references you will learn the origin and the therapeutic alternatives of SEBORRHEIC DERMATITIS, in the attached several photos of the disease.

As of today 2023, no new creams or lotions of the already known ones have been invented, leaving MASTER FORMULATION as GREAT options for these cases, such as shampoos prepared based on sulfur, salicylic acid and hair lotions also prepared, alternated with commercial products already known.

Seborrheic dermatitis in many cases is recalcitrant, difficult to treat because patients relapse a lot once they improve, excess fat on the face and stress are GREAT triggering and relapse factors.

Greetings to all.

Dr. Jose Lapenta.

Dr. Jose M. Lapenta.

 

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REFRENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
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1.) Topical metronidazole in seborrheic dermatitis - a double-blind study.
2.) Treatment of seborrheic dermatitis: comparison of sertaconazole 2 % cream versus pimecrolimus 1 % cream.
3.) Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults.
4.) New strategies in dandruff treatment: growth control of Malassezia ovalis.
5.) Narrow-band ultraviolet B (ATL-01) phototherapy is an effective and safe treatment option for patients with severe seborrhoeic dermatitis.
6.) Four cases of sebopsoriasis or seborrheic dermatitis of the face and scalp successfully treated with 1a-24 (R)-dihydroxycholecalciferol (tacalcitol) cream.
7.) High prevalence of seborrhoeic dermatitis on the face and scalp in mountain guides.
8.) The antifungal action of dandruff shampoos.
9.) Treatment of scalp seborrheic dermatitis and psoriasis with an ointment of 40% urea and 1% bifonazole.
10.) [Effect of anti-seborrhea substances against Pityrosporum ovale in vitro].
11.) Facial seborrheic dermatitis treated with fluconazole 2% shampoo.
12.) Pityrosporum ovale and skin diseases.
13.)[Therapy of seborrheic eczema with an antifungal agent with an antiphlogistic effect].
14.) [A case of seborrhoeic blepharitis].
15.) Treatment of sebopsoriasis with itraconazole.
16.) Treatment of seborrheic dermatitis.
17.) Pitirosporum ovale (Malassezia furfur) as the causative agent of seborrhoeic dermatitis: new treatment options.
18.) Relation Between Skin Temperature and Location of Facial Lesions in Seborrheic Dermatitis
19.) Insulin Quantification in Patients With Seborrheic Dermatitis
20.) Humoral immunity to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls.
21.) Management of common superficial fungal infections in patients with AIDS.
22.) Pityrosporum infections.
23.) Seborrheic dermatitis as a revealing feature of HIV infection in Bamako, Mali [letter]
24.) Cell-mediated immune responses to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls.
25.) The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: a double blind study.
26.) A double blind study of the effectiveness of sertaconazole 2% cream vs. metronidazole 1% gel in the treatment of seborrheic dermatitis.
27.) Pimecrolimus 1% cream, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel in the treatment of seborrhoeic dermatitis: a randomized clinical study.
28.) Treatment with bifonazole shampoo for seborrhea and seborrheic dermatitis: a randomized, double-blind study.
29.) Quantitative skin cultures of Pityrosporum yeasts in patients seropositive for the human immunodeficiency virus with and without seborrheic dermatitis.
30.) A double-blind, placebo-controlled, multicenter trial of lithium succinate ointment in the treatment of seborrheic dermatitis. Efalith Multicenter Trial Group.
31.) Ketoconazole 2% emulsion in the treatment of seborrheic dermatitis.
32.) Seborrheic dermatitis in acquired immunodeficiency syndrome.
33.) Blood levels of vitamin E, polyunsaturated fatty acids of phospholipids, lipoperoxides and glutathione peroxidase in patients affected with seborrheic dermatitis.
34.) Skin surface lipids in HIV sero-positive and HIV sero-negative patients affected with seborrheic dermatitis.
35.) Seborrheic dermatitis and daylight [see comments]
36.) [Seborrheic dermatitis and cancer of the upper
respiratory and digestive tracts]
37.) The role of Pityrosporum ovale in seborrheic dermatitis.
38.) Correlation of Pityosporum ovale density with clinical severity of seborrheic dermatitis as assessed by a simplified technique.
39.) Immune reactions to Pityrosporum ovale in adult
patients with atopic and seborrheic dermatitis.
40.) [Treatment of seborrheic dermatitis with benzoyl peroxide]
41.)[The significance of yeasts in seborrheic eczema]
42.) Association of Pityrosporum orbiculare (Malassezia furfur) with seborrheic dermatitis in patients with acquired immunodeficiency syndrome (AIDS).
43.) Pityrosporum ovale in infantile seborrheic dermatitis.
44.)Infantile seborrheic dermatitis: seven-year follow-up and some prognostic criteria.
45.) Ketoconazole 2% cream versus hydrocortisone 1% cream in the treatment of seborrheic dermatitis. A double-blind comparative study.
46.) T-cell subset assay. A useful differentiating marker of atopic and seborrheic eczema in infancy?
47.) Propylene glycol in the treatment of seborrheic dermatitis of the scalp: a double-blind study.
48.) Seborrheic dermatitis and malignancy. An investigation of the skin flora.
49.) Efficacy of topical application of glucocorticosteroids compared with eosin in infants with seborrheic dermatitis.
50.) Erythema with features of seborrheic dermatitis and lupus erythematosus associated with systemic 5-fluorouracil.
51.)[Treatment of seborrheic dermatitis with low-dosage dithranol]
52.) Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream.
53.) Seborrheic dermatitis in neuroleptic-induced parkinsonism.
54.) Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial.
55.) Adherence of Malassezia furfur to human stratum corneum cells in vitro: a study of healthy individuals and patients with seborrhoeic dermatitis.
56.) Seborrhoeic dermatitis: treatment with anti-mycotic agents.
57.)Analyses of skin surface lipid in patients with microbially associated skin disease.
58.) Borage oil, an effective new treatment for infantile seborrhoeic dermatitis [letter]
59.) Transepidermal water loss and water content in the stratum corneum in infantile seborrhoeic dermatitis.
60.) [Skin lipids in seborrhea- and sebostasis-associated skin diseases]
61.) Use of topical lithium succinate in the treatment of seborrhoeic dermatitis [letter; comment]
62.) A dose-response study of irritant reactions to sodium lauryl sulphate in patients with seborrhoeic dermatitis and atopic eczema.
63.) Seborrhoeic dermatitis of the scalp--a manifestation of Hailey-Hailey disease in a predisposed individual?
64.) Use of topical lithium succinate in the treatment of seborrhoeic dermatitis [see comments]
65.) Erythema multiforme and dermatitis seborrhoides infantum as concomitant id-reactions to widespread candidosis in a suckling.
66.) The evaluation of various methods and antigens for the detection of antibodies against Pityrosporum ovale in patients with seborrhoeic dermatitis.
67.) Enhanced phagocytosis and intracellular killing of Pityrosporum ovale by human neutrophils after exposure to ketoconazole is correlated to changes of the yeast cell surface.
68.) [Therapy of seborrheic eczema with an antifungal agent with an antiphlogistic effect]
69.) Neutrophil zinc levels in psoriasis and seborrhoeic dermatitis.
70.) Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole.
71.) Studies on the yeast flora in patients suffering from psoriasis capillitii or seborrhoic dermatitis of the scalp.
72.) [Histological differential diagnosis of psoriasis vulgaris and seborrheic eczema of the scalp]
73.) Tinea versicolor with regard to seborrheic dermatitis. An epidemiological investigation.
74.)Quantitative microbiology of the scalp in non-dandruff, dandruff, and seborrheic dermatitis.
75.) Treatment of seborrheic dermatitis with biotin and vitamin B complex.
76.) L-dopa for seborrheic dermatitis.
77.) Seborrheic dermatitis of infants: treatment with biotin injections for the nursing mother.
78.) Photochemotherapy in erythrodermic seborrhoic dermatitis [letter]
79.) Old drug--in a new system--revisited.
80.) Oral use of biotin in seborrhoeic dermatitis of infancy: a controlled trial.
81.) Generalized seborrhoeic dermatitis. Clinical and therapeutic data of 25 patients.
82.)The effect of betamethasone valerate on seborrhoeic dermatitis of the scalp. A clinical, histopathological cell kinetic study.
83.) Topical glycerin in seborrhoeic dermatitis.
84.)[Therapeutic aspects of seborrhea oleosa and pityriasis simplex capillitii]
85.) Tinea versicolor and Pityrosporum orbiculare: mycological investigations, experimental infections and epidemiological surveys.
86.)[Some atypical forms of eczema in children (author's transl)]
87.) Efficacy and safety of a low molecular weight hyaluronic Acid topical gel in the treatment of facial seborrheic dermatitis final report.
88.) Treatment of seborrheic dermatitis: the efficiency of sertaconazole 2% cream vs. tacrolimus 0.03% cream.
89.) Comparison the efficacy of fluconazole and terbinafine in patients with moderate to severe seborrheic dermatitis.
90.) Efficiency of terbinafine 1% cream in comparison with ketoconazole 2% cream and placebo in patients with facial seborrheic dermatitis.
91.) A novel cosmetic antifungal/anti-inflammatory topical gel for the treatment of mild to moderate seborrheic dermatitis of the face: a open-label trial utilizing clinical evaluation and erythemadirected digital photography.
92.) Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study.
93.) Role of antifungal agents in the treatment of seborrheic dermatitis.
94.) Investigations of seborrheic dermatitis. Part II. Influence of itraconazole on the clinical condition and the level of selected cytokines in seborrheic dermatitis.
95.) Efficacy and Safety of Cream Containing Climbazole/Piroctone Olamine for Facial Seborrheic Dermatitis: A Single-Center, Open-Label Split-Face Clinical Study.
96.) Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review.
97.) Low-dose oral isotretinoin for moderate to severe seborrhea and seborrheic dermatitis: a
randomized comparative trial.
98.) Effect of itraconazole on the quality of life in patients with moderate to severe seborrheic dermatitis: a randomized, placebo-controlled trial.
99.) Zinc Pyrithione: A Topical Antimicrobial With Complex Pharmaceutics.
100.) Topical pine tar: History, properties and use as a treatment for common skin conditions.

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1.) Topical metronidazole in seborrheic dermatitis - a double-blind study.
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Dermatology 2001;202(1):35-7 
Parsad D, Pandhi R, Negi KS, Kumar B.
Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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. Copyright 2001 S. Karger AG, Basel
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3.) Single-blind, randomized controlled trial evaluating the treatment of facial seborrheic dermatitis with hydrocortisone 1% ointment compared with tacrolimus 0.1% ointment in adults.
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J Am Acad Dermatol. 2012 Jul;67(1):e11-5. doi: 10.1016/j.jaad.2011.02.032. Epub 2011 Nov 21.
Papp KA1, Papp A, Dahmer B, Clark CS.
Author information
1
Probity Medical Research Inc, Waterloo, Ontario, Canada. kapapp@probitymedical.com
Abstract
BACKGROUND:
Tacrolimus is a topical calcineurin inhibitor with immunomodulatory, anti-inflammatory, and fungicidal properties that may be beneficial in the treatment of facial seborrheic dermatitis.
OBJECTIVES:
We sought to compare the efficacy and safety of tacrolimus with standard corticosteroid treatment in adults with facial seborrheic dermatitis in a phase II, single-blind, randomized controlled trial.
METHODS:
Adult patients were enrolled in a 12-week study. Subjects were randomized to tacrolimus 0.1% ointment (n = 16) or hydrocortisone 1% ointment (n = 14) applied twice daily to symptomatic regions of the face. The primary efficacy measure was the severity of facial seborrhea at the end of treatment (day 84) as measured by the Seborrhea Area and Severity Index-Face. Secondary efficacy measures included physician and patient assessment of seborrhea, the frequency of medication application, and adverse events.
RESULTS:
The severity of facial seborrhea was similarly improved in both treatment groups (P = .86). Tacrolimus 0.1% ointment was used on significantly fewer days than 1% hydrocortisone ointment (mean missed doses per patient at first visit: 15.6 vs 7.6, P < .05; at last visit: 13.5 vs 7.7, P = .08). The majority of doses were missed because of lack of symptoms. The adverse event profile for both agents was similar; however, there was a numerically higher incidence of adverse events in the hydrocortisone group.
LIMITATIONS:
This was a small, open-label study.
CONCLUSION:
Tacrolimus 0.1% ointment required significantly fewer applications compared with hydrocortisone 1% ointment to achieve a comparable clinical response in adults with facial seborrheic dermatitis. Tacrolimus was generally well tolerated.

