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Dandruff: The most commercially exploited skin disease
Abstract
The article discuss in detail about the prevalence, pathophysiology, clinical manifestations of dandruff including the etio-pathology. The article also discusses in detail about various treatment methods available for dandruff. The status of dandruff being amphibious - a disease/disorder, and relatively less medical intervention is sought after for the treatment, dandruff is the most commercially exploited skin and scalp disorder/disease by personal care industries.
... Microbial metabolism, sebum production (oily hair), and individual susceptibilities promote dandruff severity [6][7][8][9][10]. Major risk factors for dandruff include excessive sebum over the scalp, gender, age, anatomic region of scalp formation, and microorganisms [11]. Even though there is a paucity of studies, documented associated factors are excessive exposure to sunlight, irritation of the scalp due to excess shampooing, frequent combing, use of certain cosmetic products, and exposure to dust and dirt [12,13]. ...
... The fungi prefer areas with numerous sebaceous glands because they need a high amount of lipids for their growth [26]. They convert the sebum lipid into fatty acids and triglycerides, leading to accelerated proliferation (i.e., hyperproliferation) of the keratinocytes [11,27]. ...
Objective
Dandruff, a condition caused by lipophilic Malassezia fungi, is an excessive shed of dead skin cells from the scalp. Effective preventive and curative measures of the condition depend on knowledge and understanding of the prevalence of the condition, the common etiologic species, and the associated factors. This study aimed to investigate the prevalence, common etiologic species, and associated factors of Malassezia infection in Mekelle City, Ethiopia.
Method
A facility-based cross-sectional study was conducted from February 2019 to June 2020 involving 217 participants who were visiting dermatology clinics to seek treatment for dandruff conditions. Information on the socio-demographic characteristics and hair care behaviors of the participants was obtained. Isolation and identification of Malassezia species from scalp scrapings using cultural and biochemical tests were carried out.
Results
Out of the 217 participants with dandruff, 111 (51.15%) were positive for Malassezia fungi. One hundred forty (140) Malassezia isolates were collected from the 111 positive participants. Further study of the isolates yielded three etiologic species: Malassezia globosa (67.15%), M. furfur (21.70%), and M. restricta (12.15%). Demographic characteristics, namely gender (AOR = 2.605; 95%CI: 1.427 − 4.757) and age (AOR = 2.667; 95%CI: 1.046 − 6.795), as well as hair care behaviors, namely use of hair oil (AOR = 2.964; 95%CI: 1.288 − 6.820), were associated with the presence of Malassezia species. However, the use of anti-dandruff shampoo (AOR = 2.782; 95%CI: 1.301 − 10.993) was negatively associated with the presence of Malassezia species among the participants with dandruff conditions. These findings open opportunities to devise effective prevention, management, and control measures for Malassezia-based dandruff conditions.
... Dandruff, also known as seborrheic dermatitis, is a common scalp condition characterized by excessive scaling or flaking of the skin, scalp dryness or oiliness, redness, and itchiness of the scalp [1]. Three prime etiologies are associated with seborrheic dermatitis, which includes the presence of commensal yeast of Malassezia spp., excessive secretions of the sebaceous glands, and the individual's sensitivity [2]. ...
... This results in hyperproliferation and rapid transfer of incompletely keratinized cells to the surface, which then appear as clumps or flakes, known as dandruff [6]. 1 1 1 1 1 The well-known antiseptic combination of chlorhexidine and cetrimide has been efficient in reducing the load of Malassezia spp. in in vitro settings. Similarly, our initial in vitro studies exhibited significant antifungal effects of an antiseptic liquid (ASL) formulation containing chlorhexidine and cetrimide against various Malassezia spp. ...
Background: Seborrheic dermatitis is a common scalp condition affecting the quality of life of individuals across all age groups. The uninhibited proliferation of Malassezia spp. and enhanced sebaceous gland activity often leads to scalp flaking, mild erythema, and itching, thereby worsening the situation. Here, we aimed to study the efficacy of an antiseptic liquid as a pre-shampoo rinse followed by a non-anti-dandruff shampoo as a dandruff care strategy.
Methods: The anti-dandruff efficacy of a chlorhexidine-cetrimide-based antiseptic liquid (ASL) as a pre-shampoo scalp rinse, followed by a regular non-anti-dandruff shampoo, was compared with a commercial Zinc pyrithione (ZnPTO) based anti-dandruff shampoo following a half-head paired treatment design in a randomized, placebo-controlled, double-blind trial. The study was conducted on 50 healthy human adults of both genders with moderate to severe dandruff. During the 12 weeks of this study, the product's safety and efficacy were evaluated based on the dermatologist's visual assessment, the subjects' self-assessment, the loose flake density score, and hair fall.
Results: ASL as a pre-shampoo scalp rinse demonstrated significant reduction (p<0.001 for n=47) in dandruff and itching after the treatment and the regression phase, performing at par with a marketed anti-dandruff shampoo. Moreover, ASL was established to be safe, non-irritant, and well-tolerated. No product-related adverse event, discomfort, or irritation symptoms were recorded, having any impact on hair sensory properties.
Conclusions: This study demonstrates that a regimen of a chlorhexidine+cetrimide antiseptic liquid for scalp treatment followed by rinse with a regular shampoo can prove as effective as a ZnPTO-based anti-dandruff shampoo in reducing dandruff symptoms for individuals with moderate dandruff.
... 3 Dandruff commonly affects nearly half of the prepubertal population, irrespective of gender and ethnicity. 4 The estimated prevalence of dandruff ranges between 50 to 70 percent in the overall population. 2,5 This widespread condition not only causes discomfort but also leads to embarrassment and negatively impacts the quality of life for those affected. ...
... colonization. 4 Few ingredients in the Indulekha Svetakutaja Hair Oil, Svetakutaja (W. tinctoria) and nimba has demonstrated antifungal properties. ...
Background: This study aimed to evaluate the efficacy and safety of Indulekha Svetakutaja Hair Oil in comparison with coconut oil in the management of dandruff through a randomized, double-blind, placebo controlled study. Methods: A total of 110 subjects with clinically diagnosed moderate dandruff were randomly assigned into two groups: Group A (The Indulekha Svetakutaja Hair Oil group, n=55) and Group B (Placebo coconut hair oil group, n=55), where 50 subjects in each group completed the study. The treatment phase was for 4 weeks, followed by a regression phase of 2 weeks. Subjects applied the allotted oil on their scalp, massaged and kept it for a minimum of 30 mins or overnight thrice a week, then washed it with the provided neutral shampoo for a duration of 4 weeks. Dermatological assessments, instrumental measurements and subject self-assessment questionnaire were evaluated in comparison to baseline at weekly intervals throughout the study period. Results: After 4 weeks of treatment, group A demonstrated a significantly greater reduction (p<0.05) in dandruff severity compared to group B. The Total Dandruff scores in Group A showed a significant reduction of 70.62 units while in Group B, it was noted to be 48.79 units. Nearly all participants (98%) in Group A reported a subjective perception improvement in dandruff symptoms compared to Group B. Conclusions: Indulekha Svetakutaja Hair Oil is safe and effective in controlling dandruff and improving scalp and hair health, making it a promising therapeutic option for individuals with dandruff.
... Dandruff is a common scalp skin disorder affecting almost half of the human population at the pre-pubertal age and of any gender and ethnicity. This disorder is a common condition that causes the skin on the scalp to flake [12]. Dandruff is considered to be a mild form of SD and affects aesthetic values. ...
... Dandruff is considered to be a mild form of SD and affects aesthetic values. It often triggers and causes itching, which can be embarrassing due to social issues and isolation, and can be challenging to treat [9,[12][13][14]. It has been well established that keratinocytes play a key role in the expression and generation of immunological reactions during the development of dandruff [15]. ...
Objective: The increasing resistance of Malassezia yeasts against commonly used antifungal drugs dictates the need for novel antifungal compounds. Human lactoferrin-based peptides show a broad spectrum of antimicrobial activities. Various assays were performed to find the optimal growth conditions of the yeasts and to assess cell viability, using media with low lipid content to avoid peptide binding to medium components. Methods: In the current study, we tested the antimicrobial susceptibility of 30 strains of M. furfur that cover the known IGS1 genotypic variation. Results: hLF(1-11) inhibited the growth of all species tested, resulting in minimum inhibitory concentrations (MIC) values ranging from 12.5 to 100 μg/mL. In the combinatory tests, the majority of fractional inhibitory concentration indexes (FIC) for the tested strains of M. furfur were up to 1.0, showing that there is a synergistic or additive effect on the efficacy of the antifungal drugs when used in combination with hLF(1-11). Conclusion: Results showed that hLF(1-11) could be combined with fluconazole or amphotericin for the antimicrobial treatment of resistant strains, enhancing the potency of these antifungal drugs, resulting in an improved outcome for the patient.
... Dandruff is a common scalp disorder affecting almost half of the population at the pre-pubertal age and of any gender and ethnicity,dandruff affects aesthetic value and often causes itching. It has been well established that keratinocytes play a key role in the expression and generation of immunological reactions during dandruff formation (1) The severity of dandruff may fluctuate with season as it often worsens in winter. There could be several etiopathologic ways with complex mechanisms, which may cause dandruff. ...
... The agar disc diffusion method was used to determine the antifungal activity of the selected homoeopathic medicine Thuja occidentalis with measuring of diameter of growth inhibition zones. To show effects of these medicines against malassezia fur fur suspension at concentration of (0.5 McFarland) (1)(2)(3)(4)(5) x 106 CFU/ml were adjusted. A sterile cotton swab was dipped into the adjusted suspension and swabbed over the dried surface of media plate throughout the entire surface. ...
Malassezia furfur (M. furfur), named as Pityrosporumovale previously, is a yeast-like fungus. Malassezia species occur on human and animal skin as commensals and they are associated with multiple skin disorders such as pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis (dandruff), atopic dermatitis and psoriasis. The prevalence of superficial fungal skin infection is 20-25% globally. Homoeopathic system of medicine with its wide field of literatures which were compiled based on human proving, treats acute and chronic infectious diseases successfully. On the other hand, the modern world is raising questions on the scientificity of homoeopathy constantly. So the use of Homoeopathic medicines for treating fungal infections is most relevant due to their nontoxic and noninvasive nature.This invitro study was undertaken to determine the antifungal activity of Homoeopathic medicines,The aim is to study the anti-fungal activity of Thuja occidentalis Q, 30C, 200C and 1M against Malassezia furfur and to determine the zone of inhibition produced by fungal strain Malassezia furfur and to compare the effects of the homoeopathic medicines Thuja occidentalis with different potencies. And the medicine Thuja occidentalis Q, 30C, 200C and 1M showed good antifungal activity against Malassezia furfur. INTRODUCTION Dandruff is a common scalp disorder affecting almost half of the population at the pre-pubertal age and of any gender and ethnicity,dandruff affects aesthetic value and often causes itching. It has been well established that keratinocytes play a key role in the expression and generation of immunological reactions during dandruff formation (1) The severity of dandruff may fluctuate with season as it often worsens in winter. There could be several etiopathologic ways with complex mechanisms, which may cause dandruff. Malassezia furfur, a lipophilic, dimorphic and yeast-like fungus, occurring in humans as an opportunistic pathogen affects the hair and skin and causes various diseases. (2) The role of lipophilic yeast belonging to the genus Malassezia, play a role in dandruff. Malassezia species occur on human and animal skin as commensals and they are associated with multiple skin disorders such as pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis (dandruff), atopic dermatitis and psoriasis. (3) It is associated with several skin conditions caused by fungal infections, specifically tinea versicolor and seborrhoeic dermatitis. Among the species of Malassezia, M. globosa, M. restricta, and M.sympodialis are the common types found on the skin of healthy and diseased hosts. M.furfur is also prevalent, furfur can cause infections on the trunk or the limbs, which present as pigmented macules (flat, distinct discoloration on the skin) that merge in the form of plaques. (4) Homoeopathic medicines act via an appropriate host response through body's innate self-regulatory mechanism to
... [3] hair. 50% of adults and 15-25% of the global population experience dandruff, according to [6,7]. 60% of people in America and Europe have dandruff problems [8, [9]. ...
... By lowering the sterol membrane of the P. ovale cell wall's surface tension and increasing its permeability, saponins can inhibit or kill P. ovale. The more concentrated intracellular fluid is drawn out of the cells due to the greater permeability, allowing nutrients, enzymes, and proteins to enter [14,7,6,11]. ...
Dandruff is an anomaly on the scalp caused by Pityrosporum ovale. Dandruff-treated Ketoconazole shampoo, Excessive caused dermatitis and hair damage. The problem was solved using the kapok banana weevil as an alternative treatment. This study aims to determine the quality of kapok banana weevil simplicia and its anti-functional activity against P. ovale. The study was conducted in two stages, the first of which involved Pharmacognostic profiles on macroscopy, microscopy, Simplicia quality, and phytochemical screening. Examining the inhibitory zones of the ethanolic extract of P. ovale at doses of 0.5%, 1%, 2%, 4%, 5%, 10%, 20%, and 40% reveals stage 2 antifungal activity. Employing the Kirby-Bauer diffusion as a positive control with ketoconazole and a negative control with sterile aqua dest. A 95% confidence level LSD post hoc test, one-way ANOVA, and description technique were used to evaluate the data. Results: The Kapuk banana weevil's Simplisia met high standards for Simplisia quality, and its ethanol extract was able to stop P. ovale growth by creating an inhibition zone. The ethanol extract of the Kapuk banana weevil was able to suppress the development of P. ovale with an inhibition zone extending from 0.5 to 17.16 mm and positive control (ketoconazole) of 23.5 mm. The Simplisia of the Kapuk banana weevil had good simplicia quality standards. Extract with concentration of 40%and a 17.16 mm inhibition zone, the activity was at its peak. The pharmacognostic profile demonstrates the high quality of Simplicia, and the activities of the kapok banana weevil extract are at their peak at a concentration of 40% at a diameter of 17.16 mm.
