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Dall’Oglio F, Nasca MR, Gerbino C, Micali G. An Overview of the Diagnosis and Management of Seborrheic Dermatitis. Clin Cosmet Investig Dermatol 2022; 15:1537-1548. [PMID: 35967915 PMCID: PMC9365318 DOI: 10.2147/ccid.s284671] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022]
Affiliation(s)
| | | | - Carlo Gerbino
- Dermatology Clinic, University of Catania, Catania, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Catania, Italy
- Correspondence: Giuseppe Micali, Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania, 95123, Italy, Tel + 39 095 321705, Fax + 39 095 3782425, Email
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The effect of lid hygiene on the tear film and ocular surface, and the prevalence of Demodex blepharitis in university students. Cont Lens Anterior Eye 2019; 43:159-168. [PMID: 31548151 DOI: 10.1016/j.clae.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/26/2019] [Accepted: 09/10/2019] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the effect blepharitis lid cleansers have on the tear film and ocular surface, and to examine the prevalence of Demodex folliculorum in a young population. METHODS Forty-eight university students completed a randomised, controlled, investigator-masked, eight-week clinical trial. Three eyelid hygiene products were investigated: blepharitis eyelid cleanser (OCuSOFT® Lid Scrub® PLUS foam), diluted baby shampoo (10% Johnson's® No More Tears ®) and a tea-tree based face wash (dr.organic®). Cooled boiled water was used as a control. Subjects attended for four visits: baseline, two weeks, four weeks and eight weeks. At each visit, subjective symptoms, non-invasive tear break up time, ocular surface staining and Demodex folliculorum investigation were assessed to evaluate any positive or negative effect on the tear film and ocular surface. Osmolarity was also measured at baseline and week eight only. RESULTS The overall prevalence of Demodex folliculorum found at baseline was 15%. Subjective symptoms improved in all groups, including control. There was no significant difference in mean osmolarity between the groups or within each group after eight weeks. There was a significant increase in osmolarity inter-eye variability in the baby shampoo group (5.5 ± 5.4 vs 15.2 ± 9.5; p = 0.03). There was no significant change in non-invasive tear break up time or ocular surface staining demonstrated after eight weeks of eyelid hygiene. CONCLUSION A low prevalence of Demodex folliculorum can be found in a young population. All blepharitis lid cleansers used demonstrated subjective improvement in symptoms, with no negative effects on tear break-up time or ocular surface staining. The blepharitis eyelid cleanser and tea-tree based face wash revealed no adverse effect on mean osmolarity or inter-eye variability. Similarly, baby shampoo did not cause a significant increase in mean osmolarity, however, a significant increase in inter-eye variability was found; suggesting a possible increase in ocular surface inflammation.
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Kamamoto CSL, Nishikaku AS, Gompertz OF, Melo AS, Hassun KM, Bagatin E. Cutaneous fungal microbiome: Malassezia yeasts in seborrheic dermatitis scalp in a randomized, comparative and therapeutic trial. DERMATO-ENDOCRINOLOGY 2017; 9:e1361573. [PMID: 29484095 PMCID: PMC5821162 DOI: 10.1080/19381980.2017.1361573] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/26/2017] [Indexed: 01/26/2023]
Abstract
Malassezia spp in skin microbiome scalp has been implicated in seborrheic dermatitis pathogenesis. Thus, treatment based in antifungal combined to topical keratolitic agents have been indicated as well as oral isotretinoin as it reduces the sebum production, glandular's size and possesses anti-inflammatory properties. This randomized, comparative and therapeutic trial aimed toper form the genotypic identification of Malassezia species before and after low-dose oral isotretinoin or topical antifungal treatments for moderate to severe seborrhea and/or seborrheic dermatitis on scalp. Scales and sebum of the scalp were seeded in the middle of modified Dixon and incubated at 32°C. For genotypic identification polymerase chain reaction primers for the ITS and D1/D2 ribossomal DNA were used and followed by samples sequencing. The procedure was conducted before and after therapeutic and randomized intervention for moderate to severe seborrhea/seborrheic dermatitis on the scalp, including oral isotretinoin, 10 mg, every other day and anti-seborrheic shampoo (piroctone olamine), over six months. The M. globosa and M. restricta were the most frequent species isolated on the scalp before and after both treatments. Other non-Malassezia species were also identified. The Malassezia spp. were maintained in the scalp after both treatments that were equally effective for the control of seborrhea/seborrheic dermatitis clinical signs.
