Seborrheic Dermatitis Patients Research Articles

Gut microbes and skin disease, gut-brain-skin axis: A review

Skin disease, especially eczema, dermatitis and acne, may damage appearance of people, and cause physical discomfort or mental disorders. The prevalence rate is increasing sharply and globally that has been affected all populations in the world. The diseases have various, complex pathogeny and high recurrence rate. Studies demonstrate that skin and mental state are closely related, emerging of skin diseases always accompanied with prevalence of mental disorders obviously. As early as 1930s, the dermatologist John H. Stokes and Donald M. Pillsbury at the university of Pennsylvania, proposed the gut-brain-skin unified theory. They found a close relationship between the brain and the skin. Recent studies demonstrate a mechanism among gut microbes unbalance, mental disorder and skin diseases, which has been postulated to the gut-brain-skin axis. Gut, brain and skin can interplay to each other. Psychological stress can aggravate a variety of skin diseases, particularly autoimmune skin disease, such as atopic dermatitis, psoriasis, seborrheic eczema, nodular prurigo, lichen planus, chronic urticaria, alopecia areata and pruritus sine material etc. Skin diseases are also closely related with health of digestive system. There are high ratio gastrointestinal patients who suffered from acne simultaneously. Gut microbiota is also involved in the gut-skin connection. The number of Bifidobacterium and Lactobacillus in feces are significantly less in adult patients with atopic dermatitis, than those of controls. The composition of aerobic and anaerobic bacteria in gut of those seborrheic dermatitis patients are severely changed. Similarly, more than half of acne patients go along with significant changes in the gut microbiota. Studies indicate that both gut microbiota and mental status affect the occurrence of skin diseases. On the contrary, the skin condition can also be as a barometer of mental health and gut microeubiosis. The treatment through the gut-brain-skin axis can be an important intervention to cure skin diseases. Combination of diet, probiotics, prebiotics, drug and mental health status can be positive factors in skin diseases therapy. Diet may affect the composition of gut microbes directly, and light diet can reduce the acne rate. Probiotics, like Bifidobacterium longum , Lactobacillus paracasei , Lactobacillus reuteri were reported to protect the function of intestinal barrier, help to reestablish intestinal microbiota ecological balance, and intensify the anti-inflammation effects. Some bacteria have tremendous potential in prevention and therapy of skin diseases, including eczema, allergic dermatitis, acne, allergic skin, UV induced skin damage and wound. Antibiotics can eliminate intestinal microbiota. Two weeks antibiotics treatment in mice may lead to reduce food intake, and messy, dull hair et al., in the opposite, 10 days probiotics drinking recover hair status obviously. Besides, probiotics can also restore the stress caused skin neurogenic inflammation in mice. In the present review, we aim to focus on the following hot topics around symbiosis microbiome, gut-brain-skin axis and skin diseases. To consider the gut microbiota, the brain and the skin as one combined system, instead of single reason may enhance the effects of treatment. More study should focus on the interaction of skin and intestinal microbiota, as well as the interaction mechanism of the gut-brain-skin axis, especially immune system. We urge scientists and medical doctors to pay more attentions on this field.

In Vitro Anti-Malassezia Activity of Castanea crenata Shell and Oil-Soluble Glycyrrhiza Extracts.

BackgroundA new shampoo with anti-Malassezia properties obtained from various plants is required to provide seborrheic dermatitis patients with a wider range of treatment options.ObjectiveThe aim of this study was to obtain in vitro susceptibility profiles of Malassezia restricta and M. globosa, the most important pathogenic organisms in the development of seborrheic dermatitis, to the plant extracts used in commercial anti-dandruff shampoos.MethodsMinimal inhibitory concentrations (MICs) were determined for eight candidate plant extracts and two plant-derived natural products diluted with Leeming and Notman medium to final concentrations of 0.016 to 1 mg/ml.ResultsCastanea crenata shell, Camellia sinensis leaf, and oil-soluble Glycyrrhiza extracts presented relatively low MIC values (≤0.5 mg/ml) against both strains. The C. crenata shell and oil-soluble Glycyrrhiza extracts demonstrated especially high anti-Malassezia activity, suggesting their potential use in the treatment of seborrheic dermatitis. The extracts also showed fungistatic activity against other common facultative pathogenic yeasts, Cryptococcus and Candida.ConclusionC. crenata shell and oil-soluble Glycyrrhiza extracts could potentially be used as active ingredients in anti-seborrheic and anti-dandruff shampoo formulations. They could be helpful for repeated treatments and regular prophylaxis of scalp seborrheic dermatitis.