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4.) New strategies in dandruff treatment: growth control of Malassezia ovalis.
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Dermatology 2000;201(4):332-6 
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. piergior.catalanotti@unina2.it
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
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5.) Narrow-band ultraviolet B (ATL-01) phototherapy is an effective and safe treatment option for patients with severe seborrhoeic dermatitis.
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Br J Dermatol 2000 Nov;143(5):964-8 
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. Detlev.Pirkhammer@akh-wien.ac.at
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.
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6.) Four cases of sebopsoriasis or seborrheic dermatitis of the face and scalp successfully treated with 1a-24 (R)-dihydroxycholecalciferol (tacalcitol) cream.
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Eur J Dermatol 2000 Oct-Nov;10(7):528-32 
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.
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7.) High prevalence of seborrhoeic dermatitis on the face and scalp in mountain guides.
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Dermatology 2000;201(2):146-7 
Moehrle M, Dennenmoser B, Schlagenhauff B, Thomma S, Garbe C.
Department of Dermatology, University of Tubingen, Germany. matthias.moehrle@med.uni-tuebingen.de
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
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8.) The antifungal action of dandruff shampoos.
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Mycopathologia 1999;147(2):63-5 
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.
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9.) Treatment of scalp seborrheic dermatitis and psoriasis with an ointment of 40% urea and 1% bifonazole.
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Int J Dermatol 2000 Jul;39(7):532-4 
Shemer A, Nathansohn N, Kaplan B, Weiss G, Newman N, Trau H.
Department of Dermatology,; Chaim Sheba Medical Center, Tel Hashomer, Israel.
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10.) [Effect of anti-seborrhea substances against Pityrosporum ovale in vitro].
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Hautarzt 1994 Jul;45(7):464-7 
[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.
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11.) Facial seborrheic dermatitis treated with fluconazole 2% shampoo.
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Int J Dermatol 1994 Feb;33(2):136-7 
Rigopoulos D, Katsambas A, Antoniou C, Theocharis S, Stratigos J.
Department of Dermatology, Athens University A. Sygros Hospital, Greece.
Publication Types:
Clinical trial
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============================================================
12.) Pityrosporum ovale and skin diseases.
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Keio J Med 1993 Sep;42(3):91-4 
Faergemann J.
Department of Dermatology, University of Gothenburg, Sahlgren's Hospital, Sweden.
Pityrosporum ovale is a lipophilic yeast belonging to the normal human cutaneous flora in adults. It is not only a saprophyte but also an opportunistic pathogen associated with: Pityriasis versicolor, Pityrosporum folliculitis, seborrhoeic dermatitis and some forms of atopic dermatitis. Even systemic infections have been described. In pityriasis versicolor P. ovale change from the blastospore to the mycelial form under the influence of predisposing factors such as high temperature, high relative humidity or endogenous factors such as greasy skin, sweating, heredity, immunosuppressive treatment or disorders. Topical treatment is often effective but short term treatment with fluconazole, ketoconazole or itraconazole is also effective. The great problem is recurrence and to avoid this a prophylactic treatment is mandatory. Pityrosporum folliculitis is a chronic disease characterized by pruritic follicular papules and pustules located primarily on the upper trunk, neck and upper arms. Under the influence of the same predisposing factors as in pityriasis versicolor P. ovale increase in numbers in the hair follicles. The main differential diagnosis is acne vulgaris. The effect of antifungal treatment is often dramatic. There are now many studies indicating that P. ovale plays an important role in seborrhoeic dermatitis. Many of these are treatment studies showing a good effect of antimycotics parallelled by a reduction in number of P. ovale. Severe seborrhoeic dermatitis often difficult to treat is associated with AIDS. In a recent study we have evidence for a slight T-cell defect in many patients with seborrhoeic dermatitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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13.)[Therapy of seborrheic eczema with an antifungal agent with an antiphlogistic effect].
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Mycoses 1991;34 Suppl 1:91-3 
[Article in German]
Hanel H, Smith-Kurtz E, Pastowsky S.
Hoechst AG, Frankfurt/Main.
Numerous AIDS patients show the typical seborrheic eczema in a very prominent way. For this is an inflammatory disease, combination preparations were taken frequently which contain antimycotics and corticosteroids. We investigated 7 antimycotic compounds in 3 inflammatory models: amorolfin, ciclopiroxolamine (cic), fluconazole, ketoconazole, miconazole, naftifine, and rilopirox. In an in vitro model the inflammatory activity towards the 5-lipoxygenase was investigated. 1,000 mumol naftifine, 100 mumol ketoconazole, 50 mumol cic, and 10 mumol rilopirox inhibited 5-HETE by 90%. In a cell culture model only cic had a significant activity towards cyclo-oxygenase. In this model the inhibition of the prostaglandin E2 liberation by 1 mumol cic was 40%. In an in vivo model the anti-inflammatory activity on a mouse ear was investigated (arachidonic acid induced). In this model only cic showed a significant inhibition of inflammation (50%) at 1 mg/ear. These investigations show, that cic has a strong antiphlogistic activity. In an open clinical trial with 20 patients suffering from seborrheic eczema after 4 weeks on cic cream a strong inhibition of infiltration and flakiness had been observed. The antimycotic compound cic offers a possibility to treat inflammatory mycoses without using corticosteroid combinations. In a double blind clinical trial (tinea) where cic was compared with a cic/hydrocortisone combination no statistical differences were found.
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14.) [A case of seborrhoeic blepharitis].
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Nippon Ishinkin Gakkai Zasshi 2000;41(2):121-2 
[Article in Japanese]
Ninomiya J, Takahashi C, Nakabayashi A, Teramoto T, Takiuchi I, Tahara K.
Department of Dermatology, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa 227-0043, Japan.
A fifty five-year old woman suffered from itching and scaling of the edge of her eyelid. She had long used topical corticosteroid for this condition. Direct examination of the scale by Parker KOH showed numerous fungal elements of spores and hyphae of Malassezia furfur. She was treated with oral itraconazole (100 mg daily or twice a week) for 8 weeks and was cured clinically and mycologically. The result suggests the possibility of treatment with an anti-fungal drug for seborrhoeic blepharitis or seborrhoeic dermatitis.

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15.) Treatment of sebopsoriasis with itraconazole.
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Mykosen 1985 Dec;28(12):612-8 
Faergemann J.
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16.) Treatment of seborrheic dermatitis.
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Am Fam Physician 2000 May 1;61(9):2703-10, 2713-4 
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.
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17.) Pitirosporum ovale (Malassezia furfur) as the causative agent of seborrhoeic dermatitis: new treatment options.
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Br J Dermatol 1996 Jun;134 Suppl 46:12-5: discussion 38 
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.
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VIGNETTES
18.) Relation Between Skin Temperature and Location of Facial Lesions in Seborrheic Dermatitis
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Source: Archives os Dermatology
Elizabeth K. Hale, MD
Jean-Claude Bystryn, MD
The Ronald O. Perelman Department of Dermatology
New York University School of Medicine
550 1st Ave, Room H-356
New York, NY 10016
(e-mail: bystryn@is.nyu.edu)
Seborrheic dermatitis (SD) is a common dermatologic disorder with a characteristic facial distribution. It occurs most commonly on the scalp, nasolabial folds, external ear canal, and on the hair-bearing areas of the face. The reason that lesions occur in this particular distribution is not known. Theories concerning the etiology of this distribution involve increased sebum production and implications of Pityrosporon ovale as a causative agent. In the course of evaluating the results of analysis with a very sensitive thermal imager, we were struck by a marked regional variation in the temperature of facial skin. The warmer areas of the face were those commonly affected by seborrheic dermatitis. These findings suggest that skin temperature plays a role in the etiology of SD. The following study was conducted to formally examine and confirm this relationship.

Subjects and Methods
---------------------

We used an IR-M700 thermal imager (Mitsubishi Electronics America, Cypress, Calif) with ultrahigh resolving power (>410 000 pixels) to obtain thermal images of the faces of 25 normal individuals (age range, 22-84 years). None of the patients studied had SD or other dermatitis involving the face, scalp, or ears. The polarity of the imager was set so that warm areas appeared dark and areas of lower temperature appeared light. Although the absolute temperature of the images could not be determined, the high resolution of the imager clearly demonstrated the relative warmth or coolness of distinct areas on the face.

Results
-------
The temperature pattern of skin on the face was markedly heterogeneous (Figure 1). The temperature was a mosaic of warm and cold areas, with some variability from one patient to the next, as previously noted by others.1 However, certain areas of the face were consistently warmer than others, as indicated in Table 1. Consistently warm areas included the nasolabial fold, external ear canal, hair-bearing areas of the scalp, and the beard and mustache in subjects who had facial hair. By contrast, the cheek, nose, earlobes, and chin were consistently cooler. This occurred in all subjects, regardless of age and sex. There was a striking correlation between the warmer areas of the face and the distribution of lesions in SD, as described in standard texts.2, 3
Comment
-------

We have made the fortuitous observation that there is a striking correlation between areas of relative warmth on the face and the distribution of lesions in SD. Using an ultrasensitive thermal imaging device originally developed for military use, we found that there is a striking heterogeneity in the temperature pattern of facial skin. Some areas are substantially and consistently warmer than others. Areas of relative warmth include the nasolabial folds, external ear canal, hair-bearing areas of the scalp, and the beard and mustache in subjects with facial hair, while cool areas include the cheeks, nose, earlobe, and chin. The patterns of temperature difference were reproducible; hot and cold areas were similarly distributed in 25 different individuals. The areas of relative warmth were unrelated to pathological skin conditions, since none of these subjects had any evidence of facial or scalp dermatitis.
There was a striking correlation between the warm areas of the face and the distribution of lesions in SD. This extended to hair-bearing scalp, which becomes cool when hair is lost. Of interest is that SD clears in hair-bearing areas that become bald.4 The reason that high skin temperature seems to favor the appearance of SD lesions is unknown. Perhaps P ovale, the organism thought to be an etiologic agent in the pathogenesis of SD, grows best at higher temperatures. Also, areas of the skin that are predisposed to develop SD generally have a higher proportion of sebaceous glands, and it may be that these glands are associated with increased cutaneous blood flow and therefore higher skin temperatures.

BIBLIOGRAPHY
1. DiCarlo A. Thermography and the possibilities for its applications in clinical and experimental dermatology. Clin Dermatol. 1995;13:329-336. MEDLINE 
2. Cropley TG. Seborrheic dermatitis. In: Arndt KZ, LeBoit PE, Robinson JK, Wintroub BU, eds. Cutaneous Medicine and Surgery. Philadelphia, Pa: WB Saunders Co; 1996. 
3. Plewig G, Jansen T. Seborrheic dermatitis. In: Freedberg IM, Eisen AZ, Wolff K, et al, eds. Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill Co; 1999. 
4. Rebora A, Rongioletti F. The red face: seborrheic dermatitis. Clin Dermatol. 1993;11:243-251. MEDLINE 

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VIGNETTES
19.) Insulin Quantification in Patients With Seborrheic Dermatitis
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Source: Archives of Dermatology
Bijan Dowlati, MD
Department of Internal Medicine
Division of Endocrinology
University of Texas Medical Branch at Galveston
Galveston, TX 77555-1060
Alireza Firooz, MD
Ali Khamesipour, PhD
Mehdi Lotfi, MD
Tehran, Iran
Charles A. Stuart, MD
Edgar B. Smith, MD
Galveston
Bagher Larijani, MD
Yahya Dowlati, MD, PhD
Tehran

An insulin quantification study in patients with seborrheic dermatitis is useful not only for providing further information about glucose metabolism in this disease, but also as an insight into a possible association and a role for hyperinsulinism in the pathogenesis and cause of seborrheic dermatitis.
There are few documented studies of glucose and its metabolism in persons with seborrheic dermatitis. Glucose tolerance has been reported to be increased in the blood and skin of patients with seborrheic dermatitis.1 This observation has been suggested to be a result of either a state of hyperinsulinism or a higher glucose turnover rate at the tissue level.1
Hyperinsulinism has also been associated with psoriasis and acanthosis nigricans, dermatologic disorders involving the hyperproliferation of epidermal cells.2, 3 While the hyperinsulinism in psoriasis appears to be a result of endogenous insulin resistance, there has been a discussion of the role of hyperinsulinism in the origin of acanthosis nigricans. In the case of seborrheic dermatitis, while earlier studies suggested a hyperproliferative mechanism for the disease, more recent studies support the etiological role of Malassezia .4
The purpose of this study was to determine whether patients with seborrheic dermatitis have a higher level of circulating insulin compared with the normal population, which could indicate the existence of hyperinsulinism and suggest a possible association and role for it in seborrheic dermatitis.
Subjects and Methods
----------------------
In selecting the patients with seborrheic dermatitis (excluding simple dandruff), the presence of pruritus was not a criterion. Infantile seborrheic dermatitis was excluded by using a minimum age cutoff level of 18 years. Patients with Parkinson disease were excluded to avoid any confounding factor due to the higher prevalence of seborrheic dermatitis in persons with parkinsonism.5 Since drug eruptions caused by chlorpromazine, cimetidine, and methyldopa may mimic seborrheic dermatitis,5 patients taking these medications were excluded. A history of treatment for seborrheic dermatitis was not a criterion. The control subjects, who were volunteers recruited through a posted advertisement, were determined not to have seborrheic dermatitis on the basis of a medical history taking and physical examination.
Consecutive volunteer sampling was used for both the patients and the controls. After ruling out diabetes mellitus by including only those individuals whose fasting blood glucose level was lower than 6.1 mmol/L (110 mg/dL), fasting blood samples from all 20 patients and 20 healthy controls were quantified for insulin using a serum iodine I 125 radioimmunoassay (Diagnostic Systems Laboratories Inc, Webster, Tex).
Results
-------
The results of the fasting blood glucose and serum insulin measurements, as well as other clinical parameters, for patients and controls are demonstrated in Table 1 and Table 2, respectively. Assuming a common SD of 7, and using a 2-group t test with a .05 2-sided significance level, a sample size of 20 in each group would have a power of 0.59, giving this study a type II error of about 0.41.