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Affiliation(s)
- C S L Kamamoto
- Department of Dermatology, Federal University of Sao Paulo (UNIFESP), São Paulo, SP, Brazil
| | - A S Nishikaku
- Department of Medicine, Special Mycology Laboratory, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - O F Gompertz
- Department of Microbiology, Immunology and Parasitology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - A S Melo
- Department of Medicine, Special Mycology Laboratory, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - K M Hassun
- Department of Dermatology, Federal University of Sao Paulo (UNIFESP), São Paulo, SP, Brazil
| | - E Bagatin
- Department of Dermatology, Federal University of Sao Paulo (UNIFESP), São Paulo, SP, Brazil
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Benito-León J, Laurence M. The Role of Fungi in the Etiology of Multiple Sclerosis. Front Neurol 2017; 8:535. [PMID: 29085329 PMCID: PMC5650687 DOI: 10.3389/fneur.2017.00535] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/25/2017] [Indexed: 01/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disorder of the central nervous system. Infectious triggers of MS are being actively investigated. Substantial evidence supports the involvement of the Epstein-Barr virus (EBV), though other viruses, bacteria, protists, and fungi are also being considered. Many links between fungi and diseases involving chronic inflammation have been found recently. Evidence linking MS and fungi is reviewed here. The HLA-DRB1*15 allele group is the most important genetic risk factor of MS, and is a risk factor in several other conditions linked to fungal infections. Many biomarkers of MS are consistent with fungal infections, such as IL-17, chitotriosidase, and antibodies against fungi. Dimethyl fumarate (DMF), first used as an industrial fungicide, was recently repurposed to reduce MS symptoms. Its mechanisms of action in MS have not been firmly established. The low risk of MS during childhood and its moderate association with herpes simplex virus type 2 suggest genital exposure to microbes (including fungi) should be investigated as a possible trigger. Molecular and epidemiological evidence support a role for infections such as EBV in MS. Though fungal infections have not been widely studied in MS, many lines of evidence are consistent with a fungal etiology. Future microbiome and serological studies should consider fungi as a possible risk factor for MS, and future clinical studies should consider the effect of fungicides other than DMF on MS symptoms.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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Fatsini-Blanch V, Martínez-González M, Heras-González S, de Quintana-Sancho A. RF-Itraconazole Pulse Therapy for Seborrheic Dermatitis: A Treatment Approach to Consider. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fatsini-Blanch V, Martínez-González M, Heras-González S, de Quintana-Sancho A. FR-Pulsos de itraconazol en dermatitis seborreica. Una opción terapéutica a tener en cuenta. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:583-584. [DOI: 10.1016/j.ad.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
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Abbas Z, Ghodsi SZ, Abedeni R. Effect of itraconazole on the quality of life in patients with moderate to severe seborrheic dermatitis: a randomized, placebo-controlled trial. Dermatol Pract Concept 2016; 6:11-6. [PMID: 27648378 PMCID: PMC5006547 DOI: 10.5826/dpc.0603a04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/22/2016] [Indexed: 11/16/2022] Open
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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Affiliation(s)
- Zaheer Abbas
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Z Ghodsi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robabeh Abedeni
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Seborrheic Dermatitis (SD) and dandruff are of a continuous spectrum of the same disease that affects the seborrheic areas of the body. Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD can affect the scalp as well as other seborrheic areas, and involves itchy and flaking or scaling skin, inflammation and pruritus. Various intrinsic and environmental factors, such as sebaceous secretions, skin surface fungal colonization, individual susceptibility, and interactions between these factors, all contribute to the pathogenesis of SD and dandruff. In this review, we summarize the current knowledge on SD and dandruff, including epidemiology, burden of disease, clinical presentations and diagnosis, treatment, genetic studies in humans and animal models, and predisposing factors. Genetic and biochemical studies and investigations in animal models provide further insight on the pathophysiology and strategies for better treatment.