소양인(少陽人) 형방도적산(荊防導赤散)으로 치료한 지루성피부염 4례

Objectives : The purpose of this study is to report the effectiveness of Hyeongbangdojok-san on 4 seborrheic dermatitis patients who were diagnosed as Soyangin.Methods : 4 seborrheic dermatitis patients were treated by Hyeongbangdojok-san. The effect of treatment was measured by EASI score, VAS score, photographs.Results : EASI score and VAS score decreased as a result of Hyeongbangdojok-san treatment in 4 patients.Conclusions : These case-studies showed an efficient result of using Hyeongbangdojok-san in the seborrheic dermatitis of Soyangin. And an author consider that continuous clinical study will be needed in Korean medical dermatology.

Comprehensive pyrosequencing analysis of the bacterial microbiota of the skin of patients with seborrheic dermatitis.

Seborrheic dermatitis (SD) is a chronic inflammatory dermatologic condition in which erythema and itching develop on areas of the body with sebaceous glands, such as the scalp, face and chest. The inflammation is evoked directly by oleic acid, which is hydrolyzed from sebum by lipases secreted by skin microorganisms. Although the skin fungal genus, Malassezia, is thought to be the causative agent of SD, analysis of the bacterial microbiota of skin samples of patients with SD is necessary to clarify any association with Malassezia because the skin microbiota comprises diverse bacterial and fungal genera. In the present study, bacterial microbiotas were analyzed at non-lesional and lesional sites of 24 patients with SD by pyrosequencing and qPCR. Principal coordinate analysis revealed clear separation between the microbiota of non-lesional and lesional sites. Acinetobacter, Corynebacterium, Staphylococcus, Streptococcus and Propionibacterium were abundant at both sites. Propionibacterium was abundant at non-lesional sites, whereas Acinetobacter, Staphylococcus and Streptococcus predominated at lesional sites; however, the extent of Propionibacterium colonization did not differ significantly between lesional and non-lesional sites according to qPCR. Given that these abundant bacteria hydrolyze sebum, they may also contribute to SD development. To the best of our knowledge, this is the first comprehensive analysis of the bacterial microbiotas of the skin of SD patients.

Effect of itraconazole on the quality of life in patients with moderate to severe seborrheic dermatitis: a randomized, placebo-controlled trial.

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.

A highly sensitive LC–MS/MS method for determination of ketoconazole in human plasma: Application to a clinical study of the exposure to ketoconazole in patients after topical administration

A simple, rapid and highly sensitive LC–MS/MS method was developed and validated for the determination of ketoconazole in human plasma. Sample preparation was accomplished through a single step liquid–liquid extraction by ethyl acetate. The chromatography separation was carried out on a Hedera CN (150mm×2.1mm, 5μm) column with isocratic elution using acetonitrile and 10mM ammonium acetate containing 0.1% formic acid (45:55, v/v) as the mobile phase. The flow rate was 0.5mL/min. Detection was performed in the positive ion electrospray ionization mode using multiple reaction monitoring of the transitions of 531.2→489.3 and 286.1→217.1 for ketoconazole and letrozole (the internal standard), respectively. The method exhibited good linearity over the concentration range of 0.01–12ng/mL for ketoconazole. The intra- and inter-batch precision and accuracy of ketoconazole were all within the acceptable criteria. The method was successfully applied to a clinical study of the exposure to ketoconazole in Chinese seborrheic dermatitis patients after topical administration of two ketoconazole formulations of foam and lotion, respectively. The study results showed that there was little systemic absorption of ketoconazole in patients for the two formulations, and the ketoconazole foam and lotion are safe therapeutic drugs for seborrheic dermatitis patients.

