Seborrheic Dermatitis and Dandruff: A Comprehensive Review

Artificial intelligence-based prescription of personalized scalp cosmetics improved the scalp condition: efficacy results from 100 participants

Background: Scalp-related symptoms such as dandruff and itching are common with diverse underlying etiologies. We previously proposed a novel classification and scoring system for scalp conditions, called the scalp photographic index (SPI); it grades five scalp features using trichoscopic images with good reliability. However, it requires trained evaluators.Aim: To develop artificial intelligence (AI) algorithms for assessment of scalp conditions and to assess the feasibility of AI-based recommendations on personalized scalp cosmetics.Methods: Using EfficientNet, convolutional neural network (CNN) models (SPI-AI) ofeach scalp feature were established. 101,027 magnified scalp images graded according to the SPI scoring were used for training, validation, and testing the model Adults with scalp discomfort were prescribed shampoos and scalp serums personalized according to their SPI-AI-defined scalp types. Using the SPI, the scalp conditions were evaluated at baseline and at weeks 4, 8, and 12 of treatment.Results: The accuracies of the SPI-AI for dryness, oiliness, erythema, folliculitis, and dandruff were 91.3%, 90.5%, 89.6%, 87.3%, and 95.2%, respectively. Overall, 100 individuals completed the 4-week study; 43 of these participated in an extension study until week 12. The total SPI score decreased from 32.70 ± 7.40 at baseline to 15.97 ± 4.68 at week 4 (p < 0.001). The efficacy was maintained throughout 12 weeks.Conclusions: SPI-AI accurately assessed the scalp condition. AI-based prescription of tailored scalp cosmetics could significantly improve scalp health.

Potential Application of Camel Milk as a Therapeutic Ingredient in Bath Soaps and Shampoos

The increasing worldwide market for natural-ingredient-based cosmetic toiletries is fuelled by the awareness of the dangers of synthetic cosmetics and benefits of natural-based cosmetics on the skincare and management of skin disorders. Besides naturally formulated cosmetics being biodegradable, they also contain ingredients which are chemically beneficial to human skin. Milk-based cosmetics are very promising since milk is rich in essential components such as lactoferrins, vitamins, and lactic acids, which have shown therapeutic properties against disorders such as skin cancer, acne scars, and dandruff. One of the milk that is very promising in the cosmetics industry is the camel milk. Currently, there is limited information in literature regarding the use of camel milk in cosmetics and their benefits. Camel milk stands out from bovine milk following its unique therapeutic properties and chemical composition, making it a potential ingredient for skincare and haircare products such as bath soaps and shampoos. The aim of this paper is to review the available literature on camel milk composition and evaluate the contribution of camel milk constituents to cosmetics.

Souza AB, Levita DP, Mello CC, da Silva AFM, dos Santos TC, Ronconi CM. Innovating Leishmaniasis Treatment: A Critical Chemist's Review of Inorganic Nanomaterials

Leishmaniasis, a critical Neglected Tropical Disease caused by Leishmania protozoa, represents a significant global health risk, particularly in resource-limited regions. Conventional treatments are effective but suffer from serious limitations, such as toxicity, prolonged treatment courses, and rising drug resistance. Herein, we highlight the potential of inorganic nanomaterials as an innovative approach to enhance Leishmaniasis therapy, aligning with the One Health concept by considering these treatments' environmental, veterinary, and public health impacts. By leveraging the adjustable properties of these nanomaterials─including size, shape, and surface charge, tailored treatments for various diseases can be developed that are less harmful to the environment and nontarget species. We review recent advances in metal-, oxide-, and carbon-based nanomaterials for combating Leishmaniasis, examining their mechanisms of action and their dual use as standalone treatments or drug delivery systems. Our analysis highlights a promising yet underexplored frontier in employing these materials for more holistic and effective disease management.

Nutrition, Obesity, and Seborrheic Dermatitis: Systematic Review

BACKGROUND

Pathogenesis of seborrheic dermatitis involves lipid secretion by sebaceous glands, Malassezia colonization, and an inflammatory response with skin barrier disruption. Each of these pathways could be modulated by diet, obesity, and nutritional supplements. Current treatment options provide only temporary control of the condition; thus, it is essential to recognize modifiable lifestyle factors that may play a role in determining disease severity.

OBJECTIVE

This study aimed to summarize published evidence on diet, nutritional supplements, alcohol, obesity, and micronutrients in patients with seborrheic dermatitis and to provide useful insights into areas of further research.

METHODS

A literature search of Scopus, PubMed, and MEDLINE (Ovid interface) for English language papers published between 1993 and 2023 was conducted on April 16, 2023. Case-control studies, cohort studies, and randomized controlled trials with 5 or more subjects conducted on adult participants (>14 years) were included, case reports, case series, and review papers were excluded due to insufficient level of evidence.

RESULTS

A total of 13 studies, 8 case-control, 3 cross-sectional, and 2 randomized controlled trials, involving 13,906 patients were included. Seborrheic dermatitis was correlated with significantly increased copper, manganese, iron, calcium, and magnesium concentrations and significantly lower serum zinc and vitamin D and E concentrations. Adherence to the Western diet was associated with a higher risk for seborrheic dermatitis in female patients and an increased consumption of fruit was associated with a lower risk of seborrheic dermatitis in all patients. The prebiotic Triphala improved patient satisfaction and decreased scalp sebum levels over 8 weeks. Most studies find associations between regular alcohol use and seborrheic dermatitis, but the association between BMI and obesity on seborrheic dermatitis severity and prevalence is mixed.

CONCLUSIONS

This review sheds light on specific promising areas of research that require further study, including the need for interventional studies evaluating serum zinc, vitamin D, and vitamin E supplementation for seborrheic dermatitis. The negative consequences of a Western diet, alcohol use, obesity, and the benefits of fruit consumption are well known; however, to fully understand their specific relationships to seborrheic dermatitis, further cohort or interventional studies are needed.

TRIAL REGISTRATION

PROSPERO CRD42023417768; https://tinyurl.com/bdcta893.

Card9 and MyD88 differentially regulate Th17 immunity to the commensal yeast Malassezia in the murine skin

The fungal community of the skin microbiome is dominated by a single genus, Malassezia. Besides its symbiotic lifestyle at the host interface, this commensal yeast has also been associated with diverse inflammatory skin diseases in humans and pet animals. Stable colonization is maintained by antifungal type 17 immunity. The mechanisms driving Th17 responses to Malassezia remain, however, unclear. Here, we show that the C-type lectin receptors Mincle, Dectin-1, and Dectin-2 recognize conserved patterns in the cell wall of Malassezia and induce dendritic cell activation in vitro, while only Dectin-2 is required for Th17 activation during experimental skin colonization in vivo. In contrast, Toll-like receptor recognition was redundant in this context. Instead, inflammatory IL-1 family cytokines signaling via MyD88 were also implicated in Th17 activation in a T cell-intrinsic manner. Taken together, we characterized the pathways contributing to protective immunity against the most abundant member of the skin mycobiome. This knowledge contributes to the understanding of barrier immunity and its regulation by commensals and is relevant considering how aberrant immune responses are associated with severe skin pathologies.