... It is also one of the most common scalp disorders and a much-exploited skin disease commercially. 1 Pathophysiology of dandruff There are several contributing factors that lead to the overpopulation of Malassezia fungus, which otherwise dwells on the human scalp in a commensal relationship in small numbers. These include poor scalp hygiene, water loss from scalp leading to increased sebum section, increased β-endorphin secretion due to age, environmental and seasonal changes 2 as well as stress. ...
Background- Dandruff is a common scalp condition caused by an imbalance in the scalp microflora leading to the overgrowth of Malassezia fungi. Although not a serious medical condition, it does cause considerable discomfort and embarrassment to those affected. Despite the availability of synthetic treatment options, India's diverse botanical heritage offers to provide hopeful alternatives based on traditional medicine practices. Some of the plants that have been tested to show efficacy in inhibiting Malassezia populations include lemongrass, eucalyptus and Indian gooseberry (amla). Utilizing the advantages of modern topical cosmetic serums, which are recognized for increasing consumer acceptance and longer contact time with treatment surface, a new formulation was created for dandruff therapy. Objective: Utilizing the advantages of modern topical cosmetic serums, which are recognized for increasing consumer acceptance and longer contact time with treatment surface, a new formulation was created for dandruff therapy. So, the aim of the present study is to formulate an antidandruff scalp serum of three herbal drugs. The serum incorporates the oils of lemongrass, eucalyptus and amla, blending them into an o/w type emulsion which is simple to use and easy to apply, and safe. Methods:To prepare the serum emulsion, we have combined all active essential oils together with a carrier oil and Vitamin E, then we added it to the aqeous base of water and glycerin. Emulsifying agents and other necessary excipients were also added as per the requirement. The product was then evaluated for its quality. Results: The resultant product showed good rheological properties and was well formulated. User satisfaction is a factor that is satisfied. Conclusion: The new method offers a safe, efficient herbal solution for dandruff, while also providing nourishment for the scalp and tackling inflammation
... As a result, dandruff may increase hair shedding in individuals with AGA (male-and female-pattern baldness) [1,17,20,21]. This hair shedding may also be related to the subclinical inflammation observed in patients with dandruff [22]. SD and dandruff can also extend the hair eclipse phase, that is, the latency period between hair shedding. ...
Ketoconazole shampoo has well‐documented consistent efficacy and safety in treating dandruff and seborrhoeic dermatitis (SD) when compared to other active antidandruff ingredients such as selenium sulphide, corticosteroids and zinc pyrithione. Clinical superiority of ketoconazole shampoo has been demonstrated in several double‐blind, randomized studies. This article delves into the broader applications of ketoconazole shampoo in hair care beyond its established role in managing SD and dandruff. Ketoconazole may help reduce hair shedding, particularly in conditions like SD and dandruff. Ketoconazole shampoo can also help reduce chronic scalp inflammation that may otherwise cause hair follicle damage and hair loss. Its anti‐androgen properties offer significant potential in reducing hair shedding and promoting healthier hair growth. Ketoconazole shampoo may serve as a complementary treatment to minoxidil and finasteride in the management of androgenetic alopecia. These properties make ketoconazole shampoo a logical option for comprehensive scalp and hair care.
... Dandruff is the most common scalp condition, affecting approximately 50% of the population. It arises from factors such as reduced hydration levels, disrupted barrier function, altered cell proliferation, and changes in natural moisturizing factors (Ranganathan & Mukhopadhyay, 2010;Wang et al., 2015). Factors contributing to dandruff include a sedentary lifestyle, oily skin, stress, fatigue, extreme temperatures, and exposure to salty water, infrequent hair washing, and obesity. ...
The human scalp harbors a diverse microbial community that plays a crucial role in scalp health and disease. This study aimed to analyze the microbiome of both healthy and dandruff-affected scalps to elucidate microbial composition differences and potential associations with dandruff pathology. Samples were collected from three healthy and three dandruff-affected individuals, and the V4 region of the 16S rRNA gene and the ITS1 region were sequenced to characterize bacterial and fungal communities, respectively. Taxonomic analysis identified 5 dominant phyla and 31 genera within the samples, revealing a shift from Actinomycetota dominance in healthy scalps to Basidiomycota dominance in dandruff-affected scalps. Notably, the fungal phylum Ascomycota, including Malassezia, was also more abundant in dandruff-affected scalps. This transition emphasizes the intricate interactions among microbial communities and their potential impact on scalp health. These findings suggest specific microbial shifts are associated with dandruff, highlighting the potential for targeted therapeutic strategies that modulate the scalp microbiome to improve scalp health. Further research is needed to elucidate the specific interactions between these microbial groups and their impact on scalp health.
... Adolescents has been define by world Health Organization as a period of life spannning between10-19 years, they no long children but not yet adults. 1 the dandruff not a life threatening problems yet it often threatens mental piece undoubtably. It is an estimated that dandruff affect half of the adolesecent population, dispite such high prevalence, their etiolgy is not well understood. ...
Introduction: The dandruff is one of the common skin conditions among adolescents. World 50% of the general population and is mostly seen in males than females among adolescents
Methods: A quantitative research approach was adopted to assess the knowledge on prevention and management of dandruff among adolescents. Non- probability convenience sampling technique was used to select the sample.
Result: The findings of the study that 15% of the subjects were having good knowledge, 82% were having average knowledge and 3% were having poor knowledge. There is a significant association found knowledge sore and the type of family.
Conclusion: The study revealed that there is need of awareness program for regarding prevention and management of dandruff for adolescents.
Key wards: knowledge, prevention, dandruff, adolescents
... In vitro hair study, to evaluate the performance of 1% selenium sulfide +3% salicylic acid shampoo compared to 2% ketoconazole +2% salicylic acid shampoo in improving hair smoothness, hair softness, hair moisture, hair shine, hair manageability and reducing the hair frizz formulations to enhance these properties, with selenium sulfide and salicylic acid being prominent due to their antifungal and keratolytic effects, respectively. 2,4,5,8 This study focuses on evaluating the efficacy of a novel formulation comprising 1% selenium sulfide and 3% ...
Background: Recently, there's been more focus on finding hair care products that improve quality, manageability, and scalp health. Different active ingredients are used in products to improve these properties, with selenium sulfide and salicylic acid being important for their antifungal and keratolytic effects. Therefore, this study evaluates the efficacy of a novel hair care formulation, 1% selenium sulfide and 3% salicylic acid shampoo (Product A), in improving hair quality compared to a benchmark product, 2% ketoconazole and 2% salicylic acid shampoo (Product B). The main goal was to evaluate the impact of these formulations on hair smoothness, softness, moisture, shine, manageability, and frizz reduction through an in-vitro hair swatch study. Methods: The study involved baseline treatment followed by the application of the respective shampoos, with subsequent evaluation of hair quality parameters by a trained expert panel. Results: Results indicated that both products significantly improved hair smoothness and softness. However, product A outperformed product B in hair manageability and frizz reduction, with a 20% improvement in manageability and a 32% reduction in frizz. Product B, while showing greater improvement in moisture retention (13% vs. 6%), experienced a decline in shine, whereas product A maintained shine levels. Conclusions: Statistical analysis revealed significant differences in performance, with product A showing superior results overall. These findings suggest that product A offers a more balanced and effective solution for hair care, particularly in manageability and frizz control. Further research, including clinical trials, is recommended to validate these results and explore long-term effects.
... Poor hygiene, excessive exposure to dust, sunlight, hair cosmetics or pollutants could be a few of the causes that could lead to dandruff. In addition, there are commensal microorganisms that become pathogenic, proliferate and colonize the scalp under certain conditions, leading to various dermatological issues such as dandruff, seborrheic dermatitis, and pityriasis versicolor (Ranganathan and Mukhopadhyay 2010;Manuel 2010). The human scalp hosts a diverse array of microorganisms, including Staphylococcus spp, Propionibacterium acne and Malassezia furfur. ...
Malassezia furfur is the primary etiological agent of dandruff (Pityriasis capitis). Although herbal shampoos are preferred for their natural, mild ingredients over synthetic counterparts, they are often perceived as less effective in managing flaky scalp conditions or furfuration causing dandruff. The study compares the antifungal efficacy of herbal and synthetic shampoos against M. furfur. Seven shampoos including herbal (HS_Adv, HS_M&P, HS_Aloe), synthetic (SYN_01, SYN_02, SYN_03) and an antifungal shampoo containing ketoconazole (KETO) were employed in the study. Experiments were designed to stimulate real-world conditions, utilizing disc-diffusion assay, 3-minute shampoo contact at mild dilutions (1% and 5%), recurrent 3-minute shampoo contact every 24 h with intermittent recovery. Both disc diffusion and 3-minute shampoo contact demonstrated that all shampoos were effectively inhibiting the viability of M. furfur. However, a single 3-minute shampoo contact followed by a prolonged recovery of 72 h revealed SYN_01 and KETO with maximal antifungal action. In contrast, herbal shampoos were as effective as synthetic options when M. furfur was subjected to 3-minute shampoo contact every 24 h with intermittent recovery. Comprehensive ingredient analysis revealed the robust antifungal activity in SYN_01 was probably because of the presence of various surfactants, allergens and a potent synthetic antifungal agent, Piroctone olamine. This study experimentally demonstrates that herbal shampoos are as effective as synthetic options in managing M. furfur-induced dandruff when applied consistently. The findings highlight the importance of regular scalp cleansing for dandruff management and provide valuable insights into the antifungal potential of both herbal and synthetic formulations.
... Overcrowding, inadequate personal cleanliness, and a warm, humid environment are all perfect conditions for Malassezia growth. Males are more likely than females to have dandruff, which affects 5% of the population and often appears after puberty [1,2] . Dandruff can be categorized as either a skin scaling disorder or a sebaceous gland disorder. ...
... The complex causes of dandruff include excess sebum secretion from the sebaceous glands, hormonal imbalance, and excessive proliferation of Malassezia species in the scalp. The viable numbers of these yeasts reportedly increase 1.5-2-fold in numbers when dandruff is present [2]. These species degrade triglycerides in the sebum to produce oleic acid, which is absorbed into the stratum corneum. ...
... [2] Ketombe adalah kelainan kulit kepala umum yang mempengaruhi hampir separuh penduduk dunia usia pubertas dan pada setiap gender maupun etnis. [3] Faktor predisposisi ketombe lainnya adalah suhu tinggi, kelembapan tinggi atau faktor endogen seperti kulit berminyak, keringat yang berlebihan, hiperproloferasi epidermis, keturunan, stress, pengobatan imunosupresif dan penyakit sistemik. [2] Prevalensi ketombe didunia yakni mencapai 50% dari keseluruhan populasi dunia. ...
Indonesia memiliki iklim tropis dan kelembapan yang tinggi sehingga membuat potensi tumbuhnya ketombe yang disebabkan oleh jamur Pityrosporum ovale semakin tinggi. Lengkuas merah memiliki senyawa eugenol, sedangkan minyak zaitun memiliki senyawa fenolik yang berfungsi sebagai antifungi. Tujuan dari penelitian ini untuk mengetahui efektivitas kombinasi ekstrak rimpang lengkuas merah dan minyak zaitun sebagai antijamur Pityrosporum ovale. Penelitian ini merupakan penelitian eksperimental, proses esktraksi lengkuas merah menggunakan metode maserasi dengan pelarut n-heksan. Uji daya hambat pertumbuhan jamur Pityrosporum ovale dengan metode difusi menggunakan paper disc. Kombinasi ekstrak rimpang lengkuas merah dan minyak zaitun yaitu P1 (25%:75%), P2 (75%:25%), P3 (50%:50%), P4 (100%:0%), P5 (0%:100%), kontrol positif (ketoconazole 2%) dan kontrol negatif (DMSO 1%). Data berupa zona hambat dianalisis menggunakan one way ANOVA dan dilanjutkan dengan uji Pos-hoc LSD. Program statistic yang digunakan adalah SPSS 24.0 dengan taraf signifikansi 95%. Hasil penelitian menunjukkan bahwa kombinasi ekstrak n-heksan rimpang lengkuas merah dan minyak zaitun efektif sebagai antijamur Pityrosporum ovale (p < 0,05). Kombinasi ekstrak n-heksan rimpang lengkuas merah 75% dengan minyak zaitun 25% (P2) paling efektif sebagai antijamur Pityrosporum ovale dengan zona hambat 11,14 mm (kriteria hambat kuat).
... Dandruff, or pityriasis capitis (seborrheic dermatitis of the scalp), tends to persist despite a variety of treatments [1]. It is characterized by increased scalp scaling, aggravated by factors such as sun exposure, genetic predispositions affecting the epidermal barrier, and dryness [2][3][4]. Winter conditions often exacerbate dandruff due to low relative humidity, while indoor heating systems further deplete moisture and increase air pollution. Persistent dryness leads to the buildup of dead skin cells, contributing to dandruff [5]. ...
Scalp dandruff, a prevalent dermatological condition marked by flaking and itching, affects a large segment of the population. Sun exposure, genetics, and dryness, along with winter conditions, indoor heating, and hard water, all contribute to moisture loss and scalp imbalance. This study aimed to evaluate the safety,
efficacy, and tolerability of a novel regimen combining a scalp scrub with hydroxy acid derivatives for exfoliation and dandruff removal, and a serum containing copper tripeptide-1, witch hazel (Hamamelis virginiana), hesperidin, hyaluronic acid, and pea protein (Pisum sativum) for hydration and scalp health. This prospective, interventional, open-label, single-center study assessed the safety, efficacy, and in-use tolerability of a scalp scrub and serum regimen for mild to moderate dandruff. Ethical approval was granted by ACEAS - Independent Ethics Committee and all participants provided written consent. The study evaluated changes in Adherent Scalp Flaking Score (ASFS), scalp hydration with the Corneometer® CM 825,
hair thickness, hair density, and scalp condition using CASLite Nova. Scalp appearance and treatment usage perception were evaluated on day 1, day 8, and day 15. Statistical analysis was conducted using SPSS Statistics v29.0.1.0 (IBM Corp., Armonk, NY) and Microsoft Excel 2019, with results reported as p-values and
95% confidence intervals (CI).