Comment
-------

In this study, the mean fasting serum insulin concentrations in patients with seborrheic dermatitis are not significantly different from that of the control group, indicating that an association between hyperinsulinism and this disease is unlikely. Therefore, the increased glucose tolerance previously reported in these patients cannot be caused by hyperinsulinism. In contrast, considering a physiological pancreatic response to glucose stimulation for the release of insulin, hyperinsulinism would be associated with insulin resistance and an impaired glucose tolerance,6 such as that seen in psoriasis.2
Increasing age and obesity (defined as >120% ideal body weight) have been associated with impaired glucose tolerance and hyperinsulinism, respectively.7 Our patients were slightly younger than the control subjects (302 vs 402 years; P =.004), which might result in a slightly lower age-related insulin concentration. The weights of the patients (expressed as percent ideal body weight) were not significantly higher (P=.08), even though 9 patients compared with 6 controls were 20% or more above their ideal weights. Nevertheless, significant differences in insulin concentrations between the 2 groups were not observed (P=.13). The hyperinsulinism observed in patient 12 is believed to be an isolated finding, and is most probably related to his state and degree of obesity (166% ideal body weight).
Finally, despite the suggestions of a role of hyperinsulinism in the origin of such hyperproliferative disorders as acanthosis nigricans, this study further disfavors the previously assumed hyperproliferative cause of seborrheic dermatitis with hyperinsulinism as a possible causal factor. Accumulating evidence indicates a stronger support for a mycological origin for this disease.

BIBLIOGRAPHY
1. Hafiez AA, Abdel-Kader MM, El-Mofty AM, Ismail AA, Bassili F. Glucose tolerance in blood and skin of patients with seborrheic dermatitis. Indian J Dermatol. 1976;22:81-86. MEDLINE 
2. Fratino P, Bellomo G, Pelfini C, Bellazi R, Jucci A, Rabbiosi G. Insulin receptors in psoriasis. Acta Derm Venereol Suppl (Stockh). 1979;87:38-40. MEDLINE 
3. Stuart CA, Peters EJ, Prince MJ, Richards G, Cavallo A, Meyer WJ III. Insulin resistance with acanthosis nigricans: the roles of obesity and androgen excess. Metabolism. 1986;35:197-205. MEDLINE 
4. Faergemann J, Jones CT, Hettler O, Loria Y. Pityrosporum ovale(Malassezia furfur) as the causative agent of seborrheic dermatitis: new treatment options. Br J Dermatol. 1996;134:12-15. MEDLINE 
5. Champion RH, Burton JL, Ebling FJG. Textbook of Dermatology. Oxford, England: Blackwell Scientific Publications; 1992:546, 550. 
6. Stuart CA, Gilkison CR, Keenan BS, Nagamani M. Hyperinsulinemia and acanthosis nigricans in African Americans. J Natl Med Assoc. 1997;89:523-527. MEDLINE 
7. Greenspan FS, Baxter JD. Basic & Clinical Endocrinology. Norwalk, Conn: Appleton & Lange; 1994:685, 733. 

This work was mainly supported by an institutional research grant (Dr Dowlati) from the Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
We would like to thank the staff at the Center for Research and Education in Skin Diseases and Leprosy as well as the Institute for Endocrinology and Metabolism, Tehran.

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20.) Humoral immunity to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls.
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SO - Exp Dermatol 1994 Oct;3(5):227-33
AU - Ashbee HR; Fruin A; Holland KT; Cunliffe WJ; Ingham E
PT - JOURNAL ARTICLE
AB - This study examined the humoral immune responses to Malassezia furfur serovars A, B and C of 10 patients with pityriasis versicolor, 10 patients with seborrheic dermatitis and 20 age- and sex-matched controls. A transferable solid-phase ELISA was used to determine titres of total Igs, IgM, IgA and IgG specific to M. furfur serovars A, B and C. The results demonstrated that patients with seborrheic dermatitis had a significantly higher titre of total Igs to serovar A than patients with pityriasis versicolor; and that patients with seborrheic dermatitis had a significantly higher titre of IgA to serovar C than patients with pityriasis versicolor. The titres of total Igs for controls and patients with seborrheic dermatitis were significantly lower to serovar B than to serovar C. A modified TSP ELISA was used to determine the titres of the IgG subclasses. Titres of IgG1,3,4 to serovar B were significantly higher in seborrheic dermatitis patients than pityriasis versicolor patients and titres of IgG3 to serovar A were significantly higher in seborrheic dermatitis patients than pityriasis versicolor patients. However, despite the differences between the patient groups, none of these results was significantly different to those of controls. Thus, this study did not demonstrate any differences in humoral immunity of patients suffering from Malassezia-associated dermatoses when compared to normal controls. These results may suggest that the humoral immune response to M. furfur is not related to the pathogenesis of Malassezia-associated dermatoses, but simply to the carriage of M. furfur on the skin.
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21.) Management of common superficial fungal infections in patients with AIDS.
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SO - J Am Acad Dermatol 1994 Sep;31(3 Pt 2):S60-3
AU - Elmets CA
PT - JOURNAL ARTICLE; REVIEW (25 references); REVIEW, TUTORIAL
AB - Cutaneous fungal infections are a major source of morbidity in HIV-infected patients, and their management poses special challenges. Superficial mycoses, such as tinea pedis, tinea cruris, tinea corporis, and onychomycosis, are no more common in HIV-infected patients than in the HIV-negative population but are of greater severity. Although they respond to topical and systemic antifungal agents, HIV-positive patients are predisposed to frequent recurrences. Unusual types of fungal infections such as Majocchi's granuloma are more likely to develop in HIV-infected patients and respond best to systemic antifungal therapy with imidazoles or triazoles. Infections with Candida albicans develop in virtually all HIV-positive patients. Although mucosal involvement is the most common, patients may also develop superficial cutaneous infections. Topical agents are frequently all that is necessary, but in some, oral medications are required. Although fluconazole is effective, an appreciable number of isolates are resistant. Patients with pityriasis versicolor and seborrheic dermatitis, in which Pityrosporum species are thought to be involved, respond well to short courses of oral ketoconazole. Milder forms of seborrheic dermatitis can also be treated with low-potency topical steroids or topical ketoconazole. The oral triazole fluconazole is not particularly effective in the management of seborrheic dermatitis. Although the cause of eosinophilic pustular folliculitis, a common disorder in immunosuppressed HIV-positive patients, is unknown, some can be cured with high doses of itraconazole, suggesting that fungi are important in the pathogenesis of the disease in some patients.
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22.) Pityrosporum infections.
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SO - J Am Acad Dermatol 1994 Sep;31(3 Pt 2):S18-20
AU - Faergemann J
PT - JOURNAL ARTICLE; REVIEW (17 references); REVIEW, TUTORIAL
AB - Pityrosporum ovale is a lipophilic yeast that is part of the normal human adult cutaneous flora. It is both a saprophyte and an opportunistic pathogen associated with pityriasis versicolor, Pityrosporum folliculitis, seborrheic dermatitis, and some forms of atopic dermatitis. Systemic infections have also been described. In this article the diagnosis and management of pityriasis versicolor, Pityrosporum folliculitis, seborrheic dermatitis, and atopic dermatitis will be discussed.
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23.) Seborrheic dermatitis as a revealing feature of HIV infection in Bamako, Mali [letter]
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SO - Int J Dermatol 1994 Aug;33(8):601-2
AU - Mahe A; Boulais C; Blanc L; Keita S; Bobin P
PT - LETTER
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24.) Cell-mediated immune responses to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls.
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SO - Exp Dermatol 1994 Jun;3(3):106-12
AU - Ashbee HR; Ingham E; Holland KT; Cunliffe WJ
PT - CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
AB - It has been postulated that patients with Malassezia furfur-associated dermatoses have a deficient cell-mediated immune response to M. furfur. This study examined the cell-mediated immune responses to M. furfur serovars A, B and C of 10 patients with pityriasis versicolor and 10 age- and sex-matched controls; and 10 patients with seborrheic dermatitis and 10 age- and sex-matched controls. The responses to each serovar of M. furfur were assessed using the lymphocyte transformation assay and the leukocyte migration inhibition assay. The lymphocyte transformation responses of the patients with pityriasis versicolor to M. furfur serovars A, B and C (0/10, 6/10 and 5/10 respectively) were not significantly different from those of controls (0/10, 2/10 and 1/10). However, for patients with seborrheic dermatitis, significantly more patients' lymphocytes responded to serovars B and C (6/10 and 6/10 respectively) than those of controls (1/10 and 1/10). No patient or control responded to serovar A. In the leukocyte migration inhibition assay, the leukocytes from a greater proportion of patients with pityriasis versicolor (5/7) responded to serovar B than controls (2/10); and the leukocytes from a greater proportion of patients with seborrheic dermatitis (4/10) responded to serovar C than controls (0/9). Thus, this data did not indicate the presence of any cell-mediated immune deficiency to M. furfur in patients with pityriasis versicolor or seborrheic dermatitis, as measured by the lymphocyte transformation assay or the leukocyte migration inhibition assay. The greater responsiveness of T lymphocytes from patients may indicate that T lymphocytes might be involved in the pathogenesis of these diseases.

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25.) The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: a double blind study.
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Indian J Dermatol Venereol Leprol. 2006 Jul-Aug;72(4):266-9.
Siadat AH1, Iraji F, Shahmoradi Z, Enshaieh S, Taheri A.
Author information
1
Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. amirhossein1@yahoo.com
Abstract
BACKGROUND:
Seborrheic dermatitis is a common, chronic inflammatory disease of the skin, characterized by erythematous plaques that are covered with yellow, greasy, scales and may or may not be associated with itching. Although a few studies have suggested use of topical metronidazole for the treatment of seborrheic dermatitis, there is no general consensus about it.
AIMS:
To evaluate the efficacy of 1% metronidazole gel and its vehicle alone, in the treatment of seborrheic dermatitis.
METHODS:
This was a double-blind, prospective, clinical trial. Fifty six patients with seborrheic dermatitis were randomly allocated to either apply 1% metronidazole gel or placebo to their facial lesions, twice daily for 8 weeks. All the patients were evaluated and scored every 2 weeks for 8 weeks. The results were analyzed statistically.
RESULTS:
A total of 56 patients entered this study and 53 patients completed the treatment course. There was no significant difference in terms of demographic data and lesions severity score. There were statistically significant differences in the reduction of mean severity scores between the 2 groups at the second, fourth, sixth and eighth weeks of treatment (p<0.05). Metronidazole gel significantly decreased mean of seborrheic dermatitis severity score from the 2nd visit (p<0.001).
CONCLUSION:
Metronidazole gel is an effective treatment for facial seborrheic dermatitis.
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26.) A double blind study of the effectiveness of sertaconazole 2% cream vs. metronidazole 1% gel in the treatment of seborrheic dermatitis.
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Ann Parasitol. 2013;59(4):173-7.
Goldust M, Rezaee E, Raghifar R.
Abstract
Seborrheic dermatitis (SD) is generally treated with topical steroids, antifungals, or both. The aim of this study was to compare the efficacy of sertaconazole 2% cream vs. metronidazole 1% gel in the treatment of seborrheic dermatitis. A group of 156 patients suffering from SD were studied. The patients were randomly divided into two groups. The first group received local sertaconazole 2% cream and they were recommended to use the cream twice a day for 4 weeks. In the control group, thirty patients received metronidazole 1% gel twice a day for four weeks. At the point of referral, and also 2 and 4 weeks after the first visit, the patients were examined by a dermatologist to identify improvement of clinical symptoms. A higher level of satisfaction was observed after 28 days in the sertaconazole group (87.1%) than the metronidazole group (56.4%). Considering its efficacy, safety, and acceptability profiles, sertaconazole 2% cream is a worthwhile alternative to existing antifungal therapies for the treatment of seborrheic dermatitis.
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27.) Pimecrolimus 1% cream, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel in the treatment of seborrhoeic dermatitis: a randomized clinical study.
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J Dermatolog Treat. 2009;20(6):344-9. doi: 10.3109/09546630802687349.
Cicek D1, Kandi B, Bakar S, Turgut D.
Author information
Department of Dermatology, Firat University Faculty of Medicine, Elazig, Turkey. dr.demetcicek@yahoo.com
Abstract
BACKGROUND:
Seborrhoeic dermatitis is a common, chronic, papulosquamous dermatosis. Treatment of seborrhoeic dermatitis includes topical treatments such as corticosteroids, antifungals, metronidazole and pimecrolimus.
OBJECTIVE:
This study aimed to compare and contrast the efficacy and tolerability of pimecrolimus cream 1%, methylprednisolone aceponate 0.1% cream and metronidazole 0.75% gel topical treatments in the treatment of facial seborrhoeic dermatitis.
METHODS:
The study included a total of 64 (32 males and 32 females) consecutive patients with facial seborrhoeic dermatitis. Patients were randomized into three equal groups. One group applied pimecrolimus 1% cream, another group applied methylprednisolone aceponate 0.1% cream, and the third group applied metronidazole 0.75% gel to their facial lesions twice daily for 8 weeks. Assessment of the disease severity was performed at baseline and at weeks 2, 4, and 8. Clinical measures assessed were erythema, scaling and pruritus, which were evaluated using a four-point scale (0-3).
RESULTS:
Of the 64 patients, 17 (80%) in the metronidazole group, 21 (100%) in the pimecrolimus group and 22 (100%) in the methylprednisolone aceponate group completed the study. Four patients in the metronidazole group left the study. All of the therapeutic agents were found to be effective; however, the efficacy of pimecrolimus was higher than those of metronidazole and methylprednisolone (p < 0.05). When side effects associated with pimecrolimus and metronidazole were compared, the latter was found to be associated with more side effects (p < 0.05).
CONCLUSIONS:
We suggest pimecrolimus to be a therapeutic option for seborrhoeic dermatitis cases that show an unfavourable response to methylprednisolone aceponate.
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28.) Treatment with bifonazole shampoo for seborrhea and seborrheic dermatitis: a randomized, double-blind study.
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SO - Acta Derm Venereol 1992 Nov;72(6):454-5
AU - Segal R; David M; Ingber A; Lurie R; Sandbank M
PT - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
AB - Forty-four patients with seborrhea and seborrheic dermatitis of the scalp were treated with either bifonazole shampoo (22 patients) or the vehicle shampoo (22 patients) in a randomized, double-blind vehicle-controlled study. The patients were instructed to wash their scalps 3 times weekly for 6 weeks and were examined every 3 weeks. Responses were evaluated by clinicians using a clinical grading of scaling, erythema and overall improvement, and also by the patients, who assessed pruritus and overall improvement, using a scale of 0 to 3. The improvement following the bifonazole shampoo was found to be significantly greater than that achieved with the vehicle shampoo in regard to the clinical evaluation of scaling (p = 0.01) as well as patient evaluation of pruritus (p = 0.008) and overall improvement (p = 0.03). No major adverse side effects were recorded.
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29.) Quantitative skin cultures of Pityrosporum yeasts in patients seropositive for the human immunodeficiency virus with and without seborrheic dermatitis.
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SO - J Am Acad Dermatol 1992 Jul;27(1):37-9
AU - Wikler JR; Nieboer C; Willemze R
PT - JOURNAL ARTICLE
AB - BACKGROUND: Previous studies have suggested that Pityrosporum yeasts may be important in the pathogenesis of seborrheic dermatitis (SD). SD occurs more frequently and has a different clinical appearance in patients who are human immunodeficiency virus (HIV)-seropositive than in HIV-seronegative patients. OBJECTIVE: Our purpose was to investigate the role of Pityrosporum yeasts in the pathogenesis of seborrheic dermatitis in HIV-seropositive patients. METHODS: Twenty-eight HIV-seropositive patients, including seven patients with SD and 21 without SD, and 20 HIV-seronegative patients with SD (n = 10) and without SD (n = 10) were investigated. Quantitative Pityrosporum cultures were taken from the face, chest, and back. RESULTS: None or only a small amount of Pityrosporum yeasts were cultured from SD lesions and SD predilection sites in HIV-seropositive patients. From the SD lesions in the HIV-seronegative control group large amounts of Pityrosporum yeasts were cultured. CONCLUSION: The results of this and other studies suggest that Pityrosporum yeasts play no role in SD in HIV-seropositive patients and that SD in these patients is a distinct entity to be separated from "classical" SD in HIV-seronegative patients.
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30.) A double-blind, placebo-controlled, multicenter trial of lithium succinate ointment in the treatment of seborrheic dermatitis. Efalith Multicenter Trial Group.
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SO - J Am Acad Dermatol 1992 Mar;26(3 Pt 2):452-7
PT - CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
AB - 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.