Unveiling the mechanism of essential oil action against skin pathogens: from ancient wisdom to modern science

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.

What are the 100 most cited fungal genera?

The global diversity of fungi has been estimated between 2 to 11 million species, of which only about 155 000 have been named. Most fungi are invisible to the unaided eye, but they represent a major component of biodiversity on our planet, and play essential ecological roles, supporting life as we know it. Although approximately 20 000 fungal genera are presently recognised, the ecology of most remains undetermined. Despite all this diversity, the mycological community actively researches some fungal genera more commonly than others. This poses an interesting question: why have some fungal genera impacted mycology and related fields more than others? To address this issue, we conducted a bibliometric analysis to identify the top 100 most cited fungal genera. A thorough database search of the Web of Science, Google Scholar, and PubMed was performed to establish which genera are most cited. The most cited 10 genera are Saccharomyces, Candida, Aspergillus, Fusarium, Penicillium, Trichoderma, Botrytis, Pichia, Cryptococcus and Alternaria. Case studies are presented for the 100 most cited genera with general background, notes on their ecology and economic significance and important research advances. This paper provides a historic overview of scientific research of these genera and the prospect for further research. Citation: Bhunjun CS, Chen YJ, Phukhamsakda C, Boekhout T, Groenewald JZ, McKenzie EHC, Francisco EC, Frisvad JC, Groenewald M, Hurdeal VG, Luangsa-ard J, Perrone G, Visagie CM, Bai FY, Błaszkowski J, Braun U, de Souza FA, de Queiroz MB, Dutta AK, Gonkhom D, Goto BT, Guarnaccia V, Hagen F, Houbraken J, Lachance MA, Li JJ, Luo KY, Magurno F, Mongkolsamrit S, Robert V, Roy N, Tibpromma S, Wanasinghe DN, Wang DQ, Wei DP, Zhao CL, Aiphuk W, Ajayi-Oyetunde O, Arantes TD, Araujo JC, Begerow D, Bakhshi M, Barbosa RN, Behrens FH, Bensch K, Bezerra JDP, Bilański P, Bradley CA, Bubner B, Burgess TI, Buyck B, Čadež N, Cai L, Calaça FJS, Campbell LJ, Chaverri P, Chen YY, Chethana KWT, Coetzee B, Costa MM, Chen Q, Custódio FA, Dai YC, Damm U, de Azevedo Santiago ALCM, De Miccolis Angelini RM, Dijksterhuis J, Dissanayake AJ, Doilom M, Dong W, Alvarez-Duarte E, Fischer M, Gajanayake AJ, Gené J, Gomdola D, Gomes AAM, Hausner G, He MQ, Hou L, Iturrieta-González I, Jami F, Jankowiak R, Jayawardena RS, Kandemir H, Kiss L, Kobmoo N, Kowalski T, Landi L, Lin CG, Liu JK, Liu XB, Loizides M, Luangharn T, Maharachchikumbura SSN, Makhathini Mkhwanazi GJ, Manawasinghe IS, Marin-Felix Y, McTaggart AR, Moreau PA, Morozova OV, Mostert L, Osiewacz HD, Pem D, Phookamsak R, Pollastro S, Pordel A, Poyntner C, Phillips AJL, Phonemany M, Promputtha I, Rathnayaka AR, Rodrigues AM, Romanazzi G, Rothmann L, Salgado-Salazar C, Sandoval-Denis M, Saupe SJ, Scholler M, Scott P, Shivas RG, Silar P, Souza-Motta CM, Silva-Filho AGS, Spies CFJ, Stchigel AM, Sterflinger K, Summerbell RC, Svetasheva TY, Takamatsu S, Theelen B, Theodoro RC, Thines M, Thongklang N, Torres R, Turchetti B, van den Brule T, Wang XW, Wartchow F, Welti S, Wijesinghe SN, Wu F, Xu R, Yang ZL, Yilmaz N, Yurkov A, Zhao L, Zhao RL, Zhou N, Hyde KD, Crous PW (2024). What are the 100 most cited fungal genera? Studies in Mycology 108: 1-411. doi: 10.3114/sim.2024.108.01.

The Sequelae and Moderators of Influence of Dandruff on Mental Health Among Mainland Chinese Adults

Introduction

The psychological impact of dandruff has been largely understudied.

Methods

In this cross-sectional study (N = 2116), we examined the consequences of self-perception of dandruff severity on mental health, quality of life, and sleep quality among Chinese adults. Additionally, we examined the moderating factors that influence these associations.

Results

Bivariate analyses revealed that greater self-perceived dandruff severity was associated with poorer mental health, lower quality of life, and reduced sleep quality. Furthermore, dandruff severity was positively correlated with appearance anxiety, feelings of helplessness, and perceived stigma. Individuals with more severe dandruff experienced increased teasing and ostracism and, subsequently, heightened psychological distress. Moderation analyses demonstrated that females were more adversely affected by dandruff than males, and those with comorbid skin conditions or a history of being teased and ostracized during adolescence due to dandruff experienced exacerbated negative outcomes.

Discussion

This study highlights the need for further research on the psychological consequences of self-perceived severity of dandruff and potential interventions to mitigate its impact.

Methodology Validation: Correlating Adherent Scalp Flaking Score (ASFS) With Phototrichogram for Scalp Dandruff Evaluation in Adult Subjects

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.

Efficacy of probiotics in hair growth and dandruff control: A systematic review and meta-analysis

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.

Pediatric Dermatitis Seborrhoica - A Clinical and Therapeutic Review

Pediatric dermatitis seborrhoica (DS) is a common inflammatory disorder of infancy and adolescence distinct from atopic dermatitis. We performed a narrative review on clinical and therapeutic aspects of the disease. The prevalence varies geographically and can reach up to 10%. There is a slight male predominance. Although etiopathology is not well known, both endogenous and exogenous factors contribute. Skin microbiome and its interaction with sebaceous gland function is crucial. The inflammatory pathways include innate immune function and skin barrier disturbances. Malassezia spp. and certain bacteria are increased in lesional skin. DS develops in different clinical subtypes, from localized cephalic to disseminated disease with a risk of erythroderma and eczema herpeticatum. Treatment consists of skin care and topical and rarely systemic medical therapy. Cornerstones of treatment are antifungals and mild corticosteroids. Targeted treatment is on the horizon. Pediatric DS is a common disorder important in the differential diagnosis of skin problems in infants and and children. Due to better understanding of its pathogenesis, new treatment options are developed.