Malassezia arunalokei sp. nov., a Novel Yeast Species Isolated from Seborrheic Dermatitis Patients and Healthy Individuals from India.

The majority of species within the genus Malassezia are lipophilic yeasts that colonize the skin of warm-blooded animals. Two species, Malassezia globosa and Malassezia restricta, are implicated in the causation of seborrheic dermatitis/dandruff (SD/D). During our survey of SD/D cases, we isolated several species of Malassezia and noticed vast variations within a few lipid-dependent species. Variations observed in the phenotypic characteristics (colony morphology, absence of catalase activity, growth at 37°C, and precipitation surrounding wells containing Tween 20 or Cremophor EL) suggested the possible presence of a novel species. Sequence divergence observed in the internal transcribed spacer (ITS) region, the D1/D2 domain, and the intergenic spacer 1 (IGS1) region of rDNA and the TEF1 gene, PCR-restriction fragment length polymorphism (RFLP) analysis of the ITS2 region, and fluorescent amplified fragment length polymorphism analysis support the existence of a novel species. Based on phenotypic and molecular characterization of these strains, we propose a new species, namely, M. arunalokei sp. nov., and we designate NCCPF 127130 (= MTCC 12054 = CBS 13387) as the type strain.

English

Yeasts of the Malassezia genus are linked to seborrheic dermatitis (SD) in humans; however, etiological species causing this disease can vary according to their geographical location. M. globosa and M. restricta are the most often isolated microorganisms and can be found in the skin of patients with SD. Nevertheless, species identification by molecular methods and the relationship among etiological agents and the clinical severity of the disease have not been determined in Mexican patients. The goal of this study was to analyze the prevalence of Malassezia species in the skin of SD patients by molecular methods in order to establish their distribution according to the severity of the disease in Monterrey, Nuevo Leon, Mexico. Skin samples from patients with SD (n = 60) were obtained by scraping and were cultured on modified Dixon agar. The Malassezia colonies were identified by amplification of the D1/D2 regions of 26S rDNA by polymerase chain reaction (PCR) and subsequent sequencing and BLAST analysis in GenBank. The positive Malassezia culture rate was 48.3%. The most commonly isolated species were Malassezia furfur (20%), Malassezia globosa (16.7%), Malassezia sympodialis (6.7%), Malassezia restricta (3.3%) and Malassezia slooffiae (1.7%). No significant difference was found in the distribution of Malassezia species according to disease severity. Key words: Seborrheic dermatitis, Malassezia, LSU rDNA D1/D2, yeasts, Malassezia furfur; M. globosa.

지루성 피부염 환자의 사상의학적 치험 5례

Objectives : The purpose of this case study is to report the effectiveness of Sasang constitutional medicine on 5 seborrheic dermatitis patients who were diagnosed as Soyangin.Methods : Among 5 seborrheic dermatitis patients, 3 of them were treated byyanggyeoksanhwa-tang, 1 of them was treated byhyeongbangsabaek-sanand 1 of them was treated byhyeongbangdojeok-san. The effects of treatment was measured by VAS score, photographs and Colormeter using Dermavision.Results : VAS scores of all patients decreased from 10 to 1,2. A㏄ording to photographies and Colormeter, all patients were noticeably improved.Conclusions : The result indicates that Sasang constitutional medicine is effective in treatment of seborrheic dermatitis patients. And the authors consider that continuous clinical study will be needed in Korean medical dermatology.