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31.) Ketoconazole 2% emulsion in the treatment of seborrheic dermatitis.
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SO - Int J Dermatol 1991 Nov;30(11):806-9
AU - Pierard GE; Pierard-Franchimont C; Van Cutsem J; Rurangirwa A; Hoppenbrouwers ML; Schrooten P
PT - CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
AB - 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%).
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32.) Seborrheic dermatitis in acquired immunodeficiency syndrome.
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SO - Cutis 1991 Sep;48(3):217-8
AU - Marino CT; McDonald E; Romano JF
PT - JOURNAL ARTICLE
AB - Cutaneous eruptions are commonly seen in acquired immunodeficiency syndrome (AIDS). Seborrheic dermatitis in this patient population is usually more severe and difficult to diagnose and treat. The butterfly distribution of the rash and the interpretation of the biopsy may suggest a diagnosis of discoid lupus erythematosus, unless the pathologist is aware of the underlying immunodeficiency. We present two cases of patients with documented acquired immunodeficiency syndrome whose initial biopsies were interpreted as discoid lupus but whose cutaneous seborrheic dermatitis actually paralleled human immunodeficiency virus disease activity.
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33.) Blood levels of vitamin E, polyunsaturated fatty acids of phospholipids, lipoperoxides and glutathione peroxidase in patients affected with seborrheic dermatitis.
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SO - J Dermatol Sci 1991 May;2(3):171-8
AU - Passi S; Morrone A; De Luca C; Picardo M; Ippolito F
PT - JOURNAL ARTICLE
AB - 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.
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34.) Skin surface lipids in HIV sero-positive and HIV sero-negative patients affected with seborrheic dermatitis.
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SO - J Dermatol Sci 1991 Mar;2(2):84-91
AU - Passi S; Picardo M; Morrone A; De Luca C; Ippolito F
PT - JOURNAL ARTICLE
AB - Skin surface lipids of patients affected with seborrheic dermatitis both HIV sero-negative (C group) and HIV sero-positive (B group) have been studied by capillary Gas chromatography-Mass spectrometry (GC-MS) in comparison with normal age matched controls (A group) to determine whether, among the three groups of individuals, there were qualitative and quantitative changes in lipid class composition and in the fatty acid and alcohol components of lipid fractions. With regard to percent composition of skin surface lipid fractions, no significant differences were found between HIV sero-positive and HIV sero-negative patients with seborrheic dermatitis. The observed significant reduction of total lipids (micrograms/sq cm) in the sites affected with the disease in comparison with controls was associated with a slight but significant decrease of squalene (P less than 0.05) and with a corresponding increase of cholesterol and cholesterol esters (P less than 0.05). These abnormalities in lipid fractions and total lipids were not observed in the uninvolved skin of subjects with seborrheic dermatitis. Fatty acid and alcohol patterns of skin lipid fractions were not significantly different among the three groups of individuals.
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35.) Seborrheic dermatitis and daylight [see comments]
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SO - Acta Derm Venereol 1991;71(6):538-9
AU - Maietta G; Rongioletti F; Rebora A
PT - JOURNAL ARTICLE
AB - Patients with mood depression have been found to have a higher prevalence of seborrheic dermatitis (SD), possibly related to their tendency to live indoors. The prevalence of outpatients with SD has now been found to be directly related to the number of gloomy days in the area. Since UV light might not be the only reason for the well-known improvement in SD in summer, an explanation possibly related to melatonin is envisaged.
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36.) [Seborrheic dermatitis and cancer of the upper
respiratory and digestive tracts]
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SO - Ann Dermatol Venereol 1991;118(9):607-9
AU - Guillaume JC; Karneff MC; Revuz J
PT - JOURNAL ARTICLE
AB - Seborrheic dermatitis (SD) is frequent in adults. Its aetiology is unknown, and the alleged causative effect of Pityrosporum-type yeasts is strongly controverted. Nutritional, genetic and neuropsychological factors may play a part in its occurrence. The responsibility of immunological factors has recently been illustrated by the high prevalence of SD in patients with acquired immunodeficiency syndrome. We found a high frequency of SD in patients under treatment for carcinomas of the upper respiratory and digestive tracts (URDT), and in order to confirm this finding we carried out a prospective case-control epidemiological study. Since most patients with URDT carcinoma are heavy drinkers and smokers, we divided our controls into two groups: chronic alcoholics without cancer (Group B) and patients with non-URDT cancers. At the time of admission, all patients were examined by the same physician, and SD was diagnosed on clinical grounds. Cases (Group A) comprised 50 patients (48 men, 2 women; mean age 56 years) with URDT carcinoma. All were alcohol and tobacco addicts. Thirty-six of these patients had undergone surgery for their cancer, and among these 19 had received radiotherapy, 8 chemotherapy and 18 both chemo- and radiotherapy. The first control group (Group B) also comprised 50 patients, all male, with a mean age of 59 years, who had been admitted for diseases due to alcoholism but showed no evidence of cancer. The second control group (Group C) consisted of 50 male patients (mean age 69 years) whose cancer was not an URDT carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS).
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37.) The role of Pityrosporum ovale in seborrheic dermatitis.
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SO - Semin Dermatol 1990 Dec;9(4):262-8
AU - Bergbrant IM; Faergemann J
PT - JOURNAL ARTICLE; REVIEW (103 references); REVIEW, TUTORIAL
AB - 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.
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38.) Correlation of Pityosporum ovale density with clinical severity of seborrheic dermatitis as assessed by a simplified technique.
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SO - J Am Acad Dermatol 1990 Jul;23(1):82-6
AU - Heng MC; Henderson CL; Barker DC; Haberfelde G
PT - JOURNAL ARTICLE
AB - One hundred patients with facial seborrheic dermatitis and 42 control subjects were studied. The number of periodic acid-Schiff-positive Pityosporum ovale yeast cells in skin scrapings per high-power field were counted and designated 1 + to 4 +. Our data indicate a correlation between the density of P. ovale and the clinical severity of seborrheic dermatitis, both before and after therapy with a precipitated sulfur/salicyclic acid shampoo. The data support the concept that yeast contributes to the pathogenesis of seborrheic dermatitis.

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39.) Immune reactions to Pityrosporum ovale in adult
patients with atopic and seborrheic dermatitis.
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SO - J Am Acad Dermatol 1990 May;22(5 Pt 1):739-42
AU - Kieffer M; Bergbrant IM; Faergemann J; Jemec GB; Ottevanger V; Stahl Skov P; Svejgaard E
PT - JOURNAL ARTICLE
AB - Pityrosporum ovale is a lipophilic yeast commonly present in the seborrheic areas of the skin of adults. Fifty-five young adult patients with atopic dermatitis, 19 patients with seborrheic dermatitis, and 19 healthy control subjects were examined for immune reactions to P. ovale, including tests for specific IgE antibodies (prick test, histamine release), IgG antibodies and epicutaneous testing. IgE antibodies against P. ovale were found in two thirds of the patients with atopic dermatitis and were more frequent in patients with lesions predominantly in the seborrheic areas. In addition, some atopic patients had positive reactions to epicutaneous tests, which suggest that delayed allergic reactions to P. ovale may also be important. In patients with seborrheic dermatitis, no evidence of immediate or delayed hypersensitivity to P. ovale was found. IgG antibody levels were low in all groups.
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40.) [Treatment of seborrheic dermatitis with benzoyl peroxide]
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SO - Ann Dermatol Venereol 1990;117(2):123-5
AU - Bonnetblanc JM; De Prost Y; Bazex J; Maignan-Gayrard P
PT - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
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41.)[The significance of yeasts in seborrheic eczema]
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SO - Hautarzt 1989 Oct;40(10):611-3
AU - Buslau M; Hanel H; Holzmann H
PT - JOURNAL ARTICLE; REVIEW (26 references); REVIEW, TUTORIAL
AB - The high prevalence of seborrheic dermatitis in HIV-infected subjects has led to intensified the discussion of the etiopathogenesis of this dermatological disease. There is increasing controversy about the significance of Pityrosporum in seborrheic dermatitis. On the other hand, recent clinical and experimental data favor the role of intestinal candidiasis in seborrheic dermatitis: a high quantity of Candida in the feces of the affected patients, elevated phospholipase activity of the Candida sp. with special pathogenic relevance for mucosal adhesion and fast and long-lasting regression of seborrheic dermatitis after vigorous therapy with oral nystatin. Similar findings have been recorded in the seborrheic forms of psoriasis.