Rosemary and neem: an insight into their combined anti-dandruff and anti-hair loss efficacy

Dandruff, a common scalp disorder characterized by flaking dead skin, is often treated with conventional topical products. However, limitations exist due to potential side effects and high costs. Therefore, searching for natural, cost-effective solutions for dandruff and hair loss is crucial. Rosemary herb and neem tree, both cultivated in Egypt, possess well-documented anti-inflammatory properties derived from their rich phenolic phytoconstituents. This study formulated a standardized combined extract of rosemary and neem (RN-E 2:1) into hair gel and leave-in tonic formats. This extract demonstrated superior efficacy against Malassezia furfur (a causative agent of dandruff) and Trichophyton rubrum (associated with scalp disorders) compared to the conventional antifungal agent, ketoconazole. The combined extract (RN-E 2:1) also exhibited potent anti-inflammatory activity. Additionally, the suppression of iNOS expression is considered concentration-dependent. Quality control verified formulation stability, and ex-vivo studies confirmed effective ingredient penetration into the epidermis, the primary site of fungal presence. Remarkably, both formulations outperformed the standard treatment, minoxidil in hair growth trials. These findings highlight the potential of natural extracts for scalp and hair health.

More yeast, more problems?: reevaluating the role of Malassezia in seborrheic dermatitis

Seborrheic dermatitis (SD) is an inflammatory skin disorder and eczema subtype increasingly recognized to be associated with significant physical, psychosocial, and financial burden. The full spectrum of SD, including dandruff localized to the scalp, is estimated to affect half of the world's population. Despite such high prevalence, the exact etiopathogenesis of SD remains unclear. Historically, many researchers have theorized a central, causative role of Malassezia spp. based on prior studies including the proliferation of Malassezia yeast on lesional skin of some SD patients and empiric clinical response to antifungal therapy. However, upon closer examination, many of these findings have not been reproducible nor consistent. Emerging data from novel, targeted anti-inflammatory therapeutics, as well as evidence from genome-wide association studies and murine models, should prompt a reevaluation of the popular yeast-centered hypothesis. Here, through focused review of the literature, including laboratory studies, clinical trials, and expert consensus, we examine and synthesize the data arguing for and against a primary role for Malassezia in SD. We propose an expansion of SD pathogenesis and suggest reframing our view of SD to be based primarily on dysregulation of the host immune system and skin epidermal barrier, like other eczemas.

Oral Cannabidiol for Seborrheic Dermatitis in Patients With Parkinson Disease: Randomized Clinical Trial

BACKGROUND

Seborrheic dermatitis (SD) affects 18.6%-59% of persons with Parkinson disease (PD), and recent studies provide evidence that oral cannabidiol (CBD) therapy could reduce sebum production in addition to improving motor and psychiatric symptoms in PD. Therefore, oral CBD could be useful for improving symptoms of both commonly co-occurring conditions.

OBJECTIVE

This study investigates whether oral CBD therapy is associated with a decrease in SD severity in PD.

METHODS

Facial photographs were collected as a component of a randomized (1:1 CBD vs placebo), parallel, double-blind, placebo-controlled trial assessing the efficacy of a short-term 2.5 mg per kg per day oral sesame solution CBD-rich cannabis extract (formulated to 100 mg/mL CBD and 3.3 mg/mL THC) for reducing motor symptoms in PD. Participants took 1.25 mg per kg per day each morning for 4 ±1 days and then twice daily for 10 ±4 days. Reviewers analyzed the photographs independently and provided a severity ranking based on the Seborrheic Dermatitis Area and Severity Index (SEDASI) scale. Baseline demographic and disease characteristics, as well as posttreatment SEDASI averages and the presence of SD, were analyzed with 2-tailed t tests and Pearson χ2 tests. SEDASI was analyzed with longitudinal regression, and SD was analyzed with generalized estimating equations.

RESULTS

A total of 27 participants received a placebo and 26 received CBD for 16 days. SD severity was low in both groups at baseline, and there was no treatment effect. The risk ratio for patients receiving CBD, post versus pre, was 0.69 (95% CI 0.41-1.18; P=.15), compared to 1.20 (95% CI 0.88-1.65; P=.26) for the patients receiving the placebo. The within-group pre-post change was not statistically significant for either group, but they differed from each other (P=.07) because there was an estimated improvement for the CBD group and an estimated worsening for the placebo group.

CONCLUSIONS

This study does not provide solid evidence that oral CBD therapy reduces the presence of SD among patients with PD. While this study was sufficiently powered to detect the primary outcome (efficacy of CBD on PD motor symptoms), it was underpowered for the secondary outcomes of detecting changes in the presence and severity of SD. Multiple mechanisms exist through which CBD can exert beneficial effects on SD pathogenesis. Larger studies, including participants with increased disease severity and longer treatment periods, may better elucidate treatment effects and are needed to determine CBD's true efficacy for affecting SD severity.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03582137; https://clinicaltrials.gov/ct2/show/NCT03582137.

Unmet needs for patients with seborrheic dermatitis

Seborrheic dermatitis (SD) is a common skin disease with signs and symptoms that may vary by skin color, associated medical conditions, environmental factors, and vehicle preference. Diagnosis of SD is based on presence of flaky, "greasy" patches, and/or thin plaques accompanied by erythema of the scalp, face, ears, chest, and groin and is associated with pruritus in many patients. The presentation may vary in different skin types and hyper- or hypopigmentation may occur, with or without erythema and minimal or no scaling. While the pathogenesis is not certain, 3 key factors generally agreed upon include lipid secretion by sebaceous glands, Malassezia spp. colonization, and some form of immunologic dysregulation that predisposes the patient to SD. Treatment involves reducing proliferation of, and inflammatory response to, Malassezia spp. Topical therapies, including antifungal agents and low potency corticosteroids, are the mainstay of treatment but may be limited by efficacy and side effects. Few novel treatments for SD are currently being studied; however, clinical trials assessing the use of topical phosphodiesterase-4 inhibitors have been completed. Improving outcomes in SD requires recognizing patient-specific manifestations/locations of the disease, including increased awareness of how it affects people of all skin types.

Safety, Efficacy and Attributes of 2.5% Selenium Sulfide Shampoo in the Treatment of Dandruff: A Single-Center Study

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.

A fast and non-invasive artificial intelligence olfactory-like system that aids diagnosis of Parkinson's disease

BACKGROUND AND PURPOSE

Several previous studies have shown that skin sebum analysis can be used to diagnose Parkinson's disease (PD). The aim of this study was to develop a portable artificial intelligence olfactory-like (AIO) system based on gas chromatographic analysis of the volatile organic compounds (VOCs) in patient sebum and explore its application value in the diagnosis of PD.