The ThriveCo scalp regimen (scalp scrub + serum) has been demonstrated to be both effective and safe in treating and reducing scalp dandruff in healthy adults. The regimen significantly reduced ASFS by effectively removing visible scalp flakes from day 1 to day 15 with continuous use. Furthermore, the kit improved overall scalp condition, increased skin hydration, and enhanced the scalp's appearance. The components include scalp scrub with hydroxy acid derivatives for exfoliation and dandruff removal, and a serum containing copper tripeptide-1, Hamamelis virginiana, hesperidin, hyaluronic acid, and pea protein (Pisum sativum) for hydration and overall scalp health over the 15-day treatment period. The synergistic effects of
this regimen work to clear visible dandruff flakes, reduce adherent scalp flaking, rejuvenate the scalp, and simultaneously strengthen the hair.
... The exact pathogenesis of dandruff remains uncertain [8]. Studies have shown that increased colonization of Malassezia spp., a normal skin flora, in dandruff lesions induces inflammation and disrupts the epidermis [8][9][10][11][12]. Malassezia spp. ...
Butterfly pea flower (Clitoria ternatea) may serve as an alternative anti-dandruff treatment; however, its effects on Malassezia spp. remain unexplored. The aim of this study was to explore the effects of C. ternatea as an herbal-based anti-dandruff treatment on Malassezia spp. DNA expression, plakoglobin levels, IL-8 levels, sebum levels, dandruff severity scores, adverse effects, and patient satisfaction. An experimental study with a pretest-posttest control design was conducted at Outpatient Clinic of Dermatology and Venereology, Arifin Achmad Hospital, Pekanbaru, Indonesia, from November 2023 to January 2024. The flower of C. ternatea was used to formulate the shampoo. The study involved 70 female patients aged 18–25 with dandruff, who were divided into two groups: (a) experimental group using 20% C. ternatea shampoo; and (b) control group using 2% ketoconazole shampoo. The present study found that 2% ketoconazole shampoo significantly reduced Malassezia spp. DNA expression compared to 20% C. ternatea shampooo (Clitoria ternatea: ΔCq=1.76±3.18; ketoconazole: ΔCq=3.77±2.90; p=0.008). No significant difference was observed in plakoglobin levels (C. ternatea: ΔCq=1.98±3.63; ketoconazole: ΔCq=2.50±2.36; p=0.427) or IL-8 levels (C. ternatea: ΔCq=3.46±4.00; ketoconazole: ΔCq=4.16 ± 3.62; p=0.459). C. ternatea significantly reduced sebum levels more than ketoconazole (C. ternatea: 1.16±0.98%; ketoconazole: 0.22±0.38%; p<0.001). Dandruff scores and patient satisfaction were similar for both shampoos (p=0.115 and p=0.336, respectively). Adverse effects were more common in the 2% ketoconazole shampoo group, affecting 21.2% of the patients. In conclusion, 2% ketoconazole shampoo is more effective in reducing Malassezia spp. DNA expression, while 20% C. ternatea shampoo offers better sebum control. Both shampoos are similarly effective in ameliorating dandruff severity and are well-tolerated, with fewer adverse effects reported for C. ternatea.
... During dandruff, the levels of Malassezia increase by 1.5 to 2 times its normal level. [9] Oleic acid penetrates the top layer of the epidermis, the stratum corneum, and evokes an inflammatory response in susceptible people which disturbs homeostasis and results in erratic cleavage of stratum corneum cells. The main symptoms of dandruff are an itchy scalp and flakiness. ...
Background: Dandruff is a common skin condition that mainly affects the scalp. Almost half of the population at the pre-pubertal age and of any gender and ethnicity will be affected. It was discovered that the responsible agent is a scalp specific fungus, Malassezia globosa. Karnasphotha (Cardiospermum helicacabum Linn.) commonly known as Balloon vine from Sapindaceae family is traditionally used for dandruff. So here an attempt is made to study the in vitro efficacy of Karnasphota (Cardiospermum helicacabum Linn.) decoction against dandruff. Aims and Objectives: In vitro Antidandruff activity of Karnasphota Mula and Beeja by Agar cup method and Biocidal activity. Methodology: In vitro Antidandruff activity of Karnasphota (Cardiospermum helicacabum Linn.) Bija and Mula Kwatha against dandruff by – Agar cup method and Biocidal activity. Result: The Karnasphotha Moola showed good antidandruff activity against Malassezia furfur in different concentrations. Whereas Karnasphotha Beeja showed no antidandruff activity against Malassezia furfur in any concentrations. Conclusion: The Karnasphotha Moola is having significant Antidandruff properties.
... It is mostly caused by Fungi like Malassezia, Candida, and Tinea. Nowadays a lot of shampoos and agents are developed as a treatment for dandruff, which includes Ketoconazole, coal tar, climbazole, etc. 1 Although, the resistance to these drugs is a concerning issue along with the chemical bases used which can be damaging to the scalp. This raises a need for the use of natural products embedded with equally efficient anti-dandruff mechanisms. ...
Introduction: Nanoparticles are being used commercially to enhance the effects on the products for better results. Silver nanoparticles are gaining popularity due to their wide range of applications considering their antimicrobial and antifungal properties. This research work uses a quick and ecological method for formation of green synthesized silver nanoparticles and its application as an anti-dandruff shampoo. Methods: Synthesis of silver nanoparticles from Citrus limon and Allium cepa aqueous peel extracts of 5mM and 10mM concentration. Characterization of the nanoparticles was done by FTIR (Fourier transform infrared spectroscopy), SEM (Scanning electron microscopy) and UV-spectroscopy. The formulation of herbal shampoo was carried out. The physical evaluation and antifungal properties (disc diffusion method) of the formulation were determined. Results: UV-spectroscopy showed peaks at a range of 350-450 nm for both nanoparticles after 24hrs and 1 week. SEM analysis showed particle morphology of spherical shape in a range of 30-100nm for both Lemon and Onion nanoparticles. FTIR identified functional groups present in nanoparticles which showed presence of O–H, C=C and C–Br for Citrus limon nanoparticles and HO-H bending in Allium cepa nanoparticles along with OH, C-Br and C-O groups. These nanoparticles were used to formulate an anti-fungal herbal shampoo using Meethi, Amla, Reetha and Shikakai extracts and anti-fungal activities were studied against the fungi Candida balantits and Candida albicans. The nanoparticles and nanoparticles incorporated shampoo formulation exhibited significant zone of inhibition stating its effectiveness against dandruff causing fungi. Conclusion: The current study included the formulation of an anti-dandruff shampoo with reduced usage of silver nitrate, thereby less quantity of nanoparticles, hence decreasing the risk of toxicity.
... As a result, Se supplementation has several positive benefits on stress, inflammation, and reproduction in women with PCOS72. Additionally, Se sulfide supplementation has several benefits for dermatology [73]. In rats with diabetes, inducing Se deficiency causes a significant rise in plasma glucose levels [74]. ...
Polycystic Ovary Syndrome (PCOS) is now a commonly occurring endocrine-metabolic condition. Symptoms of PCOS include hyperandrogenism, hirsutism, and menstrual irregularities. Dietary intake is a modifiable risk factor and can be modified to prevent or manage PCOS. In this review, we aimed to summarize the current evidence for various dietary patterns and nutrients that have been studied in association with PCOS or the symptoms of PCOS. In addition, we have also summarized the existing evidence on probiotics in relation to PCOS. The dietary patters of interest are low-carbohydrate diet, Mediterranean diet and intermittent fasting. The nutrients of interest are inositol, selenium, vitamin D and omega-3 fatty acids. Extensive literature review was conducted through PubMed/MEDLINE, Scopus, and Web of Science. Our review identified that dietary patterns including low-carbohydrate diets, the Mediterranean diet, and intermittent fasting, nutrients like inositol, vitamin D, probiotics, omega-3 fatty acids, and selenium, and probiotics seem to offer benefits for PCOS symptoms such as hormone level improvement, better glycemic control, enhanced insulin sensitivity, improved lipid levels, and reduced inflammation. Therefore, it has been shown that in addition to pharmacotherapy, dietary modifications and supplements can be effective adjunct therapy for PCOS.
... It mostly occurs after pubertal age in both genders. Persons experience itching, irritation, and redness in the scalp accompanied by flaking of dead cells either normal or high [16]. ...
Products used for hair care by humans are essential for cleaning, protection, perfuming, and beautification. These are applied directly on the skin and can be a potential factor for dermal exposure to toxic metals. The present research deals with the assessment of heavy metals in the hair care products available in the local markets of Karachi, Pakistan. A total of 20 brands of shampoo and 05 brands of conditioners were collected in triplicate and analyzed for 10 heavy metals (Fe, Mn, Cr, Ni, Cu, Co, Pb, Cd, Zn, and Hg) by atomic absorption spectrophotometer. Toxic metals were found to be higher in conditioner than in shampoo of respective color and brand. Ni and Zn concentrations have exceeded the maximum permissible limits. Consumers belonging to the lower class are more vulnerable to heavy metals exposure because of the high metal content in low-cost products. These results suggested that hair care products should also be considered as one of the sources of heavy metals exposure.
... This condition affects a significant portion of the population worldwide, with estimates suggesting that up to 50% of adults experience dandruff at some point in their lives. Despite its prevalence, the exact etiology of scalp dandruff remains unclear, with factors such as excessive sebum production, fungal colonization by Malassezia species, and individual susceptibility playing potential roles [1][2][3][4][5]. ...
Introduction
Scalp dandruff is a common dermatological condition characterized by flaking and itching of the scalp, affecting a significant portion of the population. Effective assessment methods are crucial for evaluating treatment outcomes. This study aimed to establish the reliability and correlation of three assessment techniques: Adherent Scalp Flaking Score (ASFS), phototrichogram using CASLite Nova, and the 60-second hair combing test.
Methods
This open-label, single-arm, single-center, prospective clinical study enrolled 12 adult subjects with mild to moderate dandruff. Evaluations were conducted before and after a standardized hair-wash intervention using three methods: ASFS, phototrichogram using CASLite Nova, and the 60-second hair combing test. The primary objective was to establish correlations between these assessment techniques. Inter-evaluator and inter-operator reliability were assessed using Fleiss Multirater Kappa.
Results
Significant reductions in dandruff were observed across all methods post-hair wash. The ASFS decreased from 23.67±2.06 at baseline to 6.67±4.46, showing a mean reduction of 17.00±5.22 (71.40%, p<0.001). phototrichogram analysis revealed that 60.42% of the total (n=96) scalp zones assessed were in normal condition post-hair wash compared to none at baseline. The 60-second hair combing test showed a reduction in non-adherent flakes, with 58.33% of subjects displaying light flakes and 41.67% showing no flakes post-hair wash. The chi-squared test indicated a significant association (p<0.001) between ASFS and phototrichogram results. Inter-evaluator variability for ASFS and the hair combing test demonstrated substantial agreement (Kappa=0.692 and 0.637, respectively, p<0.0001). Inter-operator reliability for phototrichogram also showed substantial agreement (Kappa=0.746, p<0.0001).
Conclusion
The study confirms the reliability and consistency of ASFS, phototrichogram, and the 60-second hair combing test in assessing scalp dandruff. The significant correlations of ASFS and phototrichogram via CASLite Nova validate their use in clinical settings. Comprehensive training for evaluators and operators is essential to achieve reproducible and accurate results. These findings provide a robust framework for future studies and clinical assessments of scalp dandruff.
... Balancing efficacy with cosmetic side effects is crucial for ensuring patient adherence to the treatment regimen. 9 Recognizing the need to maintain hair cosmesis while effectively treating dandruff has spurred the development of next-generation dandruff shampoos. These newer formulations involve the advantage of newer generation imidazole based on botanical conditioning that aim to mitigate the cosmetic side effects, such as hair damage and scalp irritation, while still providing robust antifungal action to manage dandruff symptoms effectively. ...
Azole antifungal agents are effective agents for treating scalp ailments such as seborrheic dermatitis. Luliconazole (LZ) is a new azole with unique effects against clinically important dermatomycotic fungi. This study examines the impact of different topical formulation of Luliconazole vs Ketoconazole (KZ) on damaged hair cuticle repair after 5 and 10 washes, using SEM images and sensory Analysis.
In this in-vitro study,twelve damaged hair tresses were divided into two groups, and treated with LZ and KZ formulations. Both groups underwent pretreatment with 20% Sodium Laureth sulfate (SLES) and damage induction using 9% HO and 20% ammonium solution, followed by respective LZ (Lupizol ZS, manufactured by Lupin Ltd, India) and KZ therapies. SEM imaging and expert sensory analysis were conducted at baseline, after 5, and 10 washes to evaluate surface characterization like cuticle upliftment, smoothness, and softness.
After five washes, LZ-treated hair exhibited smooth, intact cuticles with no upliftment, improving to grade 1 cuticle damage. In contrast, KZ-treated hair continued to show substantial upliftment without damage grade improvement. After ten washes, LZ maintained grade 1 damage and 0 µm upliftment, while KZ-treated strands persisted in showing considerable cuticular distress. Sensory analysis supported these results, with LZ improving hair smoothness and softness by 2.42x and 2.72x respectively, after ten washes, significantly outperforming KZ. Visually, LZ-treated hair appeared smoother and healthier, indicating its greater effectiveness in enhancing hair integrity post-washing.