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42.) Association of Pityrosporum orbiculare (Malassezia furfur) with seborrheic dermatitis in patients with acquired immunodeficiency syndrome (AIDS).
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SO - J Am Acad Dermatol 1989 May;20(5 Pt 1):770-3
AU - Groisser D; Bottone EJ; Lebwohl M
PT - JOURNAL ARTICLE
AB - The possible causative role of the yeastlike fungus Pityrosporum (Malassezia) orbiculare in the pathogenesis of seborrheic dermatitis in patients with and without acquired immunodeficiency syndrome (AIDS) has been discussed but not resolved. Ten patients with AIDS-related seborrheic dermatitis were studied for the presence of Pityrosporum organisms. On the basis of a quantitative correlation between numbers of yeast cells adherent to and extruded from keratinocytes and the clinical severity of seborrheic dermatitis, an association, if not a causative role, for Pityrosporum is strongly suggested in seborrheic dermatitis in patients with AIDS. This association was further strengthened by the marked clinical response to ketoconazole in two patients with a concomitant decrease in the number of Pityrosporum cells per keratinocyte.
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43.) Pityrosporum ovale in infantile seborrheic dermatitis.
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SO - Pediatr Dermatol 1989 Mar;6(1):16-20
AU - Ruiz-Maldonado R; Lopez-Matinez R; Perez Chavarria EL; Rocio Castanon L; Tamayo L
PT - JOURNAL ARTICLE
AB - 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).
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44.)Infantile seborrheic dermatitis: seven-year follow-up and some prognostic criteria.
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SO - Pediatr Dermatol 1989 Mar;6(1):13-5
AU - Menni S; Piccinno R; Baietta S; Ciuffreda A; Scotti L
PT - JOURNAL ARTICLE
AB - Based on clinical features, infantile seborrheic dermatitis (ISD) can be classified as follows: true seborrheic dermatitis (SD), psoriasiform seborrheic dermatitis (Psor SD), and erythrodermic seborrheic dermatitis. We reviewed the records of 72 children who had been affected by ISD several years earlier to investigate the evolution of disease, to evaluate the patients for the presence of new skin lesions, and to study family histories with respect to these conditions. In addition, we attempted to determine if there is any connection among the initial features of ISD and the types of skin lesions, and atopy or psoriasis. On reexamination, our patients previously diagnosed as having SD showed a larger variety of new skin lesions than those who had Psor SD, and 15% had developed atopic dermatitis. Atopic dermatitis was not present at follow-up in the children with previously diagnosed Psor SD. Psoriatic lesions were present in similar percentages in both groups at the time of reevaluation. Investigation of family history was not useful in predicting later development of psoriasis or atopic dermatitis. We conclude that the initial clinical features of ISD may be of prognostic value, and that SD and Psor SD are probably two different clinical entities.
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45.) Ketoconazole 2% cream versus hydrocortisone 1% cream in the treatment of seborrheic dermatitis. A double-blind comparative study.
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SO - J Am Acad Dermatol 1988 Nov;19(5 Pt 1):850-3
AU - Stratigos JD; Antoniou C; Katsambas A; Bohler K; Fritsch P; Schmolz A; Michaelidis D; De Beule K
PT - JOURNAL ARTICLE
AB - Seventy-two patients with seborrheic dermatitis were treated once daily with 2% ketoconazole cream (n = 36) or 1% hydrocortisone cream (n = 36) on a double-blind basis for 4 weeks. For the global evaluation, no significant difference could be seen between the two groups. The clinical response was 80.5% in the ketoconazole group and 94.4% in the hydrocortisone group. For the different symptoms combined (scaling, redness, itching, and papules), no significant difference was seen between the two groups when the total scores at week 2 and at week 4 were compared with the initial scores. The incidence of side effects in both groups was comparably low.
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46.) T-cell subset assay. A useful differentiating marker of atopic and seborrheic eczema in infancy?
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SO - Arch Dermatol 1988 Aug;124(8):1235-8
AU - Podmore P; Burrows D; Eedy D
PT - JOURNAL ARTICLE
AB - To confirm T-cell changes previously reported in atopic eczema, to compare T-cell subset values in atopic and seborrheic infants, and to determine whether T-cell subset assay would be a useful differentiating marker between atopic and seborrheic infants, three age- and sex-matched groups of normal, seborrheic, and atopic infants were recruited. T-cell subset values, total serum IgE, and serum IgE to specific allergens (Dermatophagoides pteronyssimus, cat epithelium, dog dander, rye grass, egg white, and milk) were measured. The results showed that total and allergen-specific IgE levels were higher in atopic disease in infancy, but no statistical differences in T-cell subset values between seborrheic and atopic infants were found. T-cell subset values are therefore not a reliable differentiating marker between atopic and seborrheic eczema in infancy.
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47.) Propylene glycol in the treatment of seborrheic dermatitis of the scalp: a double-blind study.
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SO - Cutis 1988 Jul;42(1):69-71
AU - Faergemann J
PT - JOURNAL ARTICLE
AB - 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.
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48.) Seborrheic dermatitis and malignancy. An investigation of the skin flora.
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SO - Acta Derm Venereol 1988;68(1):48-52
AU - Clift DC; Dodd HJ; Kirby JD; Midgley G; Noble WC
PT - JOURNAL ARTICLE
AB - The skin flora of patients with disseminated malignant disease and seborrheic dermatitis has been investigated and compared with controls as well as with otherwise healthy patients suffering from seborrheic dermatitis. Although significant differences were detected in both bacterial and yeast counts between different sites on the body, no significant qualitative or quantitative differences were found between the three groups of subjects. Whereas abnormalities of the skin flora have been described in seriously ill patients and in individuals subjected to occlusion, we were unable to demonstrate any changes in skin flora in patients with malignant disease and seborrheic dermatitis. Our results do not support the view that increased numbers of Pityrosporum yeasts are important in the pathogenesis of seborrheic dermatitis.
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49.) Efficacy of topical application of glucocorticosteroids compared with eosin in infants with seborrheic dermatitis.
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SO - Cutis 1987 Jul;40(1):67-8
AU - Shohat M; Mimouni M; Varsano I
PT - CLINICAL TRIAL; JOURNAL ARTICLE
AB - Two therapeutic regimens for seborrheic dermatitis in infancy were compared. Fifteen infants were treated with topical glucocorticosteroid (flumethasone pivalate 0.02 percent) and fifteen with aqueous solution of the staining agent eosin 2 percent. Following two days of treatment a similar degree of healing was noted in both groups, and after ten days almost complete healing of the lesions was observed in all of the infants.
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50.) Erythema with features of seborrheic dermatitis and lupus erythematosus associated with systemic 5-fluorouracil.
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SO - Cutis 1987 Jan;39(1):64-6
AU - Dudley K; Micetich K; Massa MC
PT - JOURNAL ARTICLE
AB - Multiple cutaneous reactions have been reported in association with topical and systemic 5-fluorouracil therapy. Three patients are reported who noted facial erythema with features of both seborrheic dermatitis and lupus erythematosus following the administration of systemic 5-fluorouracil.
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51.)[Treatment of seborrheic dermatitis with low-dosage dithranol]
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SO - Hautarzt 1985 Sep;36(9):529-30
AU - Wolbling RH; Schofer H; Milbradt R
PT - JOURNAL ARTICLE
AB - This report describes the successful treatment of facial seborrheic dermatitis with a low-dose dithranol preparation. The results of a pilot study involving 18 outpatients are presented.

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52.) Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream.
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SO - J Am Acad Dermatol 1985 May;12(5 Pt 1):852-6
AU - Skinner RB Jr; Noah PW; Taylor RM; Zanolli MD; West S; Guin JD; Rosenberg EW
PT - CLINICAL TRIAL; JOURNAL ARTICLE
AB - Thirty-seven patients with seborrheic dermatitis were treated topically with a 2% ketoconazole cream or its vehicle control in a double-blind study. The subjects were studied for numbers of Malassezia ovalis (Pityrosporum ovale) cells in their scalp scale; changes in numbers of yeast cells and morphology of M. ovalis were tabulated along with clinical assessment of improvement. The 2% ketoconazole cream, but not the placebo cream, reduced the numbers of viable yeast cells on the scalp. The clinical effect of 2% ketoconazole cream was good (75%-95% improvement) or better in eighteen of twenty subjects; the placebo cream produced good results in only three of seventeen subjects treated. Results of this study are consistent with the view that M. ovalis plays a central role in the pathogenesis of seborrheic dermatitis.
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53.) Seborrheic dermatitis in neuroleptic-induced parkinsonism.
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SO - Arch Dermatol 1983 Jun;119(6):473-5
AU - Binder RL; Jonelis FJ
PT - JOURNAL ARTICLE
AB - An increased prevalence of seborrheic dermatitis has previously been noted in idiopathic Parkinson's disease and in postencephalitic parkinsonism. Our study of 42 hospitalized patients with drug-induced parkinsonism and 47 hospitalized psychiatric patients without that disorder showed a statistically significant higher prevalence of clinically diagnosed seborrheic dermatitis in the group with drug-induced parkinsonism (59.5% v 15%). To our knowledge, this is the first report of an increased prevalence of seborrheic dermatitis with drug-induced parkinsonism.

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54.) Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial.
===========================================================
SO - Br J Dermatol 1995 Mar;132(3):441-5
AU - Peter RU; Richarz-Barthauer U
PT - CLINICAL TRIAL; CLINICAL TRIAL, PHASE I; CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; MULTICENTER STUDY
AB - 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.
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55.) Adherence of Malassezia furfur to human stratum corneum cells in vitro: a study of healthy individuals and patients with seborrhoeic dermatitis.
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SO - Mycoses 1994 Jun-Jul;37(5-6):217-9
AU - Bergbrant IM; Faergemann J
PT - JOURNAL ARTICLE
AB - 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.
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56.) Seborrhoeic dermatitis: treatment with anti-mycotic agents.
===========================================================
SO - J Dermatol 1994 May;21(5):334-40
AU - Sei Y; Hamaguchi T; Ninomiya J; Nakabayashi A; Takiuchi I
PT - JOURNAL ARTICLE
AB - 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.

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57.)Analyses of skin surface lipid in patients with microbially associated skin disease.
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SO - Clin Exp Dermatol 1993 Sep;18(5):405-9
AU - Patel SD; Noble WC
PT - JOURNAL ARTICLE
AB - The composition of the total skin surface lipid, free fatty acids and fatty acid of triglyceride was used in discriminant analyses to classify patients with severe acne vulgaris (AV), pityriasis versicolor (PV), seborrhoeic dermatitis (SD) and atopic dermatitis (AD). It was not possible to discriminate between the PV and SD patients but all the lipid groups gave a satisfactory separation between AV, PV + SD and AD patients. A similar separation was obtained when the sex of the patient was studied but not when both sex and disease were taken into account. The results suggest that there are fundamental differences in the composition of skin lipid between patients with microbially associated diseases, but the precise role of the organisms has not been ascertained.
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58.) Borage oil, an effective new treatment for infantile seborrhoeic dermatitis [letter]
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SO - Br J Dermatol 1993 Jul;129(1):95
AU - Tollesson A; Frithz A
PT - LETTER
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59.) Transepidermal water loss and water content in the stratum corneum in infantile seborrhoeic dermatitis.
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SO - Acta Derm Venereol 1993 Feb;73(1):18-20
AU - Tollesson A; Frithz A
PT - JOURNAL ARTICLE
AB - 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.
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60.) [Skin lipids in seborrhea- and sebostasis-associated skin diseases]
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SO - Hautarzt 1993 Feb;44(2):75-80
AU - Schaich B; Korting HC; Hollmann J
PT - JOURNAL ARTICLE; REVIEW (57 references); REVIEW, TUTORIAL
AB - Recent studies suggest that epidermal skin lipids play an important role in the pathogenesis of skin diseases associated with seborrhoea or sebostasis. Depending on the state of the skin, various lipids are found in varying quantities and proportions. In some sebostatic diseases, in particular, altered enzyme activities relevant to the synthesis of lipids have been identified, which may account for alterations in epidermal lipid fractions. This concept represents a substantial modification of earlier ones, according to which sebostatic or seborrhoeic skin diseases were attributed solely to decreased or increased sebum lipids, respectively. This provides an important rationale for a new approach to the therapy of certain skin diseases with specific lipid fractions, such as ceramides.

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61.) Use of topical lithium succinate in the treatment of seborrhoeic dermatitis [letter; comment]
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SO - Dermatology 1993;187(2):149-50
AU - Leeming JP
PT - COMMENT; LETTER
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62.) A dose-response study of irritant reactions to sodium lauryl sulphate in patients with seborrhoeic dermatitis and atopic eczema.
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SO - Acta Derm Venereol 1992 Nov;72(6):432-5
AU - Cowley NC; Farr PM
PT - JOURNAL ARTICLE
AB - 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.
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63.) Seborrhoeic dermatitis of the scalp--a manifestation of Hailey-Hailey disease in a predisposed individual?
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SO - Br J Dermatol 1992 Mar;126(3):294-6
AU - Marren P; Burge S
PT - JOURNAL ARTICLE
AB - A 59-year-old man was found to have typical Hailey-Hailey disease of the back, neck and axillae. In addition, he had fine white scaling in the scalp and postauricular areas. Despite the clinical appearance of seborrhoeic dermatitis, a biopsy of his scalp showed prominent suprabasal epidermal separation with acantholysis. We propose that in a genetically predisposed individual, Hailey-Hailey disease can assume atypical and non-specific appearances.
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64.) Use of topical lithium succinate in the treatment of seborrhoeic dermatitis [see comments]
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SO - Dermatology 1992;184(3):194-7
AU - Cuelenaere C; De Bersaques J; Kint A
PT - CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
AB - 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.
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65.) Erythema multiforme and dermatitis seborrhoides infantum as concomitant id-reactions to widespread candidosis in a suckling.
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SO - Mycoses 1991 Sep-Oct;34(9-10):415-7
AU - Korting HC; Vieluf D
PT - JOURNAL ARTICLE
AB - The case of a young suckling is reported in whom widespread candidosis of the napkin area was followed by the clinical signs of both erythema multiforme and dermatitis seborrhoides infantum. Both these diseased states are considered as candidids.
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66.) The evaluation of various methods and antigens for the detection of antibodies against Pityrosporum ovale in patients with seborrhoeic dermatitis.
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SO - Clin Exp Dermatol 1991 Sep;16(5):339-43
AU - Bergbrant IM; Johansson S; Robbins D; Bengtsson K; Faergemann J; Scheynius A; Soderstrom T
PT - JOURNAL ARTICLE
AB - Sera from 10 patients with seborrhoeic dermatitis and from 10 age-matched healthy individuals were examined for IgG activity against Pityrosporum ovale. The IgG activity was analysed using the following techniques: an enzyme-linked immunosorbent assay (ELISA) against whole P. ovale cells, purified cell-wall carbohydrate or protein extract, an indirect slide-immunofluorescence assay and fluorescence-activated flow cytometry using the whole organism as antigen. The ELISA method using the protein antigen was the only technique that showed a significant difference between patients and controls; a lower antibody response was found in the seborrhoeic dermatitis patients compared to healthy controls.