METHODS

The skin VOCs from 121 PD patients and 129 healthy controls were analyzed using the AIO system and three classic machine learning models were established, including the gradient boosting decision tree (GBDT), random forest and extreme gradient boosting, to assist the diagnosis of PD and predict its severity.

RESULTS

A 20-s time series of AIO system data were collected from each participant. The VOC peaks at a large number of time points roughly concentrated around 5-12 s were significantly higher in PD subjects. The gradient boosting decision tree model showed the best ability to differentiate PD from healthy controls, yielding a sensitivity of 83.33% and a specificity of 84.00%. However, the system failed to predict PD progression scored by Hoehn-Yahr stage.

CONCLUSIONS

This study provides a fast, low-cost and non-invasive method to distinguish PD patients from healthy controls. Furthermore, our study also indicates abnormal sebaceous gland secretion in PD patients, providing new evidence for exploring the pathogenesis of PD.

The burden of dermatitis from 1990-2019 in the Middle East and North Africa region

BACKGROUND

There are several types of dermatitis, each capable of causing enduring changes that extend beyond physical discomfort. In severe cases, dermatitis can significantly affect mental health, social interactions, and the overall quality of life. This study reports the burden of dermatitis in the Middle East and North Africa (MENA) region from 1990 to 2019, according to sex, age category, and socio-demographic index (SDI).

METHODS

Publicly available data regarding the point prevalence, incidence, and years lived with disability (YLDs) were collected from the Global Burden of Disease 2019 study for both the MENA region and its constituent countries. The point prevalence, incidence, and YLDs of dermatitis were represented as counts and age-standardised rates with 95% uncertainty intervals (UIs).

RESULTS

In 2019, the age-standardised point prevalence of dermatitis was 2744.6 (2517.8-3003.1) per 100,000 population, which was 2.3% lower than in 1990. The YLD rate was 92.3 (55.6-143.4) per 100,000 population, which was 3.1% lower than in 1990. The largest point prevalence rates were observed among those aged 70-74, for both sexes. The 2019 MENA/Global DALY ratio was not above one in any age group for either sex. During the period 1990 to 2019, there was no clear correlation between the burden of dermatitis and the SDI level.

CONCLUSION

The dermatitis burden in the MENA region remained relatively stable from 1990 to 2019. Future prevention efforts should focus on improving healthcare access, health education, and workplace safety regulations.

Modulating the skin mycobiome-bacteriome and treating seborrheic dermatitis with a probiotic-enriched oily suspension

Seborrheic dermatitis (SD) affects 2-5% of the global population, with imbalances in the skin microbiome implicated in its development. This study assessed the impact of an oily suspension containing Lactobacillus crispatus P17631 and Lacticaseibacillus paracasei I1688 (termed EUTOPLAC) on SD symptoms and the skin mycobiome-bacteriome modulation. 25 SD patients were treated with EUTOPLAC for a week. Symptom severity and skin mycobiome-bacteriome changes were measured at the start of the treatment (T0), after seven days (T8), and three weeks post-treatment (T28). Results indicated symptom improvement post-EUTOPLAC, with notable reductions in the Malassezia genus. Concurrently, bacterial shifts were observed, including a decrease in Staphylococcus and an increase in Lactobacillus and Lacticaseibacillus. Network analysis highlighted post-EUTOPLAC instability in fungal and bacterial interactions, with increased negative correlations between Malassezia and Lactobacillus and Lacticaseibacillus genera. The study suggests EUTOPLAC's potential as a targeted SD treatment, reducing symptoms and modulating the mycobiome-bacteriome composition.

Lesional skin of seborrheic dermatitis patients is characterized by skin barrier dysfunction and correlating alterations in the stratum corneum ceramide composition

Seborrheic dermatitis (SD) is a chronic inflammatory skin disease characterized by erythematous papulosquamous lesions in sebum rich areas such as the face and scalp. Its pathogenesis appears multifactorial with a disbalanced immune system, Malassezia driven microbial involvement and skin barrier perturbations. Microbial involvement has been well described in SD, but skin barrier involvement remains to be properly elucidated. To determine whether barrier impairment is a critical factor of inflammation in SD alongside microbial dysbiosis, a cross-sectional study was performed in 37 patients with mild-to-moderate facial SD. Their lesional and non-lesional skin was comprehensively and non-invasively assessed with standardized 2D-photography, optical coherence tomography (OCT), microbial profiling including Malassezia species identification, functional skin barrier assessments and ceramide profiling. The presence of inflammation was established through significant increases in erythema, epidermal thickness, vascularization and superficial roughness in lesional skin compared to non-lesional skin. Lesional skin showed a perturbed skin barrier with an underlying skewed ceramide subclass composition, impaired chain elongation and increased chain unsaturation. Changes in ceramide composition correlated with barrier impairment indicating interdependency of the functional barrier and ceramide composition. Lesional skin showed significantly increased Staphylococcus and decreased Cutibacterium abundances but similar Malassezia abundances and mycobial composition compared to non-lesional skin. Principal component analysis highlighted barrier properties as main discriminating features. To conclude, SD is associated with skin barrier dysfunction and changes in the ceramide composition. No significant differences in the abundance of Malassezia were observed. Restoring the cutaneous barrier might be a valid therapeutic approach in the treatment of facial SD.

Establishment of clinical evaluation criteria for scalp seborrheic dermatitis

PURPOSE

To evaluate the three symptom indicators of scalp seborrheic dermatitis (SSD), namely scalp flaking, maximum erythema area, and pruritus, to develop a "16-point scale," to explore its relationship with the severity of SSD, and verify the reliability of the 16-point scale.

METHOD

A dermatologist evaluated patients with SSD using a 16-point scale, and statistically analyzed the collected data with the help of SPSS 26.0 software. The measurement data are expressed as (mean ± SD), and the intergroup comparison was done using a non-parametric test. We performed the correlation analysis using the bivariate correlation analysis method, and the relationship among non-normal distribution data variables were analyzed using Spearman's correlation coefficient. p < 0.05 indicated that the difference was statistically significant.

RESULTS

The total score of the "16-point scale" strongly correlated with the severity of disease, where scalp flaking had the strongest correlation. As compared with a single score, the correlation of the total score with the severity of disease was higher. The scoring range for mild patients was (0, 5], that for moderate patients was (5, 9], and that for severe patients was (9, 16].

CONCLUSION

A "16-point scale", consisting of items for adherent scalp flaking (0-10), maximum erythema area (0-3), and pruritus (0-3), was used to score the patients with SSD, and the total score was strongly correlated with and differentiated the severity of SSD. Recommended evaluation criteria: a total score of 0-5 points indicates mild SSD, 6-9 points indicates moderate SSD, 10-16 points indicates severe SSD. These criteria can help to standardize disease diagnosis and treatment, and efficacy assessment.