The botanical conditioner-based formulation of LZ is more efficacious in enhancing hair integrity post-washing compared to the Ketoconazole formulation. Well-controlled human studies are required to further establish the clinical effects on human participants.
... It often leads to the presence of white or yellowish flakes, itchiness, and scalp irritation [1]. Dandruff is primarily characterized by an overgrowth of the yeast-like fungus Malassezia [10-12], which triggers an immune response, including inflammation [1,13], leading to increased cell turnover [14] and shedding of dead skin cells from the scalp, resulting in the formation of visible flakes and scalp irritation [1]. ...
Background
Probiotics are intellectually rewarding for the discovery of their potential as a source of functional food. Investigating the economic and beauty sector dynamics, this study conducted a comprehensive review of scholarly articles to evaluate the capacity of probiotics to promote hair growth and manage dandruff.
Methods
We used the PRISMA 2020 with Embase, Pubmed, ClinicalTrials.gov, Scopus, and ICTRP databases to investigate studies till May 2023. Meta-analyses utilizing the random effects model were used with odds ratios (OR) and standardized mean differences (SMD).
Result
Meta-analysis comprised eight randomized clinical trials and preclinical studies. Hair growth analysis found a non-significant improvement in hair count (SMD = 0.32, 95 % CI -0.10 to 0.75) and a significant effect on thickness (SMD = 0.92, 95 % CI 0.47 to 1.36). In preclinical studies, probiotics significantly induced hair follicle count (SMD = 3.24, 95 % CI 0.65 to 5.82) and skin thickness (SMD = 2.32, 95 % CI 0.47 to 4.17). VEGF levels increased significantly (SMD = 2.97, 95 % CI 0.80 to 5.13), while IGF-1 showed a non-significant inducement (SMD = 0.53, 95 % CI -4.40 to 5.45). For dandruff control, two studies demonstrated non-significant improvement in adherent dandruff (OR = 1.31, 95 % CI 0.13–13.65) and a significant increase in free dandruff (OR = 5.39, 95 % CI 1.50–19.43). Hair follicle count, VEGF, IGF-1, and adherent dandruff parameters were recorded with high heterogeneity. For the systematic review, probiotics have shown potential in improving hair growth and controlling dandruff through modulation of the immune pathway and gut-hair axis. The Wnt/β-catenin pathway, IGF-1 pathway, and VEGF are key molecular pathways in regulating hair follicle growth and maintenance.
Conclusions
This review found significant aspects exemplified by the properties of probiotics related to promoting hair growth and anti-dandruff effect, which serve as a roadmap for further in-depth studies to make it into pilot scales.
... lack fatty acid synthase genes; hence, they satisfy their obligate need for fatty acids by secreting multiple lipases that metabolize triglycerides in sebaceous lipids on the scalp surface to release free fatty acids [3,4]. These free fatty acids also act as skin irritants and induce inflammatory responses that are typical of dandruff [5]. ...
Background: Selenium sulfide, available as a shampoo or topical lotion at 1%, or 2.5% concentrations in India, is used as a topical antiseborrheic and antifungal for the treatment of dandruff, seborrheic dermatitis, psoriasis, and tinea versicolor. In the present study, the safety, efficacy, and attributes of 2.5% selenium sulfide shampoo were evaluated in Indian participants with dandruff.
Methods: A single-center, single-arm, prospective, investigator-initiated, open-label, post-marketing interventional study was conducted on Indian subjects aged 18-70 years diagnosed with moderate dandruff who were prescribed 2.5% selenium sulfide shampoo every three days for four weeks. The primary endpoints were 1) reduction in total dandruff score assessed using a clinical grading scale for adherent and loose dandruff from baseline to weeks 1, 2, and 4, and 2) incidence of adverse events up to the end of the study. The key secondary endpoints were 1) participants’ perception of shampoo attributes (dandruff reduction, scalp itch, scalp oiliness/greasiness, or fragrance) as assessed by a subjective self-assessment questionnaire post-first wash and at weeks 1, 2, and/or 4; 2) satisfaction with treatment as assessed by investigators and participants using a subjective self-assessment questionnaire at week 4; and 3) reduction in scalp sebum as assessed with a meibometer at weeks 2 and 4. Statistical analysis was performed using the Wilcoxon signed-rank test for continuous variables and the Chi-square test for categorical variables. A p-value of 0.05 was considered to be statistically significant.
Results: Of 34 enrolled subjects, 30 completed the four-week study. The mean (standard deviation, SD) age of the study participants was 29.8 (7.87) years, with the majority being females (n=18; 60.0%). Mean (SD) total dandruff score significantly (p=0.001) reduced from a baseline score of 11.5 (2.15) to 7.17 (2.12) at week 1, 4.93 (1.72) at week 2, and 2.5 (1.17) at week 4. All the participants reported dandruff reduction and acceptable fragrance of the shampoo at four weeks. Absence of itching and reduction in oiliness was reported by 73.3% (n=22) of participants at week 4 and by 50.0% (n=15) of participants at week 2, respectively. All participants reported good, very good, or excellent satisfaction with the test shampoo at week 4, whereas the investigators rated the shampoo as very good or excellent in managing dandruff in all participants. At week 4, erythema was reported to be absent in all participants. No adverse events were reported during the study.
Conclusions: The 2.5% selenium sulfide shampoo was found to be effective in the management of dandruff and related symptoms like itching, oiliness, and greasiness and had a good safety profile in Indian participants with dandruff.
... The conventional treatment for dandruff includes antifungal shampoos, such as ketoconazole, zinc pyrithione, or selenium sulfide, which aim to reduce the fungal growth and inflammation. However, these shampoos may have limited efficacy, side effects, or resistance [22]. ...
This review article examines the role of essential oils in hair health. Essential oils, derived from plants, are noted for their biological properties, including anti-inflammatory and antioxidant effects. They have gained popularity in hair care for their potential benefits, as hair is not only crucial for physical appearance but also for personal identity and expression. Traditional hair care products like minoxidil and shampoos may have drawbacks such as limited effectiveness, side effects, or high costs. Consequently, essential oils are being considered as natural alternatives, claimed to stimulate hair growth, prevent hair loss, and improve hair quality. However, scientific research on essential oils for hair health is scarce and inconclusive. The outcomes of essential oil treatments can vary based on factors like oil type, concentration, application method, and individual hair conditions. Risks such as allergic reactions and skin irritation are possible. The review aims to critically assess the current literature on essential oils for hair health. Topics include the molecular mechanisms of essential oils, their efficacy compared to conventional products, and optimal usage methods. The review also explores the psychological effects of essential oils on hair health and identifies areas for future research.
... It may be a yeast causing fungal infection on skins and scalp. It occurs when person not brushing hair, allergy, stress, not showering enough etc. [10,11] 5. Telogen effluvium : Telogen effluvium (TE) is a common cause of non-scarring hair loss which is usually precipitated by physiological stress such as childbirth or sudden weight loss [12]. 6. Tiniea capitis : It is also known as scalp ringworm, commonly occurs in children. ...
Hair plays a vital role in optimizing the personality of an individual as the hair is the primary noticeable part of external body and beauty for Women as well as men. The hair and scalp nature have important psychological impact on human societies. Even small changes in hairs like hair fall, whitening or greying of hair affect the self-confidence and self-esteem of an individual. For preventing and fighting against the hair problems, herbal hair scrub serves as an effective remedy. The goal of present review article is to highlights efficacy of herbal drugs on hair loss and also outlined that prevention and treatment can easily done by formulating hair scrub from those herbal drugs
... Selenium sulphide, ketoconazole, salicylic acid, sulfur, zinc pyrithione, tar, ciclopirox, clobetasol, pirolactone olamine. [11,15] Colourants and perfumes ...
Shampooing is a universal daily hair care routine in this modern era. In todays’ market, shampoo products have been advertised and commercialized for different purposes and grades like medicated, professional, baby, or regular shampoo for everyday use. These shampoos typically contain a range of core ingredients, such as, surfactants, foaming agents, conditioners, pearlescent agents, sequestrants, pH adjuster, antidandruff agents, colorants, perfumes, and preservatives. Most of these ingredients present in shampoos are synthetically made. For example, diethylamine, triethylamine, cocamide diethanolamine and some other by-products like 1,4-dioxane. Although regulatory agency has controlled the application of these synthetic ingredients in cosmetics, they are still capable of being dermally absorbed and elicit allergic reactions, skin irritation, contact dermatitis below restricted concentrations. Prolonged exposure to these synthetic ingredients is also associated with carcinogenicity and mutagenicity. This review mainly focuses on elucidating the common synthetic ingredients used in the shampoo formulation, their functions and their potential health risks following long term exposure.
... In our experience, the amounts of dandruff on the scalp and in the hair do not always correlate. (Ranganathan et al., 2010). ...
Now days, there are many problems for humans. On top of that, hair fall is a major problem noticed by teenagers. One of the main reasons for hair fall is dandruff and body heat. So, dandruff is caused by the fungus Malassezia species, and for that problem, we have a simple solution to tackle it. Rice water is a simple and effective solution for this hair fall problem. The fungal sample was isolated and identified and prepare a shampoo using rice water as a major source. Total carbohydrate and protein was determined. The prepared antifungal shampoo was tested using the well-diffusion method against the fungus Malassezia sps, which causes dandruff. The prepared rice water shampoo gives a positive result and has a high zone of inhibition against the Malassezia species. The antifungal activity was performed on the Malassezia species and shows the best result.
... Para-keratotic cells often make a part of dandruff their numbers are related to the severity of the clinical manifestation which may also be influence by seborrhoea. 2 The severity of the illness ranges from mild to severe, and it might have an erythroderma or pityriform pattern. 3 SD is one of the most prevalent skin symptoms in HIV and AIDS patients. ...
Dandruff which is also known as Huzāz/Abriya/Bafā' in Unani Medicine is one of the common ailments of scalp disorders in the world. The review gives an insight of the scalp condition which affects more than 50% of the population. This article aims at giving the etiopathology and management of the Dandruff in the Modern as well as the Unani system of Medicine. The paper also highlights some adverse effects of prolonged use of Conventional Medicine. However, the objective of this report is to review the Unani preventive measures and management of Huzāz (Dandruff) with some specific single and compound Unani formulations along with Unani Regimenal Therapies (Ilāj bi'l Tadbīr). This report concluded that the advantages of pursuing/adapting the Unani management is cost effective, easily available and having lesser or almost no side effect with these herbal approaches.
... Dandruff is a skin condition that mainly affects the scalp, symptoms with of flaking, and sometimes mild itchiness (Elewski 2005;Grimalt 2007;Borda and Wikramanayake 2015;Abbas et al. 2016). Nits are easily grown in dandruff due to their coverage by the epithelial layer; they can be prevalent in ripening in dandruff flakes (Ranganathan and Mukhopadhyay 2010). The prevalence of nits and lice was observed higher in both boys and girls (55.9% and 56.15% respectively) in the non-dandruff condition during the present study (Tables 5 and 6, Fig. 3). ...
The human head louse is a hematophagous obligate ectoparasite that causes dermatitis and hair loss problems in humans especially in children. In the present survey, the data was collected from school-going children in urban and rural areas of district Hyderabad, Sindh, Pakistan from August 2018 to August 2019. A total of 1235 children were examined including 641 boys and 594 girls. The children were divided into three groups, 4–8 years old, 9–12 years old, and 13–16 years old. Overall prevalence was recorded at 25.11% for boys and 53.36% for girls. The highest prevalence of pediculosis was found in the 9–12 years old group with 34% in boys and 70% in girls. Region-wise prevalence of lice was higher in girls (51.6%) in rural Hyderabad than boys (13.5%) in the Qasimabad region, whereas the prevalence of nits was higher in girls (80%) in rural Hyderabad than boys (54%) in Hyderabad city. The Fisher’s Exact Test was used to compare the association between the conditions prevailing pediculosis and the rate of infestation in all school children, which showed higher infestation in non-dandruff (0.29), those who shared beds and combs (0.53) and those who wash hairs twice a week (0.28). A high rate of infestation was observed in girls.
... Dandruff is the most commercially exploited skin disease [35].Every population in any geographical region is affected by dandruff at some stage in life [36].Among these treatments, most frequent and effective chemical used is Ketoconazole, which is very dangerous not only for hair but also for body health causing frequent strokes of nausea, vomiting, rashes on skin, etc if used for longer period. Ketoconazole shampoo effect of long-term use result in androgenic alopecia [40]. ...
Mycotic infections are one of the major health problems in tropical countries, and Malassezia is one of the most common fungi associated with skin diseases. In immunocompromised hosts Malassezia can also cause entire systemic infections. Malassezia is a monophyletic genus of fungi found on the skin of 7 billion humans and associated with a variety of conditions, including dandruff, dermatitis, pityriasis versicolor, seborrheic dermatitis, and folliculitis. Eclipta alba leaf was tested against four common species of Malassezia. In this present investigation In-Vitro antifungal activity of Eclipta alba extract has been evaluated against Malassezia using broth micro dilution method recommended by CLSI. The minimum inhibitory concentration (MIC) of Eclipta alba leaf extract against Malassezia has been determined and their comparison have also done with-placebo-, a commercially available synthetic antifungal drugs Fluconazole and Ketoconazole. The results showed that all the test pathogens i.e. Malassezia globosa, Malassezia furfur, Malassezia sympodialis, and Malassezia restricta could be inhibited by Eclipta alba leaf extract. MIC (MIC range 0.625 to 1.25 mg/ml) of Eclipta alba leaf extract, against Malassezia was found very close to popular synthetic antifungal drugs Fluconazole and Ketoconazole and have less side effects. The antioxidant activity was also determined by means of the DPPH free radical scavenging test. Further, a modified DPPH approach is presented in this study.Based on these findings, now we can say that the formulations based on Leaf extracts of Eclipta alba and its constituents can be an alternative source for the treatment of Dandruff and Malassezia associated skin diseases.