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67.) Enhanced phagocytosis and intracellular killing of Pityrosporum ovale by human neutrophils after exposure to ketoconazole is correlated to changes of the yeast cell surface.
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SO - Mycoses 1991 Jan-Feb;34(1-2):29-33
AU - Richardson MD; Shankland GS
PT - JOURNAL ARTICLE
AB - In seborrhoeic dermatitis an inflammatory response occurs secondary to large numbers of Pityrosporum yeasts appearing within and beneath the epidermis. To study the interaction between human neutrophils and P. ovale and any immunomodulating effect of antifungal agents, the yeast was exposed to ketoconazole and then incorporated into neutrophil monolayer assays. Phagocytosis was complement dependent and reached a maximum after 40 min. Ketoconazole at 25, 50 and 100 mg l-1 had no significant effect on phagocytosis of P. ovale. However, when yeast cells were pretreated with ketoconazole for 2 h before exposure to the phagocyte monolayer there was a significant enhancement of phagocytosis with increasing drug concentration. Intracellular killing of P. ovale was assessed by methylene blue dye exclusion. In the absence of ketoconazole, 5% of intracellular yeast cells were killed following internalization for 2 h. Pretreatment of yeast cells with ketoconazole at 10 and 100 mg l-1 for 2 h prior to ingestion significantly increased intracellular killing to a maximum of 23%. This study demonstrates that yeast cells of P. ovale are readily ingested by human neutrophils by a complement dependent process. Phagocytosis is enhanced if the organism is exposed to ketoconazole before opsonisation and ingestion. The inability of neutrophils to kill P. ovale is modulated in the presence of therapeutic concentrations of ketoconazole.
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68.) [Therapy of seborrheic eczema with an antifungal agent with an antiphlogistic effect]
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SO - Mycoses 1991;34 Suppl 1:91-3
AU - Hanel H; Smith-Kurtz E; Pastowsky S
PT - CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
AB - Numerous AIDS patients show the typical seborrheic eczema in a very prominent way. For this is an inflammatory disease, combination preparations were taken frequently which contain antimycotics and corticosteroids. We investigated 7 antimycotic compounds in 3 inflammatory models: amorolfin, ciclopiroxolamine (cic), fluconazole, ketoconazole, miconazole, naftifine, and rilopirox. In an in vitro model the inflammatory activity towards the 5-lipoxygenase was investigated. 1,000 mumol naftifine, 100 mumol ketoconazole, 50 mumol cic, and 10 mumol rilopirox inhibited 5-HETE by 90%. In a cell culture model only cic had a significant activity towards cyclo-oxygenase. In this model the inhibition of the prostaglandin E2 liberation by 1 mumol cic was 40%. In an in vivo model the anti-inflammatory activity on a mouse ear was investigated (arachidonic acid induced). In this model only cic showed a significant inhibition of inflammation (50%) at 1 mg/ear. These investigations show, that cic has a strong antiphlogistic activity. In an open clinical trial with 20 patients suffering from seborrheic eczema after 4 weeks on cic cream a strong inhibition of infiltration and flakiness had been observed. The antimycotic compound cic offers a possibility to treat inflammatory mycoses without using corticosteroid combinations. In a double blind clinical trial (tinea) where cic was compared with a cic/hydrocortisone combination no statistical differences were found.
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69.) Neutrophil zinc levels in psoriasis and seborrhoeic dermatitis.
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SO - Br J Dermatol 1990 Sep;123(3):319-23
AU - Leung RS; Turnbull AJ; Taylor JA; Russell-Jones R; Thompson RP
PT - JOURNAL ARTICLE
AB - The median zinc content of neutrophils was significantly reduced in 16 patients with psoriasis in comparison to both normal controls and six patients with seborrhoeic dermatitis (P less than 0.05). This reduction was unrelated to the extent of skin involvement. Plasma and erythrocyte zinc levels were unchanged.

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70.) Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole.
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SO - Arch Dermatol 1990 Feb;126(2):181-4
AU - Hill MK; Goodfield JD; Rodgers FG; Crowley JL; Saihan EM
PT - JOURNAL ARTICLE
AB - The yeast Pityrosporum orbiculare is thought to cause the folliculitis associated with seborrheic eczema. However, a combination of mechanical and microbiological factors may be involved, with follicular occlusion leading to yeast overgrowth and folliculitis. Scanning electron microscopy was used to investigate this hypothesis. Skin biopsy specimens obtained from patients with Pityrosporum folliculitis were examined by scanning electron microscopy before and after oral ketoconazole therapy. Patients with active disease showed occlusion of noninflamed follicles, which resolved after ketoconazole treatment. Follicular occlusion was not present in biopsy specimens obtained from unaffected controls nor was it related to the presence of P orbiculare. These findings suggest that follicular occlusion may be a primary event in the development of this folliculitis, with yeast overgrowth a secondary occurrence. The beneficial effect of ketoconazole in this disease may be due to direct effects on the follicle.
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71.) Studies on the yeast flora in patients suffering from psoriasis capillitii or seborrhoic dermatitis of the scalp.
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SO - Mycoses 1990 Jan;33(1):29-32
AU - Senff H; Bothe C; Busacker J; Reinel D
PT - JOURNAL ARTICLE
AB - In 65 patients with scalp psoriasis or seborrhoic dermatitis of the scalp, stool specimens, tongue swabs and scalp scales were examined for yeasts. The stool specimens showed in 70.8% of the patient group massive and in 7.7% moderate yeast colonization. Yeasts were found in 47.7% of the tongue cultures and in 12.5% of the scalp scales. Candida albicans was the predominant pathogen in the faeces and on the tongue. In comparison with a control group, frequency of yeasts in faeces and on the tongue in patients with psoriasis capillitii and seborrhoic dermatitis of the scalp could be shown to be significantly higher.
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72.) [Histological differential diagnosis of psoriasis vulgaris and seborrheic eczema of the scalp]
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SO - Hautarzt 1979 Sep;30(9):478-83
AU - Braun-Falco O; Heilgemeir GP; Lincke-Plewig H
PT - JOURNAL ARTICLE
AB - The clinical differential diagnosis between seborrheic dermatitis and psoriasis vulgaris of the scalp can be difficult. We, therefore, tried to elaborate histopathological criteria for a differentiation of the two dermatoses. Forty excisional biopsies were analysed without knowing the clinical diagnosis. The histopathological substrate within the epidermis is characterized in psoriasis by dermatitis-like and in seborrheic dermatitis by psoriasis-like alterations. Therefore, in some cases a definite histopathological diagnosis could not be made. Strong criteria favouring psoriasis are: moderate condensed hyperkeratosis with alternating parakeratosis, PAS-reactive serum inclusions and Munro abscesses within the horny layer, spongiform pustles and neutrophilic leukocytes within the epidermis. Strong criteria for seborrheic dermatitis are: irregular acanthosis with relatively thin condensed orthoor parakeratotic horny layer, spongiosis and spongiotic vesicles, exocytosis of lymphocytes and the lack of any hard criterias for psoriasis. The results may suggest that seborrheic dermatitis of the scalp may transform into psoriasis in patients with a genetical disposition ("psoriatic diathesis", "latent psoriasis") via a Kobner reaction. The existence of the seborrheic dermatitis (Morbus Unna) is not doubted by these investigations.
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73.) Tinea versicolor with regard to seborrheic dermatitis. An epidemiological investigation.
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SO - Arch Dermatol 1979 Aug;115(8):966-8
AU - Faergemann J; Fredriksson T
PT - JOURNAL ARTICLE
AB - This is a retrospective study of 232 patients, and a prospective survey of 48 patients, regarding susceptibility factors in tinea versicolor, particularly in association with seborrheic dermatitis. In both surveys, a higher (10.4%) than expected (3.8%) percentage of association with seborrheic dermatitis was found.
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74.)Quantitative microbiology of the scalp in non-dandruff, dandruff, and seborrheic dermatitis.
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SO - J Invest Dermatol 1975 Jun;64(6):401-5
AU - McGinley KJ; Leyden JJ; Marples RR; Kligman AM
PT - JOURNAL ARTICLE
AB - The composition of the scalp microflora was assessed quantitatively in normal individuals and in patients with dandruff and seborrheic dermatitis, disorders characterized by increasing scaling. Three organisms were constantly found: (1) Pityrosporum, (2) aerobic cocci, and (3) Corynebacterium acnes. Pityrosporum (mainly Pityrosporum ovale) made up 46% of the total microflora in normals, 74% in dandruff, and 83% in seborvheic dermatitis. The geometric mean number of organisms per cm-2 in non-dandruff subjects was 5.04 times 10-5; 9.22 times 10-5 in dandruff subjects; and 6.45 times 10-5 in those with seborrheic dermatitis. The cocci were dominantly Baird-Parker type SII and no quantitative or qualitative change occurred in the scaling disorders. C. acnes comprised 26% of the flora on the normal scalp, 6% in dandruff, and only 1% in seborrheic dermatitis. These results differ significantly from previous reports which describe a much more complex microflora and suggest an etiologic role for microorganisms in dandruff.
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75.) Treatment of seborrheic dermatitis with biotin and vitamin B complex.
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SO - J Pediatr 1972 Sep;81(3):630-1
AU - Nisenson A; Barness LA
PT - JOURNAL ARTICLE
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76.) L-dopa for seborrheic dermatitis.
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SO - N Engl J Med 1970 Oct 15;283(16):879
AU - Parish LC
PT - JOURNAL ARTICLE
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77.) Seborrheic dermatitis of infants: treatment with biotin injections for the nursing mother.
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SO - Pediatrics 1969 Dec;44(6):1014-6
AU - Nisenson A
PT - JOURNAL ARTICLE
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78.) Photochemotherapy in erythrodermic seborrhoic dermatitis [letter]
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SO - Arch Dermatol 1977 Sep;113(9):1295-6
AU - Dahl KB; Reymann F
PT - LETTER
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79.) Old drug--in a new system--revisited.
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SO - Cutis 1977 Jun;19(6):852-4
AU - Olansky S
PT - JOURNAL ARTICLE
AB - Sodium sulfacetamide, penetrating antibacterial, in combination with hydrocortisone and sulfur, has enjoyed twenty years of remarkable safety, with outstanding efficacy and patient acceptance, in the prescription treatment of pustular acne and severe, refractory seborrheic dermatitis. Recently, this combination has been reported to be highly effective concomitant therapy for perioral dermatitis. Almost paradoxically, it achieves these desired goals without the excessive erythema and discomforting irritation associated with retinoic acid and benzoyl peroxide.
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80.) Oral use of biotin in seborrhoeic dermatitis of infancy: a controlled trial.
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SO - Med J Aust 1976 Apr 17;1(16):584-5
AU - Keipert JA
PT - CLINICAL TRIAL; JOURNAL ARTICLE
AB - 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.
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81.) Generalized seborrhoeic dermatitis. Clinical and therapeutic data of 25 patients.
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SO - Arch Dis Child 1975 Nov;50(11):871-4
AU - Messaritakis J; Kattamis C; Karabula C; Matsaniotis N
PT - JOURNAL ARTICLE
AB - 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.
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82.)The effect of betamethasone valerate on seborrhoeic dermatitis of the scalp. A clinical, histopathological cell kinetic study.
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SO - Acta Derm Venereol 1974;54(5):373-5
AU - Marks R; Bhogal B; Wilson L
PT - CLINICAL TRIAL; JOURNAL ARTICLE
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83.) Topical glycerin in seborrhoeic dermatitis.
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SO - Lancet 1972 Nov 11;2(785):1037-8
AU - Benaim-Pinto C
PT - JOURNAL ARTICLE
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84.)[Therapeutic aspects of seborrhea oleosa and pityriasis simplex capillitii]
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SO - Hautarzt 1979 May;30(5):236-41
AU - Gloor M
PT - JOURNAL ARTICLE
AB - The treatment of seborrhoea oleosa capillitii should aim at inhibiting depletion of the sebaceous glands, lipid synthesis in the sebaceous gland and microbial lipolysis of the triglycerides in the scalp and hair lipids. The use of isopropyl alcohol as a vehicle in a hair tonic reduces sebum depletion. Coal tar and estrogens reduce the lipid synthesis in the sebaceous gland. The lipolysis can be inhibited by various surfactants, isopropyl alcohol, colloidal sulphur, selenium disulphide, Omadine MDS and benzoyl peroxide. In the treatment of pityriasis simplex capillitii (dandruff) one aims at achieving inhibition of mitosis in the epidermis and, if possible, an additional "keratolytic" effect. Inhibition of mitosis could be demonstrated for coal tar, corticosteroids, selenium disulphide, cadmium sulphide, Omadine MDS, Zn Omadine and ichthyol sodium. Colloidal sulphur, salicylic acid, Omadine MDS and various surfactants act "keratolytically"
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85.) Tinea versicolor and Pityrosporum orbiculare: mycological investigations, experimental infections and epidemiological surveys.
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SO - Acta Derm Venereol Suppl (Stockh) 1979;(86):1-23
AU - Faergemann J
PT - JOURNAL ARTICLE
AB - In patients with tinea versicolor, Pityrosporum orbiculare was cultured from tinea versicolor lesions in 100%, from normal-looking skin in 80%, and from apparently healed lesions in 69%. P. orbiculare was isolated from normal skin in 85% of patients with seborrheic dermatitis and in 90% of volunteers. The best substrate for isolation of P. orbiculare was a peptone-glucose-yeast extract medium containing glycerol monostearate and Tween 80, overlaid with olive oil. Germ tubes were produced when P. orbiculare was incubated in an atmosphere containing air with 7% CO2. Cultures of P. orbiculare and P. ovale did not show any fluorescence in Wood's light. The in vitro activity of miconazole, clotrimazole, econazole, sodium omadine, and sodium thiosulphate against P. orbiculare was found to correlate to the good clinical effect of these drugs in tinea versicolor. In addition several substances used as solvents or in vehicles had an inhibitory activity against P. orbiculare in vitro. Inoculation with P. orbiculare under plastic occlusion on the glabrous follicle-rich inside of the rabbit ear resulted in a tinea versicolor-like lesion after I week in 3 of 4 animals. One week after inoculation with P. orbiculare under plastic occlusion, experimental infections similar to those found clinically in tinea versicolor were seen in 10 of 12 patients with a history of tinea versicolor and in 3 of 6 normal volunteers. It was not possible to produce experimental infections without occlusion. Spontaneous healing usually occurred. In a retrospective study of 232 patients and prospective survey of 48 patients regarding susceptibility factors in tinea versicolor a higher (10.4%) than expected (3.8%) connection to seborrheic dermatitis was found.
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86.)[Some atypical forms of eczema in children (author's transl)]
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SO - Ann Dermatol Venereol 1978 Apr;105(4):369-71
AU - Hambly EM; Wilkinson DS
PT - JOURNAL ARTICLE
AB - Among 466 children under the age of 12 years who presented with eczema in a 5-year period, 68 p. 100 were atopic. 136 had various atypical signs of atopy. 44 suffered from pityriasis alba of sufficient intensity to justify referral for this reason; 10 had the typical features of seborrhoeic dermatitis of infants. 27 suffered from "forefoot" eczema ("juvenile plantar dermatosis"). The course and characteristics of this condition are discussed and compared with the series recently described in the West of Scotland. Our cases were exactly similar except for an aggravation in the summer months and the fact that our cases responded poorly to topical corticosteroids alone though improved with coal tar. Atopy and contact sensitivity to shoe materials are rare in both groups. We feel that this may be classified as "frictional" dermatitis and agree with our Scottish colleagues that the introduction of nylon socks during the last ten years may be important.
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87.) Efficacy and safety of a low molecular weight hyaluronic Acid topical gel in the treatment of facial seborrheic dermatitis final report.
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J Clin Aesthet Dermatol. 2014 May;7(5):15-8.
Schlesinger T1, Rowland Powell C1.
Author information
1
Dermatology and Laser Center of Charleston, Clinical Research Department, Charleston, South Carolina.
Abstract
OBJECTIVE:
Hyaluronic acid sodium salt gel 0.2% is a topical device effective in reducing skin inflammation. Facial seborrheic dermatitis, characterized by erythema and or flaking/scaling in areas of high sebaceous activity, affects up to five percent of the United States population. Despite ongoing study, the cause of the condition is yet unknown, but has been associated with yeast colonization and resultant immune derived inflammation. First-line management typically is with keratolytics, topical steroids, and topical antifungals as well as the targeted immunosuppressant agents pimecrolimus and tacrolimus. The objective of this study was to evaluate the efficacy and safety of a novel topical antiinflammatory containing low molecular weight hyaluronic acid.
DESIGN AND SETTING:
Prospective, observational, non-blinded safety and efficacy study in an outpatient setting.
PARTICIPANTS:
Individuals 18 to 75 years of age with facial seborrheic dermatitis.
MEASUREMENTS:
Outcome measures included scale, erythema, pruritus, and the provider global assessment, all measured on a five-point scale. Subjects were assessed at baseline, Week 2, Week 4, and Week 8.
RESULTS:
Final data with 13 of 17 subjects are presented. Hyaluronic acid sodium salt gel 0.2% was shown through visual grading assessments to improve the provider global assessment by 65.48 percent from baseline to Week 4. Reductions in scale, erythema, and pruritus were 76.9, 64.3, and 50 percent, respectively, at Week 4. At Week 8, the provider global assessment was improved from baseline in 92.3 percent of subjects.
CONCLUSION:
Treatment with topical low molecular weight hyaluronic acid resulted in improvement in the measured endpoints. Final data reveal continued improvement from that seen in the interim data shown previously. Topical low molecular weight hyaluronic acid is another option that may be considered for the treatment of facial seborrheic dermatitis in the adult population. Compliance and tolerance were excellent.
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88.) Treatment of seborrheic dermatitis: the efficiency of sertaconazole 2% cream vs. tacrolimus 0.03% cream.
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Ann Parasitol. 2013;59(2):73-7.
Goldust M1, Rezaee E, Raghifar R, Hemayat S.
Author information
1
Student Research Committee, Tabriz University of Medical Sciences, Iran. Drmgoldust@yahoo.com
Abstract
The treatment of seborrheic dermatitis (SD) includes topical antifungal agents to eradicate Malassezia spp. corticosteroids to treat the inflammatory component of the disease, and keratolytics to remove scale and crust. The aim of this study was to compare the efficiency of sertaconazole 2% cream and tacrolimus 0.03% cream in the treatment of seborrheic dermatitis. In this clinical trial study, sixty patients suffering from SD were studied. Thirty patients received local sertaconazole 2% cream with a recommendation to use the cream twice a day for 4 weeks. In the control group, thirty patients received tacrolimus 0.03% cream twice a day for four weeks. At the time of referral, and 2 and 4 weeks after first visit, the patients were examined by a dermatologist to check the improvement of clinical symptoms. The mean ages of the sertaconazole and tacrolimus groups were 30.98 +/- 12.24 and 34.67 +/- 10.82, respectively. The highest level of satisfaction (90%) was observed 28 days after sertaconazole use. Only 83.3% satisfaction was noted in the tacrolimus group. The relationship between patient satisfaction and sertaconazole 2% cream receive in 28th day was significant (P = 0.006). Sertaconazole 2% cream may be an excellent alternative therapeutic modality for treating seborrheic dermatitis.

