Facial Seborrhoeic Dermatitis Research Articles

Ketoconazole 2% cream alters the skin fungal microbiome in seborrhoeic dermatitis: a cohort study.

Seborrhoeic dermatitis (SD) is a common chronic inflammatory dermatosis. Current theories on the pathogenesis of SD highlight the role of microbes on the skin surface. Ketoconazole is commonly used for the treatment of SD; however, there are limited data focusing on the effects of ketoconazole in shaping the skin microbiome in patients with SD. In this prospective cohort study, we used a high-throughput DNA sequencing method to characterize the cutaneous microbial communities of patients with SD before and after topical ketoconazole treatment. In total, 30 patients with facial SD and 15 age- and sex-matched healthy controls (HCs) were enrolled in this study. Skin swabs were collected from SD lesional sites of the cheek at baseline, after ketoconazole treatment and 2 weeks post-treatment. DNA was extracted from skin samples. The bacterial 16S V3V4 rRNA and fungal internal transcribed spacer 1-5F regions were sequenced, and the microbial community compositions were analysed. Significantly lower bacterial and fungal diversities were detected at the lesional sites of facial SD compared with HCs. A decreased relative abundance of Cutibacterium and increased abundances of Malassezia and Staphylococcus were found in facial SD. Disease diversity was positively correlated with the relative abundances of Malassezia, Staphylococcus and Corynebacterium, while transepidermal water loss was negatively associated with the relative abundance of Cutibacterium. After ketoconazole treatment, fungal Shannon diversity and the relative abundances of Candida and Aspergillus were significantly increased at the lesional sites, and the relative abundance of Malassezia showed a decreasing trend. These changing trends were maintained until 2 weeks post-treatment. Facial SD showed lower fungal diversity accompanied by increased relative abundances of Malassezia and Staphylococcus and decreased relative abundance of Cutibacterium. Ketoconazole treatment reduced Malassezia and increased fungal diversity to restore skin microbial communities.

The efficacy and safety of pimecrolimus 1% cream vs. sertaconazole 2% cream in the treatment of patients with facial seborrhoeic dermatitis: a randomized blinded trial.

Facial seborrhoeic dermatitis (FSD) is a chronic inflammatory skin disorder characterized by remission and exacerbation episodes. In most cases, FSD requires long-term treatment. To compare the efficacy and safety of pimecrolimus and sertaconazole in patients with FSD. In total, 60 patients with FSD were enrolled in this double-blind, active-controlled, randomized trial, and instructed to topically apply either pimecrolimus 1% cream (30 patients) or sertaconazole 2% cream (30 patients) twice daily for 4 weeks. Assessment of disease severity was performed using the Scoring Index (SI) at baseline, on Days 14 and 28, and at 4 weeks after treatment cessation. The levels of satisfaction from treatment and any adverse effects (AEs) were also assessed in both groups. Although the severity of disease reduced upon treatment in both groups, application of pimecrolimus caused a significantly better improvement than sertaconazole on Days 14 and 28 (P < 0.01 and P < 0.001, respectively). The rate of relapse was significantly lower in the pimecrolimus compared with the sertaconazole group at 4 weeks after treatment cessation (P = 0.01). The highest level of satisfaction (46.7%) was observed on Day 28 in the pimecrolimus group. Both topical treatments had acceptable safety profiles; however, pimecrolimus 1% cream was significantly (P < 0.01) less irritating than sertaconazole 2% cream. Pimecrolimus is associated with faster response and fewer AEs than sertaconazole in patients with FSD.

Identification of Malassezia species in the facial lesions of Chinese seborrhoeic dermatitis patients based on DNA sequencing.

The genus Malassezia is important in the aetiology of facial seborrhoeic dermatitis (FSD), which is the most common clinical type. The purpose of this study was to analyse the distribution of Malassezia species in the facial lesions of Chinese seborrhoeic dermatitis (SD) patients and healthy individuals. Sixty-four isolates of Malassezia were isolated from FSD patients and 60 isolates from healthy individuals. Sequence analysis of the internal transcribed spacer (ITS) region was used to identify the isolates. The most frequently identified Malassezia species associated with FSD was M. furfur (76.56%), followed by M. sympodialis (12.50%) and M. japonica (9.38%). The most frequently isolated species in healthy individuals were M. furfur (61.67%), followed by M. sympodialis (25.00%), M. japonica (6.67%), M. globosa (3.33%), and M. obtusa (3.33%). Overall, our study revealed that while M. furfur is the predominant Malassezia species in Chinese SD patients, there is no significant difference in the distribution of Malassezia species between Chinese SD patients and healthy individuals.