Natural Topical Treatment Contributes to a Reduction of Dry Scalp Symptoms in Children

Background

Dry scalp conditions affect a significant portion of the population, including children. Emerging evidence indicates the potential for improvement of atopic symptoms through altering the skin microbiome. Therefore, a topical treatment consisting of probiotic extracts, honey, turmeric, and vitamin B12 was manufactured to improve dry scalp symptomology through sustained balance of the microbiome.

Purpose

This interventional clinical study aims to determine the safety and efficacy of the topical treatment in reducing dry scalp symptomology in children 1-17 years old with dry scalp symptoms.

Methods

Participants applied the topical dry scalp treatment 2-3 times per week for two weeks. Safety and efficacy of the topical treatment was determined through physician assessment using the validated Investigator's Global Assessment (IGA) scale and the Total Severity Scale (TSS) during pre- and post-treatment clinic visits as well as parent reports at baseline, 1-week midpoint, and 2-week exit.

Results

Use of the topical treatment was associated with reduced symptoms of itchiness, dryness, irritation, and flakiness in children. The average IGA score was 3.0 at baseline and 2.0 after treatment, corresponding to a score difference of 1.0 (p < 0.001, 95% CI: 0.7, 1.2). The TSS score difference was 1.9 (p < 0.001, 95% CI: 1.4, 2.4). The total parent-reported scalp severity score decreased from 16.6 (95% CI: 14.8, 18.4) to 12.4 (p < 0.001, 95% CI: 11.0, 13.7) at 2-week exit.

Discussion

Study results mirror those reported in a study conducted in adults and point to the safety and efficacy of this natural topical treatment in reducing dry scalp symptomology in children. Based on our data, the combination of probiotic extracts and other anti-inflammatory ingredients appears to improve overall scalp health and appearance, though further studies will need to be conducted to further elucidate the link between clinical improvement and a balanced scalp microbiome.

Treatment with the Topical Antimicrobial Peptide Omiganan in Mild-to-Moderate Facial Seborrheic Dermatitis versus Ketoconazole and Placebo: Results of a Randomized Controlled Proof-of-Concept Trial

Facial seborrheic dermatitis (SD) is an inflammatory skin disease characterized by erythematous and scaly lesions on the skin with high sebaceous gland activity. The yeast Malassezia is regarded as a key pathogenic driver in this disease, but increased Staphylococcus abundances and barrier dysfunction are implicated as well. Here, we evaluated the antimicrobial peptide omiganan as a treatment for SD since it has shown both antifungal and antibacterial activity. A randomized, patient- and evaluator-blinded trial was performed comparing the four-week, twice daily topical administration of omiganan 1.75%, the comparator ketoconazole 2.00%, and placebo in patients with mild-to-moderate facial SD. Safety was monitored, and efficacy was determined by clinical scoring complemented with imaging. Microbial profiling was performed, and barrier integrity was assessed by trans-epidermal water loss and ceramide lipidomics. Omiganan was safe and well tolerated but did not result in a significant clinical improvement of SD, nor did it affect other biomarkers, compared to the placebo. Ketoconazole significantly reduced the disease severity compared to the placebo, with reduced Malassezia abundances, increased microbial diversity, restored skin barrier function, and decreased short-chain ceramide Cer[NSc34]. No significant decreases in Staphylococcus abundances were observed compared to the placebo. Omiganan is well tolerated but not efficacious in the treatment of facial SD. Previously established antimicrobial and antifungal properties of omiganan could not be demonstrated. Our multimodal characterization of the response to ketoconazole has reaffirmed previous insights into its mechanism of action.

The Skin and Natural Cannabinoids-Topical and Transdermal Applications

The chemical constituents of the Cannabis plant known as cannabinoids have been extensively researched for their potential therapeutic benefits. The use of cannabinoids applied to the skin as a potential method for both skin-related benefits and systemic administration has attracted increasing interest in recent years. This review aims to present an overview of the most recent scientific research on cannabinoids used topically, including their potential advantages for treating a number of skin conditions like psoriasis, atopic dermatitis, and acne. Additionally, with a focus on the pharmacokinetics and security of this route of administration, we investigate the potential of the transdermal delivery of cannabinoids as a method of systemic administration. The review also discusses the restrictions and difficulties related to the application of cannabinoids on the skin, emphasizing the potential of topical cannabinoids as a promising route for both localized and systemic administration. More studies are required to fully comprehend the efficacy and safety of cannabinoids in various settings.

Beard Alopecia: An Updated and Comprehensive Review of Etiologies, Presentation and Treatment

Facial hair is an important social and psychologic aspect of clinical appearance for men. The purpose of this review is to provide a comprehensive overview of the causes of alopecia of the beard including the prevalence, pathophysiology, clinical presentation, and treatment. In this review, we highlight more common causes of beard alopecia including alopecia areata and pseudofolliculitis barbae, infectious causes such as tinea barbae and herpes simplex folliculitis, and rare causes including dermatopathia pigmentosa reticularis and frontal fibrosing alopecia. This review serves as an important resource for clinicians when faced with patients suffering from beard alopecia.

First Use of Tapinarof Monotherapy for Seborrhoeic Dermatitis: A Case Report

Abstract is missing (Short communication)

Alteration in skin mycobiome due to atopic dermatitis and seborrheic dermatitis

A microbiome consists of viruses, bacteria, archaea, fungi, and other microeukaryotes. It influences host immune systems and contributes to the development of various diseases, such as obesity, diabetes, asthma, and skin diseases, including atopic dermatitis and seborrheic dermatitis. The skin is the largest organ in the human body and has various microorganisms on its surface. Several studies on skin microbiomes have illustrated the effects of their composition, metabolites, and interactions with host cells on diseases. However, most studies have focused on the bacterial microbiome rather than the fungal microbiome, namely, mycobiome, although emerging evidence indicates that fungi also play a critical role in skin microbiomes through interactions with the host cells. I briefly summarize the current progress in the analysis of mycobiomes on human skin. I focused on alteration of the skin mycobiome caused by atopic and seborrheic dermatitis, with an emphasis on the Malassezia genus, which are the most dominant fungi residing here.

Malassezia restricta-mediated Lipoperoxidation: A Novel Trigger in Dandruff

Dandruff is a common scalp disorder with multiple microbial and host-related factors contributing to its aetiology, including alterations in scalp sebum. Despite existing evidence that the yeast Malassezia restricta plays a key role in the onset of dandruff, the interplay of these factors is poorly understood. Recently, squalene monohydroperoxide and malondialdehyde were established as biomarkers of dandruff-afflicted scalp, highlighting the role of sebum lipoperoxidation in the triggering and maintenance of dandruff, although its mechanism of action is unknown. The current study provides evidence that M. restricta mediates sebum peroxidation, leading to production of squalene monohydroperoxide and malondialdehyde. Furthermore, in vitro data show that these lipoperoxidation products act on epidermal cells and alter the skin barrier. These results support the role of Malassezia restricta-induced lipoperoxides as triggers of dandruff, which suggests that blocking their production could be a novel anti-dandruff treatment approach.