... Dandruff is the most commercially exploited skin disease [35].Every population in any geographical region is affected by dandruff at some stage in life [36].Among these treatments, most frequent and effective chemical used is Ketoconazole, which is very dangerous not only for hair but also for body health causing frequent strokes of nausea, vomiting, rashes on skin, etc if used for longer period. Ketoconazole shampoo effect of long-term use result in androgenic alopecia [40]. ...
... Capitis refers to the location of the affection, i.e. the scalp. The word dandruff (dandruff, dandriffe) is of Anglo-Saxon origin, a combination of 'tan' meaning 'tetter' and 'drof' meaning 'dirty' [2]. Dandruff, although not regarded as one of the most serious conditions in the dermatological science, it becomes important due to its effect on the aesthetic or cosmetic effect on the individual as well the psychological factors involved with the varioussymptoms involved with this condition such as pruritus [3]. ...
... The general condition and behaviour of affected vicuñas with dandruff were apparently similar to that of the vicuñas without dandruff, as reported by Rosadio et al. (2012), however, these conditions are masked because the stress of the animals during the capture and shearing. According to the One World One Health approach, the presence of dandruff in vicuñas probably affects their behaviour and welfare, because it is known that discomfort, itching and burning sensations are common in humans (Ranganathan & Mukhopadhyay, 2010). Dandruff was observed on the fibre as skin epithelial flakes, in various forms of small greyish-white particles closely adherent to the fibre, some flakes detach from the fibre (Figure 2). ...
El objetivo de este estudio fue evaluar la presencia de caspa en la vicuña y su influencia en seis características textiles principales de la fibra de vicuña según sitio de muestreo, edad y sexo. En el modelo lineal se incluyeron cuatro factores: caspa, edad, sexo y sitio de muestreo del vellón. El estudio reveló una alta prevalencia de caspa, 20.55% en 2017 y 22.97% en 2021. La caspa comienza en la cabeza y se extiende a la parte inferior del cuello, línea dorsal, paleta y costillar medio. Se observó una reducción signi-ficativa del diámetro medio de fibra (DMF) en vicuñas adultas y hembras con caspa. En los sitios del costillar y grupa, el DMF fue más fino y homogéneo, excepto en la parte inferior del cuello, barriga, paleta y muslo, donde la fibra mostró una tendencia a engro-sarse. Además, la caspa reduce significativamente el DMF en la parte inferior del cuello, costillar anterior y central. La caspa reduce el DMF (-0.63 µm), DE (-0.52 µm), FH (-1.04 µm) e incrementa la CU (6.58 °/mm) y el FC (0.52%), mas no se afecta el CV. En conclusión, la presencia de caspa en vicuñas afecta el bienestar de los animales e influye en las cualidades textiles de la fibra, lo que afecta el comercio y los ingresos de las comunidades campesinas.
... In the late 19th century, the principal evidence which established a connection between Malassezia spp. and dandruff was their increased presence by 1.5-2 times the normal level on the skin of people suffering from dandruff (Hay, 2011;Ranganathan and Mukhopadhyay, 2010). Guillot and his colleagues (1996) reported that M. globosa, M. restricta, M. obtusa, M. sloofiae, M. sympodialis, M. furfur and M. pachydermatis are responsible for causing dandruff. ...
Dandruff is a perennial skin condition manifesting as inflammation and physiologic scaling on the scalp. Malassezia species are the part of the skin microflora of humans and the etiological agents of dandruff. Malassezia comprises of lipophilic and non-lipophilic yeasts. At present topical azoles are used for the treatment of dandruff. This study was conducted to isolate and identify the Malassezia spp. from dandruff samples and to determine their responsiveness towards antifungal agents such as fluconazole, ketoconazole, miconazole and nystatin. Malassezia spp. was isolated using selective media and identified by biochemical tests and microscopic examination. Antifungal activities were assessed by the Kirby Bauer method using well diffusion technique. Total fifteen Malassezia spp. including M. furfur, M. pachydermatis, M. sympodialis and M. globosa were identified from twenty five dandruff samples. Among them, M. furfur was most prevalent (66.67%) followed by M. pachydermatis (13.33%), M. sympodialis (13.33%) and M. globosa (6.67%). All strains were sensitive to the antifungal agents but to different extent. Fluconazole and ketoconazole proved to be the most effective agents against these microorganisms.
... ketoconazole, fluconazole etc. 11 Unlike the systemic infections, dandruff is a common scalp condition targeting people of all ages and health status. [12][13][14] The genus Malassezia is commonly associated with dandruff as opposed to the genus Rhodotorula. 15,16 Nevertheless, Rhodotorula mucilaginosa has been detected on healthy scalps 17 and reported as part of skin microbiota responsible for atopic dermatitis in humans. ...
Rhodotorula are environmental yeasts originally considered non-pathogenic in nature. However, over the last three decades, different species of this yeast have established themselves as pathogens in humans, causing systemic infections among the immunocompromised population. In this study, Rhodotorula species were isolated from dandruff samples using selective media by observing colony morphology and color. The isolates were later identified via biochemical tests and microscopic examinations. In addition, the sensitivity of the isolates to the three antifungal agents, namely ketoconazole, nystatin and fluconazole were tested by using the disk diffusion technique. On completion of the tests, only two species of Rhodotorula were identified from 35 dandruff samples and designated as R1 and R3. Both isolates displayed sensitivity towards ketoconazole and nystatin. No antifungal sensitivity was documented against fluconazole. This study gave preliminary indication of the presence of Rhodotorula species in dandruff samples, and its sensitivity towards antifungal agents.
... Gàu là một trong những rối loạn sừng hóa thường gặp nhất trên da đầu, ảnh hưởng đến hơn một nửa dân số trên toàn thế giới [1], [2]. Rối loạn này tuy lành tính, nhưng có tính chất dai dẳng, có thể ảnh hưởng đến tâm lý và chất lượng cuộc sống nếu không được chẩn đoán và điều trị đúng cách. ...
Introduction: Dandruff is one of the most commonly seen issues in Dermatology units, making patients mentally uncomfortable. Commensal fungi on the scalp, particularly Malassezia spp., play an important role on pathogenesis of dandruff. This study aims to investigate fungal species on the scalp of dandruff patients at Ho Chi Minh City Hospital of Dermato - Venereology.
Materials - Methods: This case - series study involved 99 dandruff patients at Ho Chi Minh City Hospital of Dermato - Venereology from January to May 2021, who were appointed to microscopic examination for fungal structure. Patient data were collected based on questionnaires; clinical data were recorded by the doctors. Scalp samples were inoculated into Sabouraud agar and modified Dixon agar, which is subsequently identified by fungal biochemical reactions. All data were analysed by SPSS software (version 20).
Results: 99 dandruff patients presented mostly with itchy scalp (highest proportion of 76,8%), followed by erythema (66,7%). Fungi were isolated in 73,7% of all cases, including M. globosa (41,1%), M. furfur (32,9%), M. restricta (13,7%), M. pachydermatis (9,6%), and M. sympodialis (2,7%). Itch and erythema did not show significant difference between Malassezia species.
Conclusions: Malassezia, dominantly M. globosa and M. furfur, were identified in a large number of dandruff patients.
The human scalp harbors a diverse microbial community that plays a crucial role in scalp health and disease. This study aimed to analyze the microbiome of both healthy and dandruff-affected scalps to elucidate microbial composition differences and potential associations with dandruff pathology. Samples were collected from three healthy and three dandruff-affected individuals, and the V4 region of the 16S rRNA gene and the ITS1 region were sequenced to characterize bacterial and fungal communities, respectively. Taxonomic analysis identified 5 dominant phyla and 31 genera within the samples, revealing a shift from Actinomycetota dominance in healthy scalps to Basidiomycota dominance in dandruff-affected scalps. Notably, the fungal phylum Ascomycota, including Malassezia, was also more abundant in dandruff-affected scalps. This transition emphasizes the intricate interactions among microbial communities and their potential impact on scalp health. These findings suggest specific microbial shifts are associated with dandruff, highlighting the potential for targeted therapeutic strategies that modulate the scalp microbiome to improve scalp health. Further research is needed to elucidate the specific interactions between these microbial groups and their impact on scalp health. ABSTRACT Introduction
Objective
Dandruff is a common scalp condition characterized by the chronic shedding of large clumps of epidermal cells. Alongside negative physical symptoms, dandruff is thought to have a detrimental impact on individuals' mental health. The aim of this study was to determine whether the clinical benefits of using an anti‐dandruff shampoo (ADS) will result in improved psychological wellbeing in individuals suffering from dandruff. Further, this study aimed to investigate whether this improvement would manifest in changes in self‐esteem and confidence behaviours.
Methods
A 4‐week dandruff reduction intervention was implemented using a Piroctone Olamine ADS formulation. The control group continued to use their non‐ADS. Self‐evaluation metrics, including the Scalpdex, State Self‐Esteem Scale and self‐perceived hair and scalp characteristics questionnaires, were employed to measure changes in self‐perceptions of hair and scalp health and psychological wellbeing. Following this analysis, the dataset was then combined with unpublished internal data of a similar intervention study using a Zinc Pyrithione ADS formulation. A mediation analysis was conducted on the combined data to examine the relationship between dandruff symptoms, emotions, and overall behavioural functioning.
Results
First, the ADS effectively reduced the clinical symptoms of dandruff. Second, Scalpdex scores indicated that the use of ADS, compared to non‐ADS, lessened the adverse effects of dandruff on symptom perception and emotional distress. Third, the impact of dandruff on behavioural functioning diminished over time, and measures of confidence, scalp comfort and scalp health improved over time, irrespective of product type. Fourth, there was no change in measures of self‐esteem for either shampoo. Subsequently, the mediation analysis revealed that across both studies, ADS treatment improved symptoms, emotional wellbeing, and functioning ratings on the Scalpdex questionnaire. Importantly, it also found that improvements in physical symptoms of dandruff improved behavioural functioning indirectly, via its mediating effect on scalp‐related emotional wellbeing.
Conclusions
This study demonstrated that reducing dandruff's physical symptoms directly enhanced emotional well‐being related to scalp and hair, and indirectly improved overall daily functioning. These findings suggest that addressing dandruff symptoms not only increases physical comfort but also positively impacts individuals' mental and emotional health, and their ability to function in their daily lives.
Hair care products are widely used to maintain the health, appearance, and condition of hair. Despite their daily use, these products are either unregulated or lightly regulated in many countries. The manufacturer is responsible for ensuring the safety and effectiveness of the products before releasing in the market.
Even though most products use approved ingredients, people can still have specific sensitivities to certain ingredients or combinations. With the increasing availability and use of these products, such sensitivities are becoming more common. This makes it essential to adopt thorough methods to ensure product safety and effectiveness.
This chapter will provide a detailed summary of how to assess the safety and effectiveness of ingredients and finished products. It will include new alternative methods to animal testing, such as in vitro (test tube), ex vivo (outside a living organism), and 3D cell models. It will also cover techniques for evaluating product sensory performance and functional benefits through instrumental measurements and user feedback, helping to create a comprehensive product assessment strategy.
Essential oils are among the most well-known phyto-compounds, and since ancient times, they have been utilized in medicine. Over 100 essential oils have been identified and utilized as therapies for various skin infections and related ailments. While numerous commercial medicines are available in different dosage forms to treat skin diseases, the persisting issues include their side effects, toxicity, and low efficacy. As a result, researchers are seeking novel classes of compounds as substitutes for synthetic drugs, aiming for minimal side effects, no toxicity, and high efficacy. Essential oils have shown promising antimicrobial activity against skin-associated pathogens. This review presents essential knowledge and scientific information regarding essential oil’s antimicrobial capabilities against microorganisms that cause skin infections. Essential oils mechanisms against different pathogens have also been explored. Many essential oils exhibit promising activity against various microbes, which has been qualitatively assessed using the agar disc diffusion experiment, followed by determining the minimum inhibitory concentration for quantitative evaluation. It has been observed that Staphylococcus aureus and Candida albicans have been extensively researched in the context of skin-related infections and their antimicrobial activity, including established modes of action. In contrast, other skin pathogens such as Staphylococcus epidermidis, Streptococcus pyogens, Propionibacterium acnes, and Malassezia furfur have received less attention or neglected. This review report provides an updated understanding of the mechanisms of action of various essential oils with antimicrobial properties. This review explores the anti-infectious activity and mode of action of essential against distinct skin pathogens. Such knowledge can be valuable in treating skin infections and related ailments.
Graphical Abstract
Scalp scrub is usually used to treat problems like dead skin cells, dandruff, and flakes, and also controls sebum imbalance which helps to regulate hair growth. This article contains how aloe vera juice, fenugreek granules, rice powder, neem extract, hibiscus dried powder, optiphen, and lemongrass oil are used in scalp scrub. The properties of natural ingredients play an important role in removing impurities from the scalp and help exfoliate the scalp, balance the sebum, and soften and moisturize the scalp.
A BSTRACT
Background
Wood apple ( Limonia acidissima ) has been reported to possess various pharmacological activities. The present study aimed to evaluate the 11 selected constituents of Wood apple ( L. acidissima ) as potent anti-dandruff and anti-acne agents using a molecular docking approach.
Materials and Methods
The 11 selected constituents of Wood apple were studied on the molecular docking behavior of Malassezia globosa Lipase-1 and Cutibacterium acnes beta-keto acyl synthase-III enzymes by using the patchdock method. Furthermore, STITCH analysis was carried out to determine the ligand-protein interactions. STITCH analysis reveals that two ligands, namely, psoralen and umbelliferone, have exhibited interactions with both the M. globosa and P. acnes KPA 171202 proteins.
Results
The docking studies revealed that isopimpinellin and saponarin exhibited the highest (ACE) atomic contact energy (−162.32 and − 318.63 kcal/mol) with that of M. globosa Lipase-1 and C. acnes beta-ketoacyl synthase-III, respectively.