A new therapeutic option for facial seborrhoeic dermatitis: indole‐3‐acetic acid photodynamic therapy

Indole-3-acetic acid (IAA) is a newly introduced photosensitizer of photodynamic therapy (PDT) for acne, presenting sebum-reducing, anti-inflammatory and antimicrobial activity. This study was designed to evaluate the efficacy and safety of IAA-PDT in the treatment of facial seborrhoeic dermatitis. In this prospective, single-blinded, 6-week trial, 23 patients with facial seborrhoeic dermatitis were treated with IAA-PDT with green light (520 nm) three times with 1-week intervals. Patients were evaluated at baseline, week 1, 2, 3 and week 6 (3 weeks after last treatment). Efficacy was determined by Seborrhoeic dermatitis Area and Severity Index (SASI), patient's assessment of the symptoms (4-point scale of itchiness, burning, erythema, scale and tightness), sebum secretion rate (measured with Sebumeter(®)), Erythema Index (EI, measured with Mexameter(®)) and physician's photographic assessment. Safety was evaluated by questionnaire at each visit. For the 22 subjects completing the trial, SASI and total symptom significantly improved at week 2, which lasted until week 6. Sebum excretion was significantly reduced at week 2 and stayed reduced until week 6. EI presented continuous reduction throughout the study. Photographic assessment showed significant improvement at each visit. The procedure was painless, and no adverse event was observed during and after the treatment. IAA-PDT is a safe and effective therapeutic option for facial seborrhoeic dermatitis.

Proactive Treatment of Adult Facial Seborrhoeic Dermatitis with 0.1% Tacrolimus Ointment: Randomized, Double-blind, Vehicle-controlled, Multi-centre Trial

The effectiveness of intermittent topical tacrolimus to prevent relapse in patients with stabilized facial seborrhoeic dermatitis has not been evaluated. The aim of this study was to determine whether proactive use of 0.1% tacrolimus ointment can keep adult facial seborrhoeic dermatitis in remission. A total of 75 patients who had stabilized facial seborrhoeic dermatitis after 2 weeks' (open-label induction) treatment with 0.1% tacrolimus were randomized in a double-blind fashion to treatment with 0.1% tacrolimus once a week, twice a week, or vehicle twice a week, for 10 weeks (maintenance). Significant improvement in erythema, scaling and pruritus compared with baseline was maintained during the maintenance phase in both tacrolimus groups, but not in the vehicle group. The mean recurrence rate according to global assessment was significantly higher in the tacrolimus once-weekly group than in the twice-weekly group. In conclusion, twice-weekly treatment with 0.1% tacrolimus ointment had superior effects in keeping facial seborrhoeic dermatitis in remission.

An open‐label efficacy pilot study with pimecrolimus cream 1% in adults with facial seborrhoeic dermatitis infected with HIV

Seborrhoeic dermatitis (SD) is a common dermatosis in human immunodeficiency virus (HIV)-positive patients, many of whom do not respond satisfactorily to conventional topical treatments such as corticosteroids and antifungals. A pilot study to investigate the efficacy and tolerability of pimecrolimus cream 1% in HIV-positive patients with facial SD. In a single-centre study, 21 HIV-infected patients with mild to severe SD were treated twice daily with pimecrolimus cream 1% for 14 days. Thereafter, treatment was discontinued and patients followed up for 5 weeks. Skin involvement at baseline and on days 7, 14, 21, 35 and 49 was assessed using a four-point clinical score and digital photography. Efficacy and safety of pimecrolimus cream 1% treatment and incidence of relapse in the follow-up phase. Results Marked improvement was seen in clinical parameters at day 7, with >or= 90% patients clear of symptoms at day 14. Relapse was observed at day 35 but signs were milder than at baseline. All patients responded to therapy, despite their immunological status. Pimecrolimus did not alter CD4(+) and CD8(+) T-cell counts or viral load during the treatment period. Pimecrolimus cream represents a new, effective therapeutic option for facial SD in HIV patients.