Seborrheic Dermatitis as a Potential Trigger of Central Centrifugal Cicatricial Alopecia: A Review of Literature

Central centrifugal cicatricial alopecia (CCCA) is a common form of scarring alopecia that affects the crown or vertex of the scalp as centrifugally spreading patches of permanent hair loss. The etiology of CCCA is uncertain. Genetic predisposition, autoimmune diseases, infections (bacterial and fungal), and other idiopathic factors have all been explored as potential risk factors for the development of CCCA. Seborrheic dermatitis (SD) has been identified in a number of studies as the most common concurrent hair disorder seen in patients with CCCA. The high prevalence of SD in African American women and its association with long-term inflammation of the scalp may increase the likelihood of a connection between SD and other inflammatory conditions of the scalp in this population. Since it has frequently been discovered as a concomitant diagnosis in patients with CCCA, we hypothesize that a history of SD may play a role in the pathogenesis of CCCA.

The Prevalence, Associated Factors, and Clinical Characterization of Malassezia folliculitis in Patients Clinically Diagnosed with Acne Vulgaris

BACKGROUND

The clinical presentation of Malassezia folliculitis (MF) can imitate acne vulgaris (AV), making it difficult to distinguish between the two conditions. Moreover, MF can coexist with AV in the same patient. The incidence of MF in patients clinically diagnosed with AV may be underestimated. This study aimed to determine the prevalence, associated factors, and clinical characterization of MF patients diagnosed with AV.

MATERIALS AND METHODS

Three hundred twenty new acne patients were questioned regarding general information, including age, sex, itchy symptoms, and past treatment history with antibiotics and steroids within four weeks. Clinical presentations of AV (location and severity), dandruff, and seborrheic dermatitis were examined by a dermatologist. Cytologic studies to determine the abnormal proliferation of Malassezia yeasts were performed from pustules or, in the absence of pustules, comedo-like papules, and comedones. The smears were stained with methylene blue and evaluated under a light microscope by the researcher.

RESULTS

The prevalence of MF in patients clinically diagnosed with AV was 28.8% (95% Confidence interval: CI = 23.8% - 33.7%), which can be classified as 24.7% were AV with MF and the remaining 4.1% were MF only. This study revealed that patients diagnosed with MF were 7.38 times more likely to have itchy symptoms than patients diagnosed with AV. MF patients had 8.89 times and 9.17 times higher risk of acneiform lesions on the scalp/ hairline and upper back than those who did not have MF, respectively.

CONCLUSION

This present study revealed a high prevalence of MF in patients clinically diagnosed with AV. Dermatologists should be aware of MF when encountering AV patients with acneiform lesions on the scalp/ hairline and upper back with pruritus. Diagnosis based on clinical presentations alone may lead to misdiagnosis. Methylene blue staining is easy to perform and beneficial to diagnose MF.

Differential microRNA profiles in elderly males with seborrheic dermatitis

Seborrheic dermatitis (SD) is one of the most common skin diseases characterized by inflammatory symptoms and cell proliferation, which has increased incidence in patients older than 50 years. Although the roles of microRNAs (miRNAs) have been investigated in several diseases, miRNA profiles of patients with SD remain unknown. This study aimed to identify differentially expressed miRNAs (DEMs) in lesions of elderly male patients with SD. We used a microarray-based approach to identify DEMs in lesions compared to those in non-lesions of patients with SD. Furthermore, Gene Ontology and pathway enrichment analysis were performed using bioinformatics tools to elucidate the functional significance of the target mRNAs of DEMs in lesions of patients with SD. Expression levels of two miRNAs-hsa-miR-6831-5p and hsa-miR-7107-5p-were downregulated, whereas those of six miRNAs-hsa-miR-20a-5p, hsa-miR-191-5p, hsa-miR-127-3p, hsa-miR-106b-5p, hsa-miR-342-3p, and hsa-miR-6824-5p-were upregulated. Functions of the SD-related miRNAs were predicted to be significantly associated with typical dermatological pathogenesis, such as cell proliferation, cell cycle, apoptosis, and immune regulation. In summary, SD alters the miRNA profile, and target mRNAs of the DEMs are related to immune responses and cell proliferation, which are the two main processes in SD pathogenesis.

The Use of Urea Cream for Hand Eczema and Urea Foam for Seborrheic Dermatitis and Psoriasiform Dermatoses of the Scalp

PURPOSE

Urea as an ingredient in topical skin applications can aid skin integrity and hydration and have keratolytic, anti-fungal, anti-bacterial, and anti-pruritic effects. Skin conditions that urea-containing formulations have been utilized to treat include hand eczema/dermatitis, seborrheic dermatitis and psoriasiform dermatoses of the scalp. Two monocentric, simple blind, observational studies were carried out in healthy participants to examine the efficacy and safety of two urea-containing products in these skin conditions.

PATIENTS AND METHODS

Study 1 tested the actions of a commercially available 30% urea topical cream on hand eczema. The product was applied ≥2/day for 28 ±2 days. Transepidermal water loss, skin redness, skin hydration, and participant ratings of efficacy and qualities were assessed prior to first product application and on days 14 and 29. Study 2 tested the actions of a commercially available foaming product containing 10% urea on seborrheic dermatitis and scalp psoriasiform dermatoses. The product was applied ≥2/day for 28 ±2 days. Desquamation index and surface occupied by squames, analysis of extracted squames, microscopic assessment of scalp photos and participant ratings of product efficacy and qualities was carried out prior to first product application and on days 14 and 29.

RESULTS

In Study 1 (n = 20 females), results showed a significant (p < 0.05) decrease in transepidermal water loss, with an increase in hydration level of the upper skin layers, and a decrease in skin redness. In Study 2 (n = 13 females, 7 males), product use led to significant (p < 0.05) decreases in desquamation measures and dryness. In both studies, the majority of participants "agreed" or "slightly agreed" that the product had good efficacy and was easy to apply. No adverse reactions were reported.

CONCLUSION

These findings point to the utility of urea in topically applied vehicles for hand eczema, seborrheic dermatitis, and psoriasiform dermatoses.

Investigation of the relationship between seborrheic dermatitis and metabolic syndrome parameters

BACKGROUND

Seborrheic dermatitis (SD) is a common, chronic inflammatory disease with relapses and remissions.

OBJECTIVES

So we planned to investigate the relationship between SD and metabolic syndrome (Mets).