Conclusion
Thus, the present finding provides new knowledge for understanding the 11 selected ligands of Wood apple ( L. acidissima ) as potent anti-dandruff and anti-acne agents.
Background
Wet-looking hairstyles that last for hours can be achieved using anti-dandruff hair gel. Natural components are included in the unique recipe of the gel to aid in dandruff treatment. Anti-dandruff hair gel is a preparation with antibacterial and antifungal activity that reduces dandruff and improves hair health.
Materials and Methods
Five different formulations contain effective ingredients, such as Linum usitatissimum , Ocimum tenuiflorum , Lawsonia inermis , Tinospora cordifolia , and Centella asiatica , which exert their effects by showing antibacterial and antifungal activity.
Results
The prepared hair gel was evaluated using parameters such as color, odor, homogeneity, texture, pH, viscosity, spreadability, washability, extrudability, stability, zone of inhibition, and in vitro skin irritation tests. By considering all the parameters, we conclude that our formulations exhibit better anti-dandruff activity. The overall experiment showed that the F2 formulation had more antibacterial activity and the F3 formulation had antifungal activity.
Conclusion
The prepared anti-dandruff hair gel effectively combats the problem. Therefore, this hair gel may be preferable to other standard hair-setting or styling gels.
Background
Ethiopia is a country located in the Horn of Africa, which combines richness in plant resources and cultures of human plant use. The people of Habru District of North Wollo Zone (Amhara Region, Ethiopia) have a long history of use of plant resources for various purposes including in traditional herbal remedy preparation and use. However, the district has not been adequately studied for its ethnobotanical resources and the associated knowledge. This study focused on human medicinal plants and their traditional uses in Habru District. The objective of the study was to document and analyze the plant species used by the local communities to treat human ailments along with the associated traditional knowledge and practices.
Methodology
The study was carried out in Habru District from June 2021 to December 2022. Ethnobotanical data were collected using semi-structured interviews, guided field walks, 13 focus group discussions (one at the district level and 12 at the kebele/subdistrict level) and market surveys. A total of 388 informants (250 males and 138 females) were selected from all 13 kebeles within Habru District using systematic random sampling, and 42 key informants were purposively selected. Descriptive statistics, preference ranking, direct matrix ranking, informant consensus factor and fidelity level were applied for data analysis.
Results
The results provide insights into the medicinal plant diversity within Habru District, where 134 plant species in 110 genera and 54 families were documented, including 2 endemics, highlighting the district’s significance in biodiversity conservation and healthcare delivery. Disease prevalence analysis showed that gastrointestinal and parasitic ailments (ICF = 0.85), febrile diseases (ICF = 0.84), and culture-related conditions exhibit high informant consensus factors. Remedy preparation involves various plant parts, predominantly leaves (47.3%), followed by roots (22.1%), fruits (7.0%), and seeds (5.8%). Freshly harvested plant parts were frequently used (58.2%), while 24.7% involved both dried and fresh parts. Oral application (47.3%) and topical use (31.8%) are the major routes of remedy administration. The marketability of medicinal plants was evident, with 16.4% of the species reported as marketable, including Terminalia brownii Fresen. Myrtus communis L., Ruta chalepensis L., Olea europaea L. subsp. cuspidata (Wall. & G.Don) Cif., Allium sativum L. and Capsicum annuum L. Multipurpose plants such as Solanum somalense Franchet. (91.3% FL), Ocimum lamiifolium Hochst. ex. Benth. (88.9% FL), and Verbascum sinaiticum Benth. (85.7% FL) exhibited notable healing potentials.
Conclusion
The current study underscores the intricate relationship between the local community and medicinal plants, emphasizing the importance of biodiversity conservation and health care and acknowledging the dynamic interplay between cultural heritage and ecosystem health. The results contribute to the development of sustainable conservation strategies, healthcare practices and the preservation of traditional knowledge, and highlight the interdependence of human societies and their natural environments. Community-based conservation initiatives with active participation of local communities are desirable for the conservation and sustainable use of medicinal plant species and their habitats. Raising public awareness about the sustainable harvesting and utilization of marketed medicinal plants (e.g., Terminalia brownii Fresen.) that are under threat is also important to ensure their availability for future generations and contribution to socioeconomic development.
The lipophilic yeast Malassezia, formerly known as Pityrosporum ovale, is primarily responsible for dandruff. The scalp and other intertriginous areas develop white, flaky, and dry scales. This incredibly pervasive condition affects more than 50% of the world's population. Because it impairs looks and itches, people all over the world are looking for an effective dandruff-controlling solution. In vitro research can produce data that supports the efficacy of homoeopathic remedies. Few in vitro antifungal research using homoeopathy have been done. The goal of the current in vitro investigation was to examine homoeopathic medicine Badiaga's in vitro potential to inhibit pathogenic Malassezia furfur. The Badiaga Q, 30C, 200C, and 90% alcohol samples were employed for the study, which was carried out using the disc diffusion method. The highest zone of inhibition for the potency 30C was around 9 mm, for Badiaga Q it was 8 mm, and for Badiaga 200C it was 6 mm against Malassezia furfur. The vehicle control, or 90% alcohol, displayed a negligibly significant inhibitory zone, and the negative control lacked a zone of clearance, which made it easier to comprehend and distinguish the way homoeopathic medicine works to prevent Malassezia furfur growth. The findings of the in vitro experiments are extremely positive and have demonstrated that homoeopathic medicines have obvious inhibitory activity against Malassezia furfur in culture plates, proving that the treatments are equally efficacious in in vitro and vivo settings.
Malassezia furfur, a lipophilic, dimorphic and yeast-like fungus, occurring in human skin as an opportunistic pathogen, causes diseases such as dandruff, pityriasis versicolar, seborrheic dermatitis, etc. Suitable media for culturing the organism were standardized. A modified medium for the culturing of M. furfur has been proposed. Growth of the fungus was also determined in the presence of different carbon sources under the influence of different temperature, pH and salinity. Plant extracts of 19 species were screened against the growth of the fungus by using disc diffusion method and the results are discussed.
Cutaneous infections induced by Malassezia ovalis (Pityrosporum ovale) represent a therapeutic problem due to the high rate of recurrence.
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.
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.
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.
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.
A simple non-invasive tape (Sebutape) adsorption method was used to recover inflammatory proteins from normal and compromised human scalp (i.e. dandruff and seborrheic dermatitis) in order to assess the inflammatory and immunologic changes relevant to these clinical conditions.
The scalps of subjects identified by a dermatologist as having either dandruff (n = 18), seborrheic dermatitis (n = 19) or normal scalp (n = 16) were visually graded to obtain total adherent scalp flaking scores (TASFS). Sebutape samples were then collected from both the high and low TASFS scalp sites using a one-minute tape application. To recover inflammatory molecules, tapes were extracted in buffered saline with sonication and the tape extracts analysed using commercial immunoassay methods for pro-inflammatory cytokines [i.e. interleukin-1alpha (IL-1alpha), IL-1beta, IL-1 receptor antagonist (IL-1ra), IL-8 and tumor necrosis factor-alpha (TNF-alpha)] and the immunologic cytokines [i.e. IL-2, IL-4, IL-10, IL-12, IL-15 and interferon gamma (IFN-gamma)]. Nitric oxide (NO) was also assayed on tape extracts using the Greiss reaction. To account for differences in protein loading on the tapes all cytokine and NO results were normalized using the total protein (TP) amounts recovered in tape extracts.
The IL-1alpha/TP levels recovered from dandruff and seborrheic scalps were significantly decreased (P = 0.03) compared to normal appearing scalp levels. The scalp levels of IL-1ra/TP and the ratio of IL-ra to IL-1alpha were significantly (P = 0.002) or directionally (P = 0.07) higher in seborrheic dermatitis scalps and dandruff scalps, respectively, compared to normal scalps. The IL-1ra and the IL-1ra/IL-1alpha ratio values correlated well with the TASFS. The TNF-alpha/TP levels recovered from dandruff scalps were significantly higher (P = 0.02) than levels recovered from seborrheic dermatitis and normal scalp subjects. IL-2/TP was significantly increased (P = 0.01) and IFN-gamma and NO significantly decreased (P = 0.05) in the seborrheic dermatitis scalp samples compared to normal controls.
The Sebutape method has proven useful for distinguishing normal from diseased scalp conditions. The cytokines recovered from the scalp tape samples showed distinct patterns that differentiated dandruff, seborrheic dermatitis and normal scalp populations. These methods may also prove useful for monitoring the clinical efficacy of therapeutic actives for treating dandruff and seborrhea.
This review describes the use of some natural products in cosmetic preparations, due to their low mammalian toxicity, with a brief description of the major use, plant parts used, the actives responsible for effect and the benefits of such products. Their use in skin care; such as dryness, eczema, acne, free-radical scavenging, antiinflammatory, antiaging and skin protection effects are explained, and also the use in hair care as hair growth stimulants, hair colorants, and for hair and scalp complaints such as dandruff. Essential oils when incorporated into finished products impart many benefits such as a pleasant aroma in perfumery, shine or conditioning effects in hair care products, emolliency and improving the elasticity of the skin.
Antimicrobial peptides of the beta-defensin family are expressed in all human epithelial tissues tested to date and have recently been the subject of vigorous investigation. Their localization and characteristics support the hypothesis that these peptides play a role in mucosal and skin defense. The lipophilic yeast Malassezia furfur is a saprophyte found in normal human cutaneous flora. Malassezia furfur is not only a saprophyte, but is also associated with several diseases such as Malassezia folliculitis, seborrheic dermatitis and some forms of atopic dermatitis, psoriasis and confluent and reticulate papillomatosis. Little is known about the mechanism by which M. furfur overcomes the natural barrier of the skin. To further define the role of the beta-defensins in the innate human skin immune response, we analyzed the mRNA expression of two human beta-defensins HBD-1 and HBD-2 in human keratinocytes treated with M. furfur. In addition, we looked into how M. furfur of TGF-beta1 and IL-10, cytokines that interfere with the development of protective cell immunity, regulate their expression. Finally, we examined the signal transduction mechanisms involved during M. furfur uptake. Cultured human keratinocytes were treated with M. furfur. The mRNA and protein expression were analyzed, respectively, by reverse transcriptase polymerase chain reaction (RT-PCR) and Western blotting. Our data demonstrate that M. furfur does not modify HBD-1 expression, whereas it up-regulates, via protein kinase C (PKC), the expression of HBD-2, TGFbeta-1 and IL-10 48 h after treatment. Our results suggest that beta-defensins are integral components of innate host defenses. They play an essential part in the resistance of the human skin surfaces against M. furfur uptake and other microbial invasion.
Dandruff is often seen in the primary care setting as well as in the dermatology field. In this article, we review the most commonly prescribed topical shampoos for treating dandruff and compare their efficacy in eradicating the symptoms of dryness and flaking of the scalp, along with providing relief of associated pruritus. Examples of such agents include keratolytics, regulators of keratinization, antimicrobials, and naturopathic therapies. We examine their mechanisms of action and their efficacy in treating dandruff.
Background: Dandruff is believed to be a fungus-mediated disease which responds to the topical delivery of antifungal agents. Although the primary causative factor is fungus related, distal events include an inflammatory cascade that eventually expresses itself as corneocyte flakes. The most common vehicle for dandruff treatment includes surfactants (i.e. shampoos), which as a chemical group have the potential to promote dermatitis. Objective: To evaluate the effect of antidandruff agents and antimicrobials on the potential contact irritancy of surfactants. Methods: Excretion of interleukin 1α by human skin equivalent cultures was measured after topical application of test materials. Results: Zinc pyrithione specifically reduces surfactant-induced expression of interleukin 1α. Neither its sodium salt nor other antimicrobial/antifungal agents had a similar effect. Conclusion: These data suggest that in addition to its known antifungal activity, zinc pyrithione may provide an additional benefit by reducing the potential irritancy of surfactant vehicles.
Synopsis Current thinking implicates P. ovale as the cause of dandruff; the condition invariably resolves when this yeast is suppressed. However, P. acnes and coagulase-negative cocci are also abundant on the scalp. A contributory role for those members of the resident microflora has not been ruled out. We used a new technique to collect and weigh scales. We have determined the percentage of nucleated cells in scales, a measure of inflammation. The density of P. acnes, P. ovale and cocci were followed during and after treatment with antibacterial solutions and two anti-fungal shampoos, Octopirox © and Magnesium Oma-dine © . The level of dandruff could not be correlated with changes in the numbers of aerobic and anaerobic bacteria. We concluded that resident bacteria probably play no role in the etiology of dandruff. Octopirox © shampoo was more efficacious than Magnesium Omadine © in reducing scaling and P. ovale. While P. ovale is necessary, Koch's postulates have not been fulfilled. The cause(s) of drandruff is (are) still unknown.
Androgenetic alopecia (AGA) is a common yet poorly understood condition. In particular, the significance of inflammatory cells close to the infrainfundibulum of transitional hairs remains obscure. This study was conducted in 20 men who used a lotion containing the antimicrobials, piroctone olamine and triclosan, regularly for 18 months. At entry, mild pruritus and abnormal hair loss were reported by the volunteers. During treatment, pruritus resolved rapidly. Comparison of clinical photographs and trichograms taken at 3-month intervals suggested signs of hair regrowth with moderate increase in density of transitional hairs. Biopsies taken at 6-month intervals were processed for immunohistochemistry. There was a decrease in the density of activated T cells in the region of the follicular infrainfundibulum and isthmus over time. IgG deposits found within the epithelial sheaths at entry to the study were absent in the subsequent biopsies. The volume of the sebaceous glands, as assessed by computerized morphometry, was not modified by the treatment. It was concluded that inflammation associated with AGA transitional hairs may be driven by the presence of microorganisms harboured in the infrainfundibulum. They may modulate the severity of AGA and may potentially be controllable. This offers a new possibility of prevention and partial reversal of hair loss in AGA.