Secondary syphilis: a multisystem disease not to be forgotten

A42-year-old homosexual man presented with a 3-month history of painful mouth ulcers and a hyperkeratotic, erythematous scaly rash affecting his palms and soles (Figure 1). He also had a 2-month history of bilateral anterior tibial pain, balanitis and a panuveitis. There was a recent history of a non-specific urethritis and a past history of shingles. In addition to the rash affecting his palms and soles, he had facial seborrhoeic dermatitis, mucosal ulceration with leukoplakia, and a balanitis with phimosis. A tender firm lump was noted over his left anterior shin. He was apyrexial and there was no lymphadenopathy or hepatosplenomegaly. Routine investigations revealed a raised erythrocyte sedimentation rate of 42 mm/h, associated with a polyclonal rise of immunoglobulins with a normal full blood count and C-reactive protein. A plantar skin biopsy showed numerous plasma cells in addition to lymphocytes within the papillary dermis (Figure 2). A Warthin–Starry stain for bacteria was negative. At the same time as the skin biopsy his vision worsened with bilateral mid-peripheral retinitis in addition to panuveitis. The skin biopsy showing numerous plasma cells and the mid-peripheral distribution of the retinitis were highly suggestive of secondary syphilis. The diagnosis of secondary syphilis was confirmed by a positive venereal disease research laboratory (VDRL) titre of 1:256, in association with a positive fluorescent treponemal antibody (FTA) test and treponema pallidum haemagglutination assay. He was also found to be positive for human immunodeficiency virus with a CD4 (t-helper cell) count of 145 × 106/litre (10.5%), and a viral load of 115 305 copies/ml. X-rays of his tibial bones revealed bilateral lytic cortical lesions, in keeping with a syphilitic osteitis. The firm tender lump over his left shin corresponded to a cortical lesion with a marked periosteal reaction (Figure 3). He was given a 10-day course of high-dose intravenous benzylpenicillin, after which his skin and mucosal lesions had almost resolved. The initial ocular inflammatory reaction settled quickly but visual acuity deteriorated 2 days after the commencement of penicillin, thought to result from an intraocular Jarisch–Herxheimer reaction. This complication was treated with a tapering dose of oral prednisolone, starting at a dose of 60 mg/day. His visual acuity subsequently returned to normal leaving a residual typical ‘salt and pepper’ scarring in the fundus (Figure 4).

Topical lithium succinate ointment (Efalith) in the treatment of AIDS-related seborrhoeic dermatitis

A randomised, double-blind, placebo-controlled trial with lithium succinate ointment was conducted in patients with AIDS-associated facial seborrhoeic dermatitis. Twice daily applications of the ointment brought about a rapid (2.5 days) and highly significant (P = 0.007) improvement in the severity of the condition. Lithium succinate ointment is well tolerated and can be a useful treatment for seborrhoeic dermatitis in this group of patients.

Total abrogation of facial seborrhoeic dermatitis with extremely low-frequency (1–1.1 Hz) ‘imprinted’ water is not allergen or hapten dependent: a new visible model for homoeopathy

Extremely low frequencies, from 1 to 1.1 Hz, imprinted in water (imprinting was done by succussing a glass containing the water) led to a total abrogation of a facial seborrhoeic dermatitis, previously proposed as a visible model for the theory of ‘memory of water’. This technique provides a new perspective on the enigma of homoeopathy and the treatment of allergic diseases and possibly all other inflammatory reactions.

Abrogation of facial seborrhoeic dermatitis with homoeopathic high dilutions of tobacco: A new visible model for Benveniste's theory of ‘Memory of Water’

The author describes the activity of homoeopathic high dilutions of tobacco to treat his familial facial seborrhoeic dermatitis induced by the hapten nicotine. A double-blind experiment against placebo and several treatments with continuous and single intakes of tobacco high dilutions led after a break to a late abrogation of dermatitis simulating a desensitization. These observations provide a new possible explanation for the placebo effect and facial seborrhoeic dermatitis is proposed as a new visible model for Benveniste's theory of ‘Memory of water’.