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89.) Comparison the efficacy of fluconazole and terbinafine in patients with moderate to severe seborrheic dermatitis.
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Dermatol Res Pract. 2014;2014:705402. doi: 10.1155/2014/705402. Epub 2014 Feb 18.
Alizadeh N1, Monadi Nori H1, Golchi J1, Eshkevari SS1, Kazemnejad E2, Darjani A1.
Author information
1
Department of Dermatology, Razi Hospital, Guilan University of Medical Sciences, Rasht 41448, Iran.
2
Department of Preventive and Community Medicine, Guilan University of Medical Sciences, Rasht, Iran.
Abstract
Background. Topical agents can be unpleasant due to long-term therapies in patients with moderate to severe seborrheic dermatitis. Systemic antifungal therapy is another alternative in treatment. Aim. This study was conducted to compare the efficacy of oral fluconazole and terbinafine in the treatment of moderate to severe seborrheic dermatitis. Methods. 64 patients with moderate to severe seborrheic dermatitis (SD) were enrolled in a randomized, parallel-group study. One study group took terbinafine 250 mg daily (n = 32) and the other one fluconazole 300 mg (n = 32) weekly for four weeks. Seborrheic dermatitis area severity index (SDASI) and the intensity of itching were calculated before, at the end of treatment, and two weeks after treatment. Results. Both drugs significantly reduced the severity of seborrheic dermatitis (P < 0.001). Multivariate linear regression revealed that efficacy of terbinafine is more than fluconazole (P < 0.01, 95% CI (0.63-4.7)). Moreover, each index of SD severity reduced 0.9 times after treatment. (P < 0.002, 95% CI (0.8-1.02)). The itching rate significantly diminished (P < 0.001); however, there was no difference between these two drugs statistically. Conclusions. Both systemic antifungal therapies may reduce the severity index of SD. However, terbinafine showed more reduction in the intensity of the disease. In other words, the more the primary intensity of the disease is, the more its reduction will be. This trial is resgistered with 201102205871N1.
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90.) Efficiency of terbinafine 1% cream in comparison with ketoconazole 2% cream and placebo in patients with facial seborrheic dermatitis.
=================================================
J Dermatolog Treat. 2013 Jun 6. [Epub ahead of print]
Azimi H1, Golforoushan F, Jaberian M, Talghini S, Goldust M.
Author information
1
Tabriz University of Medical Sciences , Tabriz , Iran.
Abstract
Objective: Different medicines have been used to treat seborrheic dermatitis but efficiency of most of them has not been confirmed. This study compared the efficiency of terbinafine 1% cream in comparison with ketoconazole 2% cream and placebo in patients with facial seborrheic dermatitis. Methods: Ninety patients were randomly divided into three groups (there were 30 persons in each group). The patients consumed one of the medicines twice a day and for 4 weeks. The scores were recorded at the trial beginning, and in the 4th and 12th weeks. Demographic features and disease severity of all three groups were normal at the beginning of the study. Results: Mean of total score in terbinafine, ketoconazole and placebo groups was decreased from 5.04 ± 2.02, 5.04 ± 1.50 and 4.97 ± 1.71 at the beginning of the study to 1.78 ± 2.47, 1.81 ± 2.43 and 3.73 ± 1.74 at the 12th week. As compared with the placebo group, mean total score significantly decreased in ketoconazole and terbinafine groups (p = 0.003). However, there was not any meaningful difference between ketoconazole and terbinafine groups (p > 0.05). There was not any serious side effect and the recurrence rate and side effects was not meaningfully different in all three groups. Conclusion: Terbinafine 1% and ketoconazole 2% creams are safe and effective in treating seborrheic dermatitis.
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91.) A novel cosmetic antifungal/anti-inflammatory topical gel for the treatment of mild to moderate seborrheic dermatitis of the face: a open-label trial utilizing clinical evaluation and erythemadirected digital photography.
============================================
Dall'oglio F1, Tedeschi A1, Fusto CM1, Lacarrubba F1, Dinotta F1, Micali G2.
Author information

1
Dermatology Clinic, University of Catania, Catania, Italy.
2
Dermatology Clinic, University of Catania, Catania, Italy - cldermct@gmail.com.

Abstract
BAKGROUND:

Topical cosmetic agents may play a role in the management of facial seborrheic dermatitis by reducing inflammation and scale production. Advanced digital photography, equipped with technology able to provide a detailed evaluation of red skin components corresponding to vascular flare (erythema-directed digital photography), is a useful tool for evaluation of erythema in patients affected by inflammatory dermatoses. The aim of this study was to assess the efficacy and safety of a new cosmetic topical gel containing ciclopiroxolamine, lactoferrin, glycero-phosphoinositol (GPI) and Aloe vera, for the treatment of facial seborrheic dermatitis by clinical and advanced digital photography evaluation.
METHODS:

An open-label, prospective, clinical trial was conducted on 25 patients with mild to moderate facial seborrheic dermatitis. Subjects were instructed to apply the gel twice daily for 45 days. The clinical efficacy was evaluated by measuring at baseline, at day 15 and 45 the degree of desquamation (by clinical examination) and erythema (by digital photography technology via VISIACRTM system equipped with RBX™), using a 5-point severity scale, and pruritus (by subject completed Visual Analogue Scale; scale from 0 to 100 mm). Finally, at baseline and at the end of the study IGA (Investigator Global Assessment) was performed using a 5-point severity scale (from 0 =worsening to 4= excellent response).
RESULTS:

At the end of treatment, a significant reduction (p< 0.001) of all considered parameterswas observed. Moreover, an excellent response (>80% improvement) was recorded in 47.9% of patients, with no case of worsening. No signs of local intolerance were documented.
CONCLUSIONS:

The tested cosmetic topical gel was effective in treating mild to moderate seborrheic dermatitisof the face. Erythema-directed digital photography may represent a noteworthy tool for the therapeutic monitoring of facial seborrheic dermatitisand an important adjunct aid in the dermatologic clinical practice.
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92.) Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study.
=============================================
sr Med Assoc J. 2008 Jun;10(6):417-8.

Shemer A1, Kaplan B, Nathansohn N, Grunwald MH, Amichai B, Trau H.
Author information

1
Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel.

Abstract
BACKGROUND:

Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections.
OBJECTIVES:

To evaluate the efficacy of itraconazole in the treatment of mild to severe facial seborrheic dermatitis.
METHODS:

Sixty patients with moderate to severe seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with oral itraconazole, initially 200 mg/day for a week, followed by a maintenance therapy of a single dose of 200 mg every 2 weeks. Four clinical parameters (erythema, scaling, burning, itching) were assessed using a 0-3 score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear.
RESULTS:

At the end of the initial treatment significant improvement was reported in three clinical parameters: erythema, scaling, itching. Maintenance therapy led to only slight further improvement. Burning sensation was only mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. No blood test abnormalities were found during the treatment.
CONCLUSIONS:

In this study initial treatment with itraconazole was beneficial in patients with moderate to severe seborrheic dermatitis.
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93.) Role of antifungal agents in the treatment of seborrheic dermatitis.
=============================================
Am J Clin Dermatol. 2004;5(6):417-22.