METHODS

54 patients over 18 years of age without known diabetes mellitus, hypertension, coronary artery disease who were clinically diagnosed with SD in our clinic and 47 healthy controls were included in the study. Body mass index (BMI) was calculated of all participants. Complete blood count, fasting blood sugar (FBG), triglyceride (TG), total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were examined. The relationship between the presence of MetS, disease severity, and duration was investigated.

RESULTS

Average age of patients was 35.4 (sd: 12). Average age of controls was 32.9 (sd: 10.7). MetS was detected in 35.2% (n = 19) of the patient group and 10.6% (n = 5) of the control group. The presence of MetS was higher in SD patients than in the control group (p = 0.004). The rate of people with high TG was significantly higher in the SD group than the controls (p = 0.015). HDL level was significantly lower in the patient group (p = 0.050). Systolic and diastolic blood pressure were high in patients (p = 0.016, p = 0.029).

CONCLUSIONS

Seborrheic dermatitis should be considered as a MetS marker and the presence of MetS should be examined in this group of patients. This can be helpful for the early diagnosis of a systemic disease complex with numerous complications. Also, treatment of MetS can also improve SD lesions.

The Efficacy and Safety of Pimecrolimus in Patients With Facial Seborrheic Dermatitis: A Systematic Review of Randomized Controlled Trials

Facial seborrheic dermatitis (SD) is a chronic inflammatory skin condition that can affect the quality of life with frequent recurrences. There is no medication as yet to cure this disease completely. There are four general categories of agents that are used to treat SD: antifungal agents, keratolytics, corticosteroids, and lastly calcineurin inhibitors. Topical therapies are the mainstream line of treatment to be used for this skin condition.

The objective of this article is to critically review the published data in the literature on the use of topical pimecrolimus 1% topical cream as an option for treating facial SD. The final purpose of this review is to answer two questions: whether pimecrolimus topical cream is effective for the treatment of SD compared to the conventional current treatments and how safe is this treatment. 

The PubMed, Clinicaltrials.gov, MEDLINE + Embase, and Cochrane library databases were searched for original randomized clinical trials (RCTs) evaluating pimecrolimus 1% topical cream and comparing it with other topical treatments for SD. A systematic review and meta-analysis were then conducted on the selected studies by grading the evidence and qualitative comparison of results among and within studies. A total of five studies were included in the review; however, only four were eligible for inclusion in the meta-analysis, in which pimecrolimus was compared with other treatments for the management of facial SD.

Pimecrolimus was found to be an effective topical treatment for facial SD, as it showed considerable desirable control of the symptoms in patients with facial SD clinically, in addition to a lower recurrence or relapsing rates; however, it had more side effects compared to other topical treatments, but the side effects were mild and tolerable.

Seasonal Patterns and Trends in Dermatoses in Poland

Background: The amount of data available online is constantly increasing, including search behavior and tracking trends in domains such as Google. Analyzing the data helps to predict patient needs and epidemiological events more accurately. Our study aimed to identify dermatology-related terms that occur seasonally and any search anomalies during the SARS-CoV-2 pandemic. Methods: The data were gathered using Google Trends, with 69 entries between January-2010 and December-2020 analyzed. We conducted the Seasonal Mann–Kendal Test to determine the strength of trends. The month with the highest seasonal component (RSV) and the lowest seasonal component (RSV) was indicated for every keyword. Groups of keywords occurring together regularly at specific periods of the year were shown. Results: We found that some topics were seasonally searched in winter (e.g., herpes, scabies, candida) and others in summer (e.g., erythema, warts, urticaria). Conclusions: Interestingly, downward trends in searches on sexually transmitted diseases in comparison with increased infection rates reported officially show a strong need for improved sexual education in Poland. There were no significant differences in trends for coronavirus-related cutaneous symptoms during 2020. We have shown that the seasonality of dermatologically related terms searched in Poland via Google did not differ significantly during SARS-CoV-2 pandemic.

Seborrheic Dermatitis in Older Adults: Pathogenesis and Treatment Options

Seborrheic dermatitis is a common and chronic skin disease, which is particularly prevalent in older adults. While a specific cause of seborrheic dermatitis remains largely unelucidated, the currently understood pathogenesis of seborrheic dermatitis revolves around the presence of Malassezia yeast colonies and an inflammatory response in the affected individual. Keratinocyte proliferation resulting from inflammasome response in the host skin leads to the clinically relevant symptoms of seborrheic dermatitis. The increasing number of older adults as a percentage of the population in the USA will lead to an even higher prevalence of the disease in the ensuing decades. Fortunately, there are multiple treatment options based on individual patient situations and preferences. Topical treatment is the gold standard, but oral therapy may be required in certain cases. In order to maximize effectiveness and minimize adverse pharmacologic effects, effective treatment for older adults must take into account changes in lifestyle and metabolism that occur with aging.

Zinc-Based Metal-Organic Frameworks in Drug Delivery, Cell Imaging, and Sensing

The design and structural frameworks for targeted drug delivery of medicinal compounds and improved cell imaging have been developed with several advantages. However, metal-organic frameworks (MOFs) are supplemented tremendously for medical uses with efficient efficacy. These MOFs are considered as an absolutely new class of porous materials, extensively used in drug delivery systems, cell imaging, and detecting the analytes, especially for cancer biomarkers, due to their excellent biocompatibility, easy functionalization, high storage capacity, and excellent biodegradability. While Zn-metal centers in MOFs have been found by enhanced efficient detection and improved drug delivery, these Zn-based MOFs have appeared to be safe as elucidated by different cytotoxicity assays for targeted drug delivery. On the other hand, the MOF-based heterogeneous catalyst is durable and can regenerate multiple times without losing activity. Therefore, as functional carriers for drug delivery, cell imaging, and chemosensory, MOFs' chemical composition and flexible porous structure allowed engineering to improve their medical formulation and functionality. This review summarizes the methodology for fabricating ultrasensitive and selective Zn-MOF-based sensors, as well as their application in early cancer diagnosis and therapy. This review also offers a systematic approach to understanding the development of MOFs as efficient drug carriers and provides new insights on their applications and limitations in utility with possible solutions.