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Affiliation(s)
- Luis J Borda
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, RMSB 2023A, Miami, Florida 33136, USA
| | - Tongyu C Wikramanayake
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, RMSB 2023A, Miami, Florida 33136, USA
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Ghodsi SZ, Abbas Z, Abedeni R. Efficacy of Oral Itraconazole in the Treatment and Relapse Prevention of Moderate to Severe Seborrheic Dermatitis: A Randomized, Placebo-Controlled Trial. Am J Clin Dermatol 2015; 16:431-7. [PMID: 26016699 DOI: 10.1007/s40257-015-0133-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seborrheic dermatitis (SD) is a chronic and relapsing disease and topical therapy may be associated with failure, particularly in severe disease. Itraconazole has been suggested as an effective treatment for severe SD. Previous studies have been open clinical trials with variable results. OBJECTIVE The aim of this study was to determine the efficacy of oral itraconazole in the treatment of patients with moderate to severe SD. METHODS Sixty-eight patients with moderate to severe SD were randomly assigned to the itraconazole (n = 35) or placebo (n = 33) groups. The trial was undertaken in Razi Hospital, Tehran. An internet-generated table was used to allocate treatments. Patients and investigator were blinded to treatments. Itraconazole 200 mg/daily or placebo was prescribed for 1 week and then for the first 2 days of every month for the following 3 months. Patients were followed for 4 months and the Seborrheic Dermatitis Area Severity Index (SDASI) was measured on nine anatomical sites. Fifty-seven patients (29 in the itraconazole group and 28 in the placebo group) completed the study. RESULTS Statistically significant improvement was observed in SDASI of both itraconazole and placebo groups (p = 0.000) but the itraconazole group showed significantly higher efficacy compared with placebo (p = 0.023). We observed clinical improvements of 93.8, 87.5, and 93.1% at the end of 2 weeks, 1 month, and 4 months, respectively, in the itraconazole group, and 82.1, 64.3, and 53.6% in the placebo group. Furthermore, recurrence rate in the itraconazole group was significantly lower than in the placebo group (p = 0.003). No blood test abnormality was seen in any patient. CONCLUSION Itraconazole is not only an effective and safe therapy for controlling exacerbations of SD but may also be used as maintenance therapy to prevent disease recurrence.
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Affiliation(s)
- Seyedeh Zahra Ghodsi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Vahdate Eslami Sq., Vahdate Eslami Ave., 11996, Tehran, Iran
| | - Zaheer Abbas
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Vahdate Eslami Sq., Vahdate Eslami Ave., 11996, Tehran, Iran.