Background: Ultraviolet Irradiation has been shown to elicit alterations in corneocyte adhesion.
Purpose: To evaluate the early events in the changes of physical properties of the stratum corneum following a single ultraviolet B (UVB) irradiation.
Method: Squamometry (Chroma C* of D-Squames) was used in 40 volunteers to assess the variations in stratum corneum cohesion during 3 consecutive days following 1.5 MED UVB irradiation on the forearms.
Results: Subjects with normal or moderately dry skin showed a significant increase in squamometry values during the 24 or 48 h following irradiation. Subjects with severe xerosis showed a progressive decrease in that value over time.
Conclusions: UV-Squamometry is a convenient, rapid and sensitive method for evaluating the direct effect of UVB radiation on the stratum corneum.
Aim An immunohistochemical study was undertaken to look at immune reaction to Malassezia ovalis in seborrheic dermatitis.
Background The role of M. ovalis in seborrheic dermatitis remains a matter of controversy despite some therapeutic evidence with the use of antifungals, especially ketoconazole.
Methods immunohistochemistry was performed on skin samples to evaluate the density of M. ovalis and to disclose deposits of immunoreactants at the level of the yeasts inside the stratum corneum.
Results M. ovalis was always decorated with the antibody to Factor XIIIa. suggesting the presence of a transglutaminase in the yeast wall. Deposits of IgG and C3 were present underneath and in close apposition to collections of M. ovalis in seborrheic dermatitis, and absent in control materials, including various types of dermatitis.
Conclusion The close topographical relationship between M. ovalis , IgG and C3 deposits is a new evidence suggesting a unique inflammatory reaction to the yeast in seborrheic dermatitis.
Thirty-two subjects who suffered from dandruff participated in a study in which one-half of the head was washed with a shampoo containing 1% zinc pyrithione (ZPT) and the other half was washed with the same shampoo without ZPT. Four groups, eight subjects per group, were shampooed one, three, six or nine times (shampoo frequency twice per week). Clinical dandruff gradings of each half of the head were made 4 days after the last shampoo in each group, when scalp biopsy samples were also taken from each half of the head. Measurements of labelling index (LI), mean epidermal thickness (MET), and assessment of the numbers of PAS- and Gram-positive micro-organisms were made on the biopsy samples. There was a progressive reduction in dandruff on the sides of the head treated with the ZPT shampoo, the differences relative to the placebo-treated areas being statistically significant after three, six and nine washes. There were no significant differences in L1 between treatment groups and the MET was shown to vary according to the treatment and the number of washes. There was a significant reduction in the number of PAS-positive micro-organisms (but not Gram-positive micro-organisms) on the ZPT-treated areas.
One hundred and sixty subjects in the general population were studied for the possible role of ABO blood groups in the infection and asymptomatic carriage rate of Pityrosporum ovale. Out of 160, 149 were positive for P. ovale in culture. Of them, 57 had dandruff and 6 had seborrhoic dermatitis. The remaining 86 were harbouring P. ovale asymptomatically. The rate of infection was almost in identical proportion with the rate of asymptomatic carrier state of P.ovale. Our study also revelated that blood group O subjects may be the most susceptible, followed by AB group. The incidence of dandruff was relatively high in males when compared to females.
Antipityosporum activity of a herbal drug combination of Wrighria tinctoria and Hibiscus rosasinensis was tested in vitro against the isolates of Pityrosporum ovale recovered from dandruff. The drug combination exhibited fungicidal activity at a concentration ranging between 500 to1000 pg/ml.
The role of microorganisms in dandruff was studied, by suppressing individually and then collectively the three major components of the scalp microflora. The effect on dandruff was assessed subjectively by clinical grading and objectively by the corneocyte count. No effect on dandruff was demonstrated when scalp organisms were suppressed. In the second group of experiments, dandruff was suppressed by selenium sulfide shampooling and the effect of continued suppression of Pityrosporum with topically applied amphotericin was measured. According to our criteria, dandruff returned to pretreatment levels, despite continued suppression of Pityrosporum. The studies demonstrate that the increased number of scalp microorganisms found in dandruff occurs as a secondary event to increased nutrients and that scalp organisms play no primary role in the pathogenesis of dandruff.
Pityrosporum orbiculare is an obligate lipophilic yeast in vitro, which suggests it possesses an extracellular lipase crucial for nutrition. If present in vivo, the enzyme would enable the yeast to utilize skin surface lipids, which may therfore play an important role in the pathogenesis of pityriasis versicolor. Cultured P. orbiculare and biopsy material from patients with pityriasis versicolor were investigated for the presence of lipase by electron microscope histochemistry. At sites of lipase activity, fatty acid hydrolyzed from Tween 80 substrate reacts with Ca++ ions to form an insoluble Ca++ soap. Exchange of Ca++ with Pb++ enables the sites of lipase activity to be visualized as electron dense deposits of insoluble lead soap. Surface lipase activity was apparent when the technique was applied to P. orbiculare grown on lipid containing medium and its specificity confirmed by removal of substrate and inhibition by di-isopropyl fluorophosphate and quinine hydrochloride, but not by sodium fluoride. When the same technique was applied to stratum corneum infected with Pityrosporum furfur (Malassez), no reaction product could be detected. It is postulated that lipase, although critical for fungal nutrition in vitro, is unlikely to be of importance in vivo. Skin surface lipids are therefore probably not relevant to the pathogenesis of pityriasis versicolor.
The clinical outcome and the effects on morphogenesis and cell ultrastructure induced by a 1% ciclopiroxolamine solution in six patients with proven pityriasis versicolor were studied. Treatment regimens consisting of a once-daily application for 1 day, 2 days (Days 1 and 4) or 3 days (Days 1, 4 and 8). Clinical evaluation, scanning (SEM) and transmission electron microscopy (TEM) were performed on skin scrapings before treatment, and at 3, 7, 15 and 21 days after the start of therapy. SEM techniques have shown severe changes in the surface ultrastructure of yeasts and hyphae of Pityrosporum spp. (Malassezia furfur) 15 days after the start of therapy. TEM techniques showed extensive internal disruption, mainly severe necrosis of the cytoplasm, 3 and 7 days after the start of treatment. However, KOH direct microscopy showed apparently normal morphology of Pityrosporum spp. (Malassezia furfur) at all assessment points. The final clinical cure in all the patients was achieved 21 days after the start of therapy.
It is currently agreed that ambient temperature influences the sebum excretion rate. By using the Sebutape technique we have confirmed this concept, which is related to an increased delivery of sebum to the surface of the skin without an increment in the number of active sebaceous follicles.
Thirty-two subjects who suffered from dandruff participated in a study in which one-half of the head was washed with a shampoo containing 1% zinc pyrithione (ZPT) and the other half was washed with the same shampoo without ZPT. Four groups, eight subjects per group, were shampooed one, three, six or nine times (shampoo frequency twice per week). Clinical dandruff gradings of each half of the head were made 4 days after the last shampoo in each group, when scalp biopsy samples were also taken from each half of the head. Measurements of labelling index (LI), mean epidermal thickness (MET), and assessment of the numbers of PAS- and Gram-positive micro-organisms were made on the biopsy samples. There was a progressive reduction in dandruff on the sides of the head treated with the ZPT shampoo, the differences relative to the placebo-treated areas being statistically significant after three, six and nine washes. There were no significant differences in LI between treatment groups and the MET was shown to vary according to the treatment and the number of washes. There was a significant reduction in the number of PAS-positive micro-organisms (but not Gram-positive micro-organisms) on the ZPT-treated areas.
One week of nightly application of sulfur-salicylic acid shampoo as a lotion was evaluated for the treatment of tinea versicolor. One half of the randomly allocated patients used the active preparation and the other half used a bland oil-in-water lotion as a placebo. Three months after completing treatment, nineteen of twenty-two using sulfur-salicylic acid shampoo were still negative by KOH examination, whereas only one of sixteen controls was negative. Skin irritation occurred in a few patients but did not reduce the effectiveness of the treatment.
A modified photometric technique has shown considerable differences between the refatting kinetics of the scalp and forehead. The refatting on the forehead occurs rapidly, probably due to the large follicular reservoir. The follicular reservoir of the scalp, which bears a large terminal hair, is much smaller and so the refatting time is longer. Thus, sebum excretion and sebum production rates probably correlate better on the scalp than on the forehead, and we suggest that the scalp may be a better site than the forehead for investigating sebaceous gland physiology.
The role of ABO blood groups in the carriage rate of dermatophytosis was studied. Blood grouping was done for 108 culture-proven dermatophytosis patients. Forty-nine patients belonged to blood group A, 54 to blood group O, three to blood group B and two to blood group AB. The incidence of dermatophytosis was found to be high in patients of blood group O and A. However, chronicity of the disease was more frequent in those in blood group A. The control group consisted of 100 healthy subjects. Sixteen out of 29 control subjects belonging to blood group A had a history of skin infections. None of the O blood group control subjects had a history of skin infections. Our study suggests that A blood group subjects may be prone to chronic dermatophytosis.
Zusammenfassung. Es wurde die Rolle der ABO-Blutgruppen für die Befallsrate mit Dermatophytosen untersucht. An 108 kulturell positiven Dermatophytose-Patienten wurde die Blutgruppe bestimmt. 49 Patienten gehörten zur Blutgruppe A, 54 zur Blutgruppe O, 3 zur Blutgruppe B und 2 zur Blutgruppe AB. Die Dermatophytose-Häufigkeit war sowohl in der Gruppe der 0-Probanden wie der A-Probanden hoch. Chroniziät der Krankheit war jedoch häufiger bei den A-Probanden. Die Kontrollgruppe bestand aus 100 gesunden Probanden. Sechzehn von 29 A-Probanden der Kontrollgruppe hatten Hautinfektionen in der Anamnese, dagegen keiner der O-Probanden. Diese Ergebnisse machen wahrscheinlich, daß Probanden der Blutgruppe A für chronische Dermatophytose disponiert sind.
A randomized double-blind clinical study was conducted on two groups of 30 volunteers using either a non-tar shampoo (2% salicylic acid, 0.75% piroctone olamine and 0.5% elubiol) or a 0.5% coal tar shampoo. Subjects were diagnosed as having moderate to marked dandruff. The study consisted of a 3-week washout, followed by a 4-week treatment and a 4-week posttreatment regression phase. The clinical evaluations and subject self-assessments showed that the non-tar shampoo was as effective as the tar shampoo. Both received high approval ratings (> or =70%). Biometrological methods proved to be more sensitive than clinical evaluations to assess the efficacy of the shampoos. The non-tar shampoo yielded a significantly better reduction of Malassezia spp. counts (p<0.02) during the treatment phase and reduced the spontaneous increase in squamometry values (p< 0.01) during the posttreatment phase. It is concluded that a formulation associating salicylic acid, piroctone olamine and elubiol exhibited increased beneficial effects compared to the coal tar shampoo.
This review addresses the current concepts about dandruff. The nature, origin and treatments of such skin conditions are scrutinized. The role of Malassezia spp. and other triggering factors is highlighted.
The timing regulation of the hair growth phases is quite complex. We name teloptosis the termination of the telogen phase with hair shedding. The initiation of the next anagen I phase is independent from teloptosis. Both events are triggered by distinct factors. Indeed, teloptosis is the result of the loss of adhesion between cells of the club hair and those of its epithelial envelope. Teloptosis synchronization is perceived as telogen effluvium, related or not to shortening of the anagen phase. Subtle changes leading to early or delayed teloptosis affect hair density. It is possible to distinguish two types of telogen hairs on a trichogram. Those with an epithelial sheath indicate strong binding, suggesting early telogen, whereas the absence of an epithelial sheath indicates loose binding, conveying teloptosis.
Transmission electron microscopy of scalp tape strips indicates that dandruff scalp possesses abnormal stratum corneum (SC) ultrastructure that is normalized by treatment with small-particle zinc pyrithione (ZPT). Similar abnormalities occur throughout the scalp of those with dandruff, even where no flaking is present. SC abnormalities are consistent with hyperproliferation, including parakeratosis, lipid droplets within corneocytes, few desmosomes, corneocyte membrane interdigitation, and excessive disorganized intercellular lipid. Reversal of SC abnormalities would require treatment of the cause(s) of dandruff, not merely flake removal. A protocol was developed to quantify scalp structural abnormalities by scoring cells from scalp tape strips for yeast number, amount of intercellular lipid, normal intercellular lipid structures, prevalence of intracellular lipid droplets, parakeratotic corneocytes, and corneocyte interdigitation. This protocol was used to compare dandruff and normal SC to dandruff SC treated with either commercial ZPT-containing shampoo or a placebo. Treatment with commercial ZPT shampoo significantly returned SC ultrastructure to normal, suggesting control of the cause of dandruff.
Atopic dermatitis (AD) is a chronic, itching, inflammatory skin disease which is associated with asthma and/or hay fever and a familial occurrence of these conditions. Genetic factors are important in the development of AD, but the exact hereditary pathway is still unknown. Dry skin and the weakened barrier function in patients with AD is very important for the patient's reactions to irritants and other external trigger factors including microorganisms. The standard treatments are topical corticosteroids, topical immunomodulating agents, and emollients. If AD cannot be controlled by this type of treatment, systemic immunomodulating agents may be used. UVB, UVA, or psoralen-UVA may also be used for widespread severe lesions. However, some patients do not respond to these standard treatment, and then it is important to consider the role of microorganisms, house dust mites or food. The role of the Malassezia yeasts in AD, especially AD located to the head and neck region, is now documented in several papers. There are also several papers indicating the role of Candida as an aggravating factor in AD. Patients with AD also develop chronic dermatophyte infections more easily, and patients with AD and chronic dermatophyte infections may show improvement in their AD when treated with antifungal drugs.