柴胡淸肝湯加減方으로 치료한 지루성피부염 치험 7례

Objective : The purpose of this case study is to report the effectiveness of Sihochunggan-tang gagambang in respect of liver meridian wind-heat or liver-heat on 7 seborrheic dermatitis patients who were in high stress and had unhealthy dietary habit. Methods : VAS (Visual Analogue Scale) score was used to check the prognosis of 7 seborrheic dermatitis patients, who have been treated with Sihochunggan-tang gagambang and acupuncture. Results : VAS score decreased as a result of Sihochunggan-tang gagambang treatment in 7 patients. Conclusion : Sihochunggan-tang gagambang can be effective treatment for the high stress and unhealthy diet related seborrheic dermatitis when diagnosed as liver meridian wind-heat or liver-heat

Malassezia intra-specific diversity and potentially new species in the skin microbiota from Brazilian healthy subjects and seborrheic dermatitis patients.

Malassezia yeasts are part of the resident cutaneous microbiota, and are also associated with skin diseases such as seborrheic dermatitis (SD). The role these fungi play in skin diseases and why they are pathogenic for only some individuals remain unclear. This study aimed to characterize Malassezia microbiota from different body sites in healthy and SD subjects from Brazil. Scalp and forehead samples from healthy, mild SD and severe SD subjects were collected. Non-scalp lesions from severe SD patients were also sampled. 5.8S rDNA/ITS2 amplicons from Malassezia sp. were analyzed by RFLP and sequencing. Results indicate that Malassezia microbiota did not group according to health condition or body area. Phylogenetic analysis revealed that three groups of sequences did not cluster together with any formally described species, suggesting that they might belong to potential new species. One of them was found in high proportions in scalp samples. A large variety of Malassezia subtypes were detected, indicating intra-specific diversity. Higher M. globosa proportions were found in non-scalp lesions from severe SD subjects compared with other areas, suggesting closer association of this species with SD lesions from areas other than scalp. Our results show the first panorama of Malassezia microbiota in Brazilian subjects using molecular techniques and provide new perspectives for further studies to elucidate the association between Malassezia microbiota and skin diseases.

UV-induced red fluorescence on facial part of patients with acne vulgaris and seborrheic dermatitis: a fluorescence spectrum study

Objective To measure the fluorescence spectral information of UVRF in the facial skin of patients with acne vulgaris and seborrheic dermatitis and to comprehend the optical properties of UVRF. Methods The lesions were squeezed to extract the sebaceous secretions containing UVRF in the facial skin. Ocean Optics USB2000+ F02243 Spectrometer and the 308nm excimer laser were used as an excitation light source to measure the signal of the LIF spectrum of UVRF in 6 acne vulgaris and 4 seborrheic dermatitis patients' facial part, compared with protoporphyrin Ⅸ. Results 1-4 peaks were detected in 10 patients' UVRF specimen respectively. The fluorescence spectra's characteristic peak of UVRF in 10 patients was at 680 nm. Protoporphyrin Ⅸ was at 688 nm and more gentle and generous than UVRF's characteristic peak. Conclusions LIF system can be used to detect the fluorescence spectroscopy of UVRF. UVRF has similar spectral characteristics to protoporphyrin Ⅸ, but it is not the same species. Key words: Acne; Seborrheic dermatitis; Fluorescence spectrum; Red fluorescence; Laser induced fluorescence

Maintenance Therapy of Facial Seborrheic Dermatitis with 0.1% Tacrolimus Ointment.

BackgroundTopical calcineurin inhibitors (TCIs) have been successfully used to treat seborrheic dermatitis (SD) patients. Meanwhile, treatment of atopic dermatitis (AD) with low-dose, intermittent TCI has been proved to reduce disease flare-ups. This regimen is known as a maintenance treatment.ObjectiveThe aim of this trial was to investigate the efficacy and tolerability of a maintenance treatment with tacrolimus ointment in patients with facial SD.MethodsDuring the initial stabilization period, patients with facial SD or AD applied 0.1% tacrolimus ointment twice daily for up to 4 weeks. Clinical measurements were evaluated on either in the whole face or on separate facial regions. When an investigator global assessment score 1 was achieved, the patient applied tacrolimus twice weekly for 20 weeks. We also compared our results with recent published data of placebo controlled study to allow an estimation of the placebo effect.ResultsThe time to the first relapse during phase II was similar in both groups otherwise significantly longer than the placebo group. The recurrence-free curves of two groups were not significantly different from each other; otherwise the curve of the placebo group was significantly different. There were no significant differences between the 2 groups in the number of DEs, and treatment days for disease exacerbations (DEs). The adverse event profile was also similar between the 2 groups. During the 20 weeks of treatment, the study population tolerated tacrolimus ointment well.ConclusionThe results of this study suggest that maintenance treatment with tacrolimus may be effective in preventing the occurrence of facial SD exacerbations.

Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country.

Background:Seborrheic dermatitis is a common chronic inflammatory skin condition that can have a negative impact on a patient's quality of life. Few studies have been conducted to assess the clinical characteristics of the disease and quality of life of the patients, especially in tropical countries.Aims and Objectives:The aim of this study was to demonstrate the clinical characteristics and quality of life of patients with seborrheic dermatitis in Thailand.Materials and Methods:A cross-sectional study was performed at a university-based hospital and tertiary referral center in Bangkok, Thailand. The validated Thai version of the dermatology life quality index (DLQI) was used to evaluate patients’ quality of life.Results:A total of 166 participants were included. One hundred and forty-seven patients (88.6%) experienced multiple episodes of the eruption. The mean of outbreaks was 7.8 times per years, ranging from once every 4 years to weekly eruption. The most common factor reported to aggravate seborrheic dermatitis was seasonality (34.9%), especially hot climate. The mean (SD) of the total DLQI score was 8.1 (6.0) with a range of 0 to 27. There was no statistically significant difference between the two DLQI categories regarding duration of disease, extent of involvement, symptoms or course of the disease.Conclusion:Although mild and asymptomatic, seborrheic dermatitis can have a great impact on the quality of life. Youth, female gender, and scalp lesions were significantly associated with higher DLQI scores.

A laboratory-based study on patients with Parkinson’s disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production

BackgroundSeborrheic dermatitis (SD) and Parkinson’s disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD.MethodsThis case–control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated.ResultsThe most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667).The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro.ConclusionFrom this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data lead to conclusion that local skin performance of PD patient’s characterized with increased sebum excretion ratio play a role in SD by stimulation of yeasts replication and enzyme production.

황련해독탕가감방(黃連解毒湯加減方)으로 치료한 지루성 피부염 치험 3례

Objectives : The purpose of this study is to report the effect of Hwangryuhaedok-tang gagambang on seborrheic dermatitis. Methods : The clinical study was done on 3 cases of seborrheic dermatitis patients with symptoms of flare, scales, pricking and itching. An author prescribed Hwangryuhaedok-tang gagambang for these patients and checked VAS(Visual Analogue Scale) scores depending on the patient's evaluation. Photographies were taken before and after the treatment. Results : VAS scores of all patients decreased from 10 to 1,2. Judging by photographies, patients noticeably improved in facial skin. As a result of examining VAS scores and photographies, Hwangryuhaedok-tang gagambang was effective on seborrheic dermatitis. Conclusions : From these results, Hwangryuhaedok-tang gagambang may be considered as a basic prescription for seborrheic dermatitis. And an author consider that continuous clinical study will be needed in Korean medical dermatology.

Molecular Characterization of the Skin Fungal Microbiota in Patients with Seborrheic Dermatitis

Background: Seborrheic dermatitis (SD) is an inflammatory disease associated with seborrhea that appears most often on the face, especially the nasolabial folds, scalp, and upper trunk, in sebaceous gland-rich areas of the skin. Although various factors are involved in the development of SD, Malassezia species of skin fungi play an important role in this skin disease. The aim of this study was to obtain basic information to elucidate the mycological involvement in the development of SD by performing a comprehensive analysis of the skin fungal microbiota of lesional and non-lesional sites in SD patients using a pyrosequencing approach. Methods: Scale samples were collected from lesional and non-lesional sites of 24 Japanese patients with seborrheic dermatitis and the skin fungal microbiome in the scale samples was analyzed using a pyrosequencing method. Results: Thirty taxa were detected from a total of 480,186 high-quality sequences. Malassezia species predominated at both lesional and non-lesional sites; however, the fungal microbiota at lesional sites was more diverse than at non-lesional sites. The fungal communities at lesional and non-lesional sites were clearly distinguished on principal coordinate analysis. Conclusion: Our data indicated that the skin fungal microbiota in lesional sites of SD patients was independent of that in non-lesional sites and will be utilized as basic information for understanding the association between skin fungi and development of SD.