Gupta AK1, Nicol K, Batra R.
Author information

1
Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Science Center (Sunnybrook site) and the University of Toronto, Toronto, Ontario, Canada. agupta@execulink.com

Abstract

Seborrheic dermatitis is a superficial fungal disease of the skin, occurring in areas rich in sebaceous glands. It is thought that an association exists between Malassezia yeasts and seborrheic dermatitis. This may, in part, be due to an abnormal or inflammatory immune response to these yeasts. The azoles represent the largest class of antifungals used in the treatment of this disease to date. In addition to their antifungal properties, some azoles, including bifonazole, itraconazole, and ketoconazole, have demonstrated anti-inflammatory activity, which may be beneficial in alleviating symptoms. Other topical antifungal agents, such as the allylamines (terbinafine), benzylamines (butenafine), hydroxypyridones (ciclopirox), and immunomodulators (pimecrolimus and tacrolimus), have also been effective. In addition, recent studies have revealed that tea tree oil (Melaleuca oil), honey, and cinnamic acid have antifungal activity against Malassezia species, which may be of benefit in the treatment of seborrheic dermatitis. In cases where seborrheic dermatitis is widespread, the use of an oral therapy, such as ketoconazole, itraconazole, and terbinafine, may be preferred. Essentially, antifungal therapy reduces the number of yeasts on the skin, leading to an improvement in seborrheic dermatitis. With a wide availability of preparations, including creams, shampoos, and oral formulations, antifungal agents are safe and effective in the treatment of seborrheic dermatitis.
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94.) Investigations of seborrheic dermatitis. Part II. Influence of itraconazole on the clinical condition and the level of selected cytokines in seborrheic dermatitis.
======================================
Trznadel-Grodzka E1, Błaszkowski M, Rotsztejn H.
Author information

1
Department of Dermatology and Pediatric Dermatology, Medical University of Lodz, Lodz, Poland.

Abstract
INTRODUCTION:

The pathogenesis of seborrheic dermatitis has not been fully elucidated. A number of anascogenic yeasts of Malassezia spp. appear to be involved in the intensity of the symptoms. The purpose of the study is to evaluate the levels of selected inflammatory cytokines, IL-2, IL-4, IFN-γ and TNF-α, in the serum after treatment with itraconazole.
MATERIAL/METHODS:

Sixty-six subjects were enrolled in the study. The control group consisted of 30 participants (23 females and 7 males) without any clinical disorders, aged 24-65 (37.41±6.08 years). Thirty-six patients with seborrheic dermatitis (16 females and 20 males), aged 19-76 (38.61±13.77), constituted the study group. The measurement of IL-2, IL-4, IFN-γ and TNF-α levels was performed by ELISA using a Human High Sensitivity kit (Diaclone, France).
RESULTS:

After six-week treatment with itraconazole administered daily at a dose of 200 mg using pulse therapy, there was remission of the disease or at least substantial clinical improvement in the patients with seborrheic dermatitis. The levels of IL-2 and IFN-γ cytokines in the study group were higher than in the control group. After the treatment the level of IFN-γ secretion in the male patients with seborrheic dermatitis significantly increased. The levels of the other studied cytokines did not significantly differ.
CONCLUSIONS:

The treatment with itraconazole had a beneficial effect on the clinical condition of the skin of the patients. IFN-γ is a cytokine whose secretion might affect the condition of the skin in seborrheic dermatitis.
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95.) Efficacy and Safety of Cream Containing Climbazole/Piroctone Olamine for Facial Seborrheic Dermatitis: A Single-Center, Open-Label Split-Face Clinical Study.
=========================================
Ann Dermatol. 2016 Dec;28(6):733-739. Epub 2016 Nov 23.

Youn HJ1, Kim SY1, Park M2, Jung WH2, Lee YW3, Choe YB3, Ahn KJ3.
Author information

1
Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea.
2
Department of Systems Biotechnology, Chung-Ang University, Anseong, Korea.
3
Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea.; Research Institute of Medical Science, Konkuk University, Seoul, Korea.

Abstract
BACKGROUND:

Seborrheic dermatitis (SD) is a multifactorial disease; Malassezia species play an important role in its pathogenesis.
OBJECTIVE:

We aimed to determine whether a cream containing climbazole/piroctone olamine (C/P cream), antifungal agents with expected efficacy against Malassezia species, could improve SD symptoms.
METHODS:

We instructed 24 patients with mild-to-moderate SD to apply the C/P cream and emollient cream on the right and left sides of the face, respectively, every morning and evening for 4 weeks. The casual sebum level (measured with Sebumeter®; Courage & Khazaka Electronic GmbH, Germany) and the extent of erythema (measured with Mexameter®; Courage & Khazaka Electronic GmbH) on the face were measured at baseline and after 4 weeks. The minimal inhibitory concentration (MIC) was determined to demonstrate the antifungal activity of the C/P cream.
RESULTS:

The casual sebum level and erythema were measured at week 4, and the median values demonstrated a quantitative improvement on the C/P cream-treated right side of the face compared to the emollient cream-treated left side. For the C/P cream, the MICs were 0.625, 5, 0.625, and 2.5 mg/ml for Malassezia restricta, M. globosa, M. sympodialis, and M. slooffiae, respectively.
CONCLUSION:

Based on the reduced casual sebum level and extent of erythema, the antifungal activity of C/P cream against Malassezia species seems useful for the treatment of mild to moderate SD.
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96.) Topical Treatment of Facial Seborrheic Dermatitis: A Systematic Review.
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Am J Clin Dermatol. 2017 Apr;18(2):193-213. doi: 10.1007/s40257-016-0232-2.

Gupta AK1,2, Versteeg SG3.
Author information

1
Department of Medicine, University of Toronto, Toronto, ON, Canada. publications@mediproberesearch.com.
2
Mediprobe Research Inc., 645 Windermere Road, London, ON, Canada. publications@mediproberesearch.com.
3
Mediprobe Research Inc., 645 Windermere Road, London, ON, Canada.

Abstract
BACKGROUND:

Facial seborrheic dermatitis (SD), a chronic inflammatory skin condition, can impact quality of life, and relapses can be frequent. Three broad categories of agents are used to treat SD: antifungal agents, keratolytics, and corticosteroids. Topical therapies are the first line of defense in treating this condition.
OBJECTIVE:

Our objective was to critically review the published literature on topical treatments for facial SD.
METHODS:

We searched PubMed, Scopus, Clinicaltrials.gov, MEDLINE, Embase, and Cochrane library databases for original clinical studies evaluating topical treatments for SD. We then conducted both a critical analysis of the selected studies by grading the evidence and a qualitative comparison of results among and within studies.
RESULTS:

A total of 32 studies were eligible for inclusion, encompassing 18 topical treatments for facial SD. Pimecrolimus, the focus of seven of the 32 eligible studies, was the most commonly studied topical treatment.
CONCLUSION:

Promiseb®, desonide, mometasone furoate, and pimecrolimus were found to be effective topical treatments for facial SD, as they had the lowest recurrence rate, highest clearance rate, and the lowest severity scores (e.g., erythema, scaling, and pruritus), respectively. Ciclopirox olamine, ketoconazole, lithium (gluconate and succinate), and tacrolimus are also strongly recommended (level A recommendations) topical treatments for facial SD, as they are consistently effective across high-quality trials (randomized controlled trials).
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97.) Low-dose oral isotretinoin for moderate to severe seborrhea and seborrheic dermatitis: a
randomized comparative trial.
==============================================
Int J Dermatol. 2017 Jan;56(1):80-85. doi: 10.1111/ijd.13408. Epub 2016 Oct 25.

de Souza Leão Kamamoto C1, Sanudo A2, Hassun KM1, Bagatin E1.
Author information

1
Department of Dermatology, Universidade Federal de São Paulo (Federal University of São Paulo [UNIFESP]), São Paulo, SP, Brazil.
2
Department of Preventive Medicine, Universidade Federal de São Paulo (Federal University of São Paulo [UNIFESP]), São Paulo, SP, Brazil.

Abstract
BACKGROUND:

The efficacy of low-dose oral isotretinoin in the treatment of seborrhea and seborrheic dermatitis has been poorly investigated in randomized studies.
OBJECTIVES:

This study was designed to determine the efficacy and safety of low-dose oral isotretinoin in the treatment of moderate to severe seborrhea and seborrheic dermatitis on the scalp and/or face.
METHODS:

A randomized, comparative clinical trial, using two groups, was conducted over 6 months. Patients in Group ISO were treated with isotretinoin 10 mg every other day. In Group X, patients received antiseborrheic topical treatment. Patient opinion, investigator assessment, scalp pruritus, sebum production, and quality of life (QoL) comprised the efficacy outcomes.
RESULTS:

The intention-to-treat population comprised a total of 45 patients with mean ± standard deviation ages of 28.7 ± 5.8 years in Group ISO and 29.8 ± 6.5 years in Group X. The rate of sebum production significantly decreased in Group ISO. Patient opinion, investigator, and QoL assessments improved in both groups.
CONCLUSIONS:

Low-dose oral isotretinoin can be a therapeutic modality for moderate to severe seborrhea and seborrheic dermatitis.
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98.) Effect of itraconazole on the quality of life in patients with moderate to severe seborrheic dermatitis: a randomized, placebo-controlled trial.
============================================
Abbas Z1, Ghodsi SZ1, Abedeni R1.
Author information

1
Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Abstract
BACKGROUND:

Few studies have examined the effect of seborrheic dermatitis (SD) and/or its consequent therapy on a patient's quality of life. Itraconazole has been suggested as an effective therapy for severe SD but its impact on Quality of Life (QoL) in these patients has never been studied before.
OBJECTIVE:

The study aimed to verify the efficacy of the itraconazole on the quality of life in patients with moderate to severe SD.
METHODS:

A randomized, double-blind, placebo controlled trial was planned to describe the effect of SD per se on QoL and to determine the impact of oral itraconazole or placebo on QoL of SD patients. Sixty-eight patients with moderate to severe SD participated in the study to receive either itraconazole or placebo. Dermatology Life Quality Index was used to evaluate their quality of life before and after treatment. Itraconazole 200 mg/daily or placebo was prescribed for one week and then the first two days of every month for the following three months. Fifty-seven patients completed the study.
RESULTS:

Significant improvement was observed in QoL of both itraconazole and placebo groups, but itraconazole group showed significantly higher improvement as compared to placebo (p=0.001). QoL was impaired significantly with high disease severity (p=0.002) and facial involvement (p=0.017).
CONCLUSIONS:

Itraconazole significantly improves the QoL in patients with moderate to severe SD.
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99.) Zinc Pyrithione: A Topical Antimicrobial With Complex Pharmaceutics.
=============================================
J Drugs Dermatol. 2016 Feb;15(2):140-4.

Schwartz JR.
Abstract

Zinc pyrithione (ZPT) is an active material that has been used for over 50 years to effectively treat dandruff and seborrheic dermatitis (D/SD). It has become the most common material for that purpose, its use has expanded to include other skin benefits such as skin hygiene. However, there is much about ZPT that is unappreciated. It is a rationally developed molecule that was modeled after the naturally occurring antimicrobial aspergillic acid. The molecular basis for its antifungal activity has been elucidated. The efficacy of ZPT originates from two attributes. First, it has a very broad antimicrobial spectrum of activity, including fungi, gram-positive and -negative bacteria. Second, the material has very low solubility, resulting in formulation and delivery as a particulate material, which has distinct performance advantages. The particles are deposited and retained on the target skin surfaces even when delivered from rinse-off products. These particles slowly release molecularly active material to interact with the surface fungal and bacteria cells to control their population, functioning as slow-release reservoirs to provide extended and persistent benefits. This particulate nature, though, results in complex pharmaceutics to realize the full efficacy benefits; it is common to see products with the same ZPT level having widely varying levels of clinical performance. Several product matrix-determined factors directly impact resultant benefits: ZPT must be retained on the skin surface achieving uniform spatial distribution laterally as well as within hair follicles (especially on scalp); ZPT must be maintained as a physically stable dispersion in product; ZPT must be maintained in a chemically active form as there are many chemical reactions that can occur that can harm ZPT bioactivity. The benefits achievable by employing ZPT require significant pharmaceutics expertise to realize the full benefits of this active material.
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100.) Topical pine tar: History, properties and use as a treatment for common skin conditions.
=============================================
Australas J Dermatol. 2016 Jan 20. doi: 10.1111/ajd.12427. [Epub ahead of print]

Barnes TM1, Greive KA1.
Author information

1
Ego Pharmaceuticals, Braeside, Victoria, Australia.

Abstract

Pine tar is the end product of pine wood carbonisation following distillation using extreme heat. An extensive literature search was conducted back to the 1950s for this review. Pine tar has been used in medicine for more than 2000 years to treat a range of skin conditions because of its soothing and antiseptic properties. Pine tar should not be confused with coal tar, which has been produced from coal for approximately a hundred years. Pine tar is thought to exert its effect by reducing DNA synthesis and mitotic activity, which promotes a return to normal keratinisation. In addition, pine tar has been shown to be antipruritic, anti-inflammatory, antibacterial and antifungal. These properties make pine tar suitable for the topical treatment of eczema, psoriasis, seborrhoeic dermatitis and other dry, itchy, flaky or inflamed skin conditions. Topical products available over-the-counter in Australia today contain up to 2.3% pine tar, and come in several different formulations that can be used on the entire body, including the face. Modern day pine tar is manufactured with increased purity to eliminate toxic phenol and carcinogenic components, which have been of concern in the past. Primary irritation is uncommon. In conclusion, the long experience with topical pine tar therapy and its worldwide usage, together with the evidence presented in this review, suggests that pine tar is an effective treatment with minimal safety risk. 

 

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