Seborrhoeic dermatitis (SD) is a common chronic inflammatory disease of the skin. Topical steroid creams and/or antifungal agents are commonly used in SD, but no resolutive therapies have been available up to now. Furthermore, little data have been available regarding clinical outcomes after cessation of topical treatments. A new formulation of betamethasone valerate 0.1% in a thermophobic, low-residue, foam vehicle (Bettamousse) (BVM) has become available for the topical treatment of scalp dermatoses. No data have been published hitherto regarding efficacy, safety and patient acceptability of this new formulation for the treatment of SD of the scalp. Study aim: To assess in an open-label, prospective, multicentre trial, the efficacy, safety and patient acceptability of BVM, as compared to baseline, in SD subjects with scalp involvement.
A total of 180 patients with moderate-to-severe SD of the scalp were enrolled in the trial. Efficacy was evaluated by analysing SD lesions for erythema, scaling and itching using a five-point grading score (0 = lesion completely cured; 1 = mild; 2 = moderate; 3 = severe and 4 = very severe lesion). The clinical global (sum) score was obtained adding the score of each item. Efficacy and safety were assessed at baseline, after 4 weeks of active treatment, followed by an 8-week follow-up period with no treatment.
In comparison with baseline, BVM significantly improved SD lesions. The sum score was reduced from 6.3 +/- 1.8 to 1.4 +/- 1.4 at the end of the active treatment period, (p < 0.0001) and to 1.7 +/- 1.8 at the end of the 8-week follow-up period (p < 0.0001). After active treatment, 93% of the patients had a sum score of </=3). At the end of 8-week of follow-up, 88% of patients maintained a sum score </=3. In addition, 85% of patients considered BVM foam to be a better topical formulation both in terms of efficacy and acceptability compared with previous treatments used.
BVM is an effective and well-tolerated topical treatment of scalp SD. Its clinical effect is also maintained after a 2-month wash-out period.
Knowledge of the hair follicle anatomy and the dynamics of hair cycling is substantial. Recognizing the anagen, catagen and telogen phases as well as teloptosis and the hair eclipse phenomenon clearly characterizes the typical hair chronobiology. Physiological modulators include hormones, neuromediators, miscellaneous biomolecules, seasons, micro-inflammation and ageing. For individuals who present with the complaint of increased hair shedding or alopecia, a host of evaluation techniques are available in addition to history, physical examination and laboratory assessment. Various clinical hair techniques can help in assessing the efficacy of drugs and cosmetics on hair growth. The methods are quite similar to those used to establish a definite diagnosis in dermatological practice. Great strides have been made during the recent decades in the methodology of hair growth trials in dermatology and cosmetology. Clinical evaluations benefit from a few additional specific techniques that enhance the perception of hair (re-) growth, shedding and alopecia. These assessments include the determination of hair patterning and density that may be helped by the 'black-and-white felt' examination. Daily hair counts, the 'hair pull test' and the 'hair feathering test' are also available. Instrumental methods provide reliable quantitative information that is useful if there are adequate controls. Some photographic methods, the trichogram, hair weighing and variants of the hair growth window technique including the phototrichogram, videotrichogram and tractio-phototrichogram provide insight into the complexities of hair cycling and shedding. Skin biopsy is indicated for diagnostic purposes, especially when the hair loss is accompanied by scarring.
Seborrheic dermatitis (SD) is a common dermatological disorder that varies greatly in severity between individuals and with time. The etiology of this disease is poorly understood. Early investigators focused on the role of Malassezia (previously Pityrosporum) yeasts in the development of SD. Some researchers have hypothesized that there is an immunological component to SD and that this disease is caused by an altered immune response to Malassezia yeasts. However, other researchers view this condition as the result of hyperproliferation. Both antifungal and anti-inflammatory preparations have been used to treat SD effectively and safely. The wide range of antifungal formulations available (creams, shampoos, oral drugs) provides safe, effective and flexible treatment options for SD.
Lipophilic yeasts of the genus Malassezia colonize the skin surface of humans and are an exacerbating factor in atopic dermatitis (AD). Two species, M. restricta and M. globosa are major cutaneous microflora in both AD patients and healthy subjects. We compared the DNA sequences of the intergenic spacer (IGS) region, located between the 26S and 5S rRNA genes of M. restricta colonizing the skin surfaces of 13 AD patients and 12 healthy subjects, and of three CBS stock strains as references. The IGS 1 sequences were divided into two major groups, corresponding to AD patients and healthy subjects. These findings suggest that a specific genotype of M. restricta plays a significant role in AD, although M. restricta commonly colonizes both AD patients and healthy subjects.
The yeasts of the genus Malassezia have been associated with a number of diseases affecting the human skin, such as pityriasis versicolor, Malassezia (Pityrosporum) folliculitis, seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and--less commonly--with other dermatologic disorders such as confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection. The study of the clinical role of Malassezia species has been surrounded by controversy because of their fastidious nature in vitro, and relative difficulty in isolation, cultivation, and identification. Many studies have been published in the past few years after the taxonomic revision carried out in 1996 in which 7 species were recognized. Two new species have been recently described, one of which has been isolated from patients with atopic dermatitis. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. It also highlights the importance of individual Malassezia species in the different dermatologic disorders related to these yeasts.
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.
Zinc pyrithione is a shampoo ingredient that has been shown to be safe and effective for dandruff and scalp psoriasis. It is thought to decrease the cell turnover rate in hyperproliferative dermatoses such as psoriasis, and also has fungistatic and antimicrobial activity, although its exact mode of action is unknown. In psoriasis, external factors, such as trauma, infection and drugs, may provoke aggravated manifestations of psoriatic skin lesions. Rarely, irritant or allergic mechanisms are likely causes of psoriatic flare and Kobnerization. A patient had had stable psoriasis for 25 years and no any other skin disease. Within 20 days, she developed an aggravated scaly erythematous patch on the scalp, where a shampoo had been applied, and simultaneously developed pustular psoriasis on both forearms. Patch testing showed a relevant sensitization to zinc pyrithione, and we observed symptomatic aggravation by provocation testing with zinc pyrithione shampoo. We report a rare case of psoriasis aggravated by the induction of allergic contact dermatitis from zinc pyrithione after using antidandruff shampoo.
Most common scalp flaking disorders show a strong correlation with sebaceous gland (SG) activity. Early SG activity in the neonate results in microfloral colonization and cradle cap. After maternal hormonal control subsides, there is little SG activity until puberty, when the SG turns on under sex hormone control. When the SG activity increases, the present but low Malassezia population has a new food source and proliferates, resulting in the scalp itching and flaking common to greater than 50% of adults. Dry scalp flaking, dandruff, and seborrheic dermatitis are chronic scalp manifestations of similar etiology differing only in severity. The common etiology is a convergence of three factors: (1) SG secretions, (2) microfloral metabolism, and (3) individual susceptibility. Dandruff and seborrheic dermatitis (D/SD) are more than superficial stratum corneum disorders, including alteration of the epidermis with hyperproliferation, excess lipids, interdigitation of the corneal envelope, and parakeratosis. The pathogenic role of Malassezia in D/SD has recently been elucidated, and is focused on their lipid metabolism. Malassezia restricta and M. globosa require lipids. They degrade sebum, free fatty acids from triglycerides, consume specific saturated fatty acids, and leave behind the unsaturates. Penetration of the modified sebaceous secretions results in inflammation, irritation, and scalp flaking.
Scalp skin is unique on the body due to the density of hair follicles and high rate of sebum production. These features make it susceptible to superficial mycotic conditions (dandruff, seborrheic dermatitis, and tinea capitis), parasitic infestation (pediculosis capitis), and inflammatory conditions (psoriasis). Because these scalp conditions share similar clinical manifestations of scaling, inflammation, hair loss, and pruritus, differential diagnosis is critically important. Diagnostic techniques and effective treatment strategies for each of the above conditions will be discussed.
Ketoconazole (KET) and zinc pyrithione (ZPT) are compounds active against the Malassezia spp. yeasts, which are believed to play a major role in dandruff and seborrheic dermatitis. We compared the efficacy and safety of KET 2% and ZPT 1% in shampoo formulations for the alleviation of severe dandruff and seborrheic dermatitis. This open randomized, parallel-group trial began with a 2-week run-in phase during which subjects applied a neutral non-antidandruff shampoo. It was followed by a 4-week randomized treatment phase and a subsequent 4-week follow-up phase without treatment. Shampooing during the treatment period was carried out twice weekly for the KET group and at least twice weekly for the ZPT group in accordance with the label instructions. A total of 343 subjects were recruited to enter the trial. Of the 331 eligible volunteers, 171 were randomized to KET 2% and 160 to ZPT 1%. Clinical assessments were performed. Beneficial effects were evidenced for both medicated shampoos, but the effect was significantly better for KET 2%, which achieved a 73% improvement in the total dandruff severity score compared with 67% for ZPT 1% at week 4 (p < 0.02). The recurrence rate of the disease was also significantly lower following KET 2% treatment than following ZPT 1% treatment. As a consequence, the overall clearing of the skin condition at the end of treatment and follow-up phase was in favor of the KET 2% formulation (p = 0.004). Side effects were minimal. It is concluded that after a 4-week treatment, KET 2% shampoo was significantly superior to ZPT 1% shampoo in the treatment of subjects with severe dandruff or seborrheic dermatitis of the scalp. It is our assumption that this difference is noticeable for the patient and as a consequence relevant. Both formulations were well tolerated.
Dandruff is a common condition in clinical practice. We undertook a study to evaluate the efficacy and safety of a combination of zinc pyrithione and polytar in a shampoo base for the treatment of dandruff.
A combination of polytar (1%) and zinc pyrithione (1%) was used for 4 weeks to treat 954 patients suffering from mild to severe dandruff. Scoring of dandruff was done on a 0-10 scale for each of the 6 regions of scalp at weeks 0, 2, 4 and 6. Follow up was for 2 weeks.
There was consistent improvement in dandruff scores over the treatment and the follow up period. There was significant improvement in signs and symptoms such as erythema and itching, with a negligible adverse event profile. The global assessment by investigators showed good-excellent results in the majority of patients and there was high acceptability for the treatment among the patients.
A combination shampoo of polytar (1%) and zinc pyrithione (1%) offers a safe and effective option in the treatment of dandruff and its associated symptoms.
Synopsis
Dandruff is a common scalp disorder affecting almost half of the postpubertal population of any ethnicity and both genders. It may, however, represent a stubborn esthetical disturbance often source of pruritus. Skin biocenosis, in particular the Malassezia spp. flora, plays a key aetiologic role, in combination with the unusual capacity of some corneocytes to be coated by these yeasts. Substantial evidence indicates that keratinocytes play an active role in the generation and expression of immunopathological reactions. This is probably the case in dandruff. Upon stimulation of a critical colonization of corneocytes by Malassezia yeasts, the release of pro‐inflammatory mediators is increased. This could lead to the subclinical microinflammation present in dandruff. In seborrheic dermatitis, local deposits of immunoglobulins and the release of lymphokines are responsible for the recruitment and local activation of leukocytes leading to the eventual amplification of the inflammatory reaction. Some ancillary non‐microbial causes of dandruff may operate through physical or chemical irritants. Many methods have been described for rating dandruff. Our favourite tools are clinical examination and squamometry. Dandruff can precipitate telogen effluvium and exacerbate androgenic alopecia. Antidandruff formulations exhibiting some direct or indirect anti‐inflammatory activity can improve both dandruff and its subsequent hair cycle disturbance.
Synopsis
Chronobiology governing the hair cycle is a fascinating and complex process. Both the hair growth cycle and the hair shaft growth are coordinated and depend on the interplay of different biological signals and various exogenous stimuli. A latency period may occur between hair shedding (teloptosis, exogen phase) and the early emergence of the next anagen VI stage. This lag time referred to on the hair eclipse phenomenon likely depends on the influence of a series of distinct synchronizers, and does not represent per se a peculiar hair cycle phase. It is the result of some dysregulations of the hair cycling, involving early teloptosis, delayed anagen I initiation or stunted hair growth at any stage between the anagen I and anagen V phases. As such, the hair eclipse phenomenon may be an erratic process occurring in physiopathological conditions affecting hair follicles singly or in focal to generalized patterns. It may be more frequent when it follows synchronized teloptosis occurring in telogen effluvium (newborn alopecia, post‐partum alopecia, seasonal alopecia and alopecia areata). It may also be prominent when microinflammation is abutted on the permanent portion of the hair follicle as in dandruff, seborrhoeic dermatitis, androgenic alopecia and photoageing baldness. Local synchronizers such as growth factors and other mediators may eventually be lacking or involved in the hair eclipse phenomenon. Their identification and characterization might drive new corrective or preventive applications.
EEMCO group (European Expert Group on Efficacy Measurement of Cosmetics and other Topical Products). EEMCO guidance for the assessment of hair shedding and alopecia
- GE Piérard
- C Piérard-Franchimont
- R Marks
- P Elsner
- GE Piérard
- C Piérard-Franchimont
- R Marks
- P Elsner
Broad spectrum antifungal activity of pyrithione zinc and its effect of the cause of dandruff associated itch
- Y de Angelis
- E MacDonald
- K Kramp
- R Bacon
- DJ Kaufman
- R Schwartz
- Y de Angelis
- E MacDonald
- K Kramp
- R Bacon
- DJ Kaufman
- R Schwartz
Dandruff has an altered stratum corneum ultrastructure that is improved with zinc phrithione shampoo
- RR Warner
- JR Schwartz
- Y Boissy
- TL Dawson
Lippicott Williams and Wilkins: Philadelphia PA
- K A Amdt
- J T Hsu
Seborrheic dermatitis and dandruff
- S Shuster
- N Blachford
Mode of action of pyridine, pyrimidine and azole antifungals: Sterol Biosynthesis inhibitors
- B H Vanden