발효된 연교금은화 추출물 외치액을 병행한 지루성 피부염 치험 4례

Objectives : The purpose of this study is to report the effect of Fermented Yungyo Keumeunhwa Extract External treatment Liquid on Seborrheic Dermatitis. Methods : Four Seborrheic Dermatitis patients on the face of each Diluted Yungyo Keumeunhwa Extract External treatment Liquid patch was 10 minutes. Results : The Fermented Yungyo Keumeunhwa Extract External treatment Liquid was effective on alleviation of symptoms like flare, scale, uredo and pricking on Seborrheic Dermatitis. Conclusions : The result indicate that Fermented Yungyo Keumeunhwa Extract External treatment Liquid has an available effect on Seborrheic Dermatitis, and authors consider that the additional clinical studies are needed to verify the effectiveness of monotherapy.

Seborrheic dermatitis and hypertension in adults: a cross‐sectional study

Seborrheic dermatitis (SD) is a chronic inflammatory skin disease that shares some features with psoriasis. Previous reports have demonstrated an association between hypertension and psoriasis. Chronic skin inflammation may plays a role in the aetiology of hypertension in both disorders. To evaluate the association between SD and hypertension in an adult large population sample. A cross-sectional study was carried out by utilizing the database of Clalit Health Services, a healthcare provider organization for over 4 million enrollees in Israel. All adult patients previously diagnosed with SD were compared with a sample of enrollees without SD regarding the prevalence of hypertension. Patients without SD were frequency matched to SD patients regarding age and sex. Data on other health-related lifestyles and comorbidities were collected. The study included all 9255 patients with SD and 9246 age- and sex-matched patients without SD. The prevalence of hypertension was significantly higher in patients with SD (27.1% vs. 24.7%, P<0.001, OR=1.13, 95% CI: 1.05-1.21). A multivariate logistic regression model demonstrated that SD was significantly associated with hypertension after controlling for confounders, including age, sex, socioeconomic status, smoking, diabetes and obesity (multivariate OR=1.23, 95% CI: 1.12-1.35, P<0.001). In this study, an association between SD and hypertension was demonstrated in adults. Many factors can be advocated to explain this association. Genetic predisposition, psychological conditions, lipid abnormalities and chronic inflammation of the skin with a change in cytokine balance should be explored as potential mechanisms.

Sympathetic skin responses from the scalp evoked by electrical stimulation in seborrheic dermatitis

Although the role of autonomic nervous system in seborrheic dermatitis (SD) is still unclear, seborrhea is sometimes accepted as a sign of autonomic dysfunction in several nervous system diseases. Therefore, we aimed to investigate the sympathetic nervous system (SNS) activity in SD by recording sympathetic skin responses (SSR) from the scalp (S-SSR). Thirty-one control subjects and 22 SD patients were studied by evoking right and left S-SSR with electrical stimulation of the right median nerve at the wrist. Mean latencies and maximum amplitudes were calculated for both sides in each group. In seven out of 31 control subjects and in 13 out of 22 patients, the S-SSR could not be elicited on either side. There were four subjects with unilateral response in the patient group. There were significantly more non-responders among the patients with SD (P < 0.000). This study suggests that in SD, the autonomic nervous system may be involved. The S-SSR is a new site for recording SSR. The responses are relatively symmetrical and can be evoked easily by electrical stimulation, and may be used to evaluate the SNS function in SD patients and also in healthy subjects.