| | - Robabeh Abedeni
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Vahdate Eslami Sq., Vahdate Eslami Ave., 11996, Tehran, Iran
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Malassezia infections: A medical conundrum. J Am Acad Dermatol 2014; 71:170-6. [DOI: 10.1016/j.jaad.2013.12.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/14/2013] [Accepted: 12/17/2013] [Indexed: 11/21/2022]
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Gupta A, Richardson M, Paquet M. Systematic Review of Oral Treatments for Seborrheic Dermatitis. J Eur Acad Dermatol Venereol 2013; 28:16-26. [DOI: 10.1111/jdv.12197] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
Affiliation(s)
- A.K. Gupta
- Division of Dermatology; Department of Medicine; University of Toronto; Toronto ON Canada
- Mediprobe Laboratories; London ON Canada
| | | | - M. Paquet
- Mediprobe Laboratories; London ON Canada
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Karincaoglu Y, Tepe B, Kalayci B, Atambay M, Seyhan M. Is Demodex folliculorum an aetiological factor in seborrhoeic dermatitis? Clin Exp Dermatol 2009; 34:e516-20. [PMID: 19486039 DOI: 10.1111/j.1365-2230.2009.03343.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Seborrhoeic dermatitis (SD) is a common inflammatory skin disease for which no single cause has been found, although many factors have been implicated. The mite Demodex folliculorum (DF) is most commonly seen in the pilosebaceous unit in humans. SD is located in areas that are rich in sebaceous glands, which are also preferred by DF. AIMS To compare the number of DF parasites in patients with clinical SD and in healthy controls, and to investigate any possible relationship between the number of DF mites and the presence of SD. METHODS The study comprised 38 patients with SD and 38 healthy controls. Standard random and lesion-specific sampling was performed in the group of patients with SD, whereas standard random sampling only was performed for controls. RESULTS Demodex folliculorum sampling was positive in 19 patients (50%) and 5 controls (13.1%). Mean DF density was 8.16 +/- 10.1/cm(2) (range 0-40) and 1.03 +/- 2.17/cm(2) (1-7) in patient and control groups, respectively. The differences between groups for DF positivity and mean DF density were significant (P = 0.001 for each). DF was found in 13 lesional areas in the patient group, but in only 5 areas in the control group (P = 0.031). CONCLUSIONS The number of DF mites was significantly higher in both lesional and nonlesional areas of patients with SD. This suggests that, when other aetiological causes are excluded, DF may have either direct or indirect role in the aetiology of SD.
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Affiliation(s)
- Y Karincaoglu
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey.
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Veraldi S, Menter A, Innocenti M. Treatment of mild to moderate seborrhoeic dermatitis with MAS064D (Sebclair®), a novel topical medical device: results of a pilot, randomized, double-blind, controlled trial. J Eur Acad Dermatol Venereol 2008; 22:290-6. [DOI: 10.1111/j.1468-3083.2007.02404.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cömert A, Bekiroglu N, Gürbüz O, Ergun T. Efficacy of oral fluconazole in the treatment of seborrheic dermatitis: a placebo-controlled study. Am J Clin Dermatol 2007; 8:235-8. [PMID: 17645378 DOI: 10.2165/00128071-200708040-00005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Seborrheic dermatitis (SD) is a common, chronic dermatosis. Although the pathogenetic mechanisms of SD are not clear, Malassezia spp. yeasts are known to cause the disease. Previous studies have shown that topical and systemic antifungals provide clinical benefit. OBJECTIVE To evaluate the safety and efficacy of short-term oral fluconazole in patients with SD. METHODS Sixty-three patients with mild-to-moderate SD were randomly allocated to receive either oral fluconazole 300 mg in a single dose per week or placebo, for 2 weeks. Twenty-seven patients taking fluconazole and 23 patients taking placebo completed the study and were analyzed. The SD area severity index (SDASI) score and the patient's subjective assessment of pruritus and burning sensation were evaluated before and after treatment. Both the investigator and the patients were blinded to treatment. RESULTS A statistically significant improvement in SDASI score after treatment compared with baseline was obtained with fluconazole (p=0.01) but not with placebo. However, the difference between the treatment groups was not statistically significant (p>0.05). Subjective improvements in symptoms, such as pruritus and burning sensation, were observed in both groups but no statistically significant differences versus baseline were seen. CONCLUSION The results of this study indicate that fluconazole provides marginal and statistically insignificant benefit for the therapy of SD. However, larger studies using different dosages and/or durations of fluconazole therapy may provide a rationale for systemic use of fluconazole in SD.
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Affiliation(s)
- Asuman Cömert
- Department of Dermatology, School of Medicine, Maltepe University, Maltepe, Istanbul, Turkey.
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