In Vivo Longitudinal Tracking of Lymphangiogenesis and Angiogenesis in Cutaneous Melanoma Mouse Model Using Multifunctional Optical Coherence Tomography

Melanoma is a high-risk skin cancer because it tends to metastasize early and ultimately leads to death. In this study, we introduced a noninvasive multifunctional optical coherence tomography (MFOCT) for the early detection of premetastatic pathogenesis in cutaneous melanoma by label-free imaging of microstructures (i.e., providing the thickness and the scattering information) and microcirculation (i.e., providing depth-resolved angiography and lymphangiography). Using MFOCT-based approaches, we presented an in vivo longitudinal observation of the tumor microenvironment in Braf^V600E/V600E;Pten^−/− mice with inducible melanoma monitored for 42 days. Quantitative analysis of MFOCT images identified an increased number of lymphatic and vascular vessels during tumor progression and faster lymphangiogenesis (beginning on day 21) than angiogenesis (beginning on day 28) in the melanoma microenvironment. We further observed lymphatic vessel enlargement from the first week of melanoma development, implying tumor cells interacting with the vessels and increased likelihood of metastasis. MFOCT identified cutaneous melanoma‒associated angiogenesis and lymphangiogenesis before the possible visual perception of the tumor (≥42 days) and before metastasis could be diagnosed using micropositron emission tomography (35 days). Thus, the proposed quantitative analysis using MFOCT has the potential for early detection of cutaneous melanoma progression or prediction of metastatic melanoma in a mouse model. However, retrospective and extensive experiments still need to be performed in the future to confirm the value of MFOCT in clinical application.

Topical Application of Temperature-Sensitive Gel Containing Caerin 1.1 and 1.9 Peptides on TC-1 Tumour-Bearing Mice Induced High-Level Immune Response in the Tumour Microenvironment

The development of topical cream drugs that increase the immune activation of tumour-infiltrating lymphocytes against tumour and chronic viral infection-associated lesions is of great immunotherapeutic significance. This study demonstrates that the topical application of a temperature-sensitive gel containing caerin 1.1 and 1.9 peptides reduces nearly 50% of the tumour weight of HPV16 E6/E7-transformed TC-1 tumour-bearing mice via improving the tumour microenvironment. Confocal microscopy confirms the time-dependent penetration of caerin 1.9 through the epidermal layer of the ear skin structure of mice. Single-cell transcriptomic analysis shows that the caerin 1.1/1.9 gel expands the populations with high immune activation level and largely stimulates the pro-inflammatory activity of NK and dendritic cells. Closely associated with INFα response, Cebpb seems to play a key role in altering the function of all Arg1^hi macrophages in the caerin group. In addition, the caerin gel treatment recruits almost two-fold more activated CD8⁺ T cells to the TME, relative to the untreated tumour, which shows a synergistic effect derived from the regulation of S1pr1, Ccr7, Ms4a4b and Gimap family expression. The TMT10plex-labelling proteomic quantification further demonstrates the activation of interferon-alpha/beta secretion and response to cytokine stimulus by the caerin gel, while the protein contents of several key regulators were elevated by more than 30%, such as Cd5l, Gzma, Ifit1, Irf9 and Stat1. Computational integration of the proteome with the single-cell transcriptome consistently suggested greater activation of NK and T cells with the topical application of caerin peptide gel.

The spectrum of skin diseases seen in a Jamaican tertiary academic medical center

BACKGROUND

The diversity of skin diseases seen in a dermatology clinic varies with the composition of the population.

OBJECTIVE

The aim was to document the spectrum of cutaneous disorders seen and the variation with sex, age, and seasons.

METHODS

This was a retrospective study on new patients attending an academic dermatology clinic in Jamaica during 2018. Disease frequencies and prevalence by sex, seasons, and age group were recorded.

RESULTS

There were 547 new patients with 329 females (60%) and 218 males (40%). The mean age was 36.8 years, ranging from 2 weeks old to 103 years old. The largest number of patients were in the third decade (20-29 years) (n = 139). More patients presented in the dry season and in spring and summer. The most common diagnoses were: seborrheic dermatitis (n = 65, 11.9%), acne (n = 56, 10.2%), and contact dermatitis (n = 38, 6.9%). The most common disease groups were dermatitis (n = 161, 29.4%), infections (n = 130, 23.8%), and inflammatory disorders (n = 129, 23.6%).

LIMITATIONS

The generalizability of our findings may be limited, and selection bias may play a role in patients choosing to attend an academic dermatology clinic.

CONCLUSIONS

Skin diseases varied with age, sex, and season with seborrheic dermatitis being most common.

Differential Diagnosis and Treatment of Itching in Children and Adolescents

Itching is prevalent in children with skin disorders and associated with effects on their mood, quality of life, and social functioning. Surprisingly, there are no data on childhood prevalence of pruritus in the general population. The aim of this article is to explore the epidemiology, clinical manifestation, and treatment for itch (pruritus) in the pediatric population (from infancy to adolescence), and to be helpful to primary care physicians who assess and diagnose pediatric patients with itching. In this study, we searched for specific keywords using PubMed and MEDLINE (Ovid) and, then, refined the retrieved searches for each cause and treatment. As a result of reviewing the literature, atopic dermatitis was shown to be the most common cause of itching, especially during infancy and through preschool. Not only skin disorders but also systemic diseases, drugs, and postburn states can predispose an individual to itching in childhood. There are traditional and newly developed treatment modalities for itching in pediatric patients. However, because the pharmacokinetics and pharmacodynamics of childhood are different from those of adults, the medications for itching have to be applied carefully for these age groups. There are many areas to be elucidated regarding the prevalence and objective assessment of pruritus in pediatric patients. Moreover, the safety profiles of medications in the pediatric population need to be better understood. Further studies to investigate itching in childhood are warranted.

Longitudinal study of the scalp microbiome suggests coconut oil to enrich healthy scalp commensals

Dandruff is a recurrent chronic scalp disorder, affecting majority of the population worldwide. Recently a metagenomic study of the Indian scalp microbiome described an imperative role of bacterial commensals in providing essential vitamins and amino acids to the scalp. Coconut oil and its formulations are commonly applied on the scalp in several parts of the world to maintain scalp health. Thus, in this study we examined the effect of topical application of coconut oil on the scalp microbiome (bacterial and fungal) at the taxonomic and functional levels and their correlation with scalp physiological parameters. A 16-weeks-long time-course study was performed including 12-weeks of treatment and 4-weeks of relapse phase on a cohort of 140 (70 healthy and 70 dandruff) Indian women, resulting in ~ 900 metagenomic samples. After the treatment phase, an increase in the abundance of Cutibacterium acnes and Malassezia globosa in dandruff scalp was observed, which were negatively correlated to dandruff parameters. At the functional level, an enrichment of healthy scalp-related bacterial pathways, such as biotin metabolism and decrease in the fungal pathogenesis pathways was observed. The study provides novel insights on the effect of coconut oil in maintaining a healthy scalp and in modulating the scalp microbiome.

Serum Levels of 25-Hydroxyvitamin D in Patients with Seborrheic Dermatitis: A Case-Control Study

Several autoimmune papulosquamous skin conditions such as psoriasis, systemic lupus erythematous, and lichen planus have been associated with vitamin D deficiency or correlated with serum vitamin D level. This study was aimed at comparing the 25-hydroxyvitamin D (25(OH)D) status in patients with facial or scalp seborrheic dermatitis with healthy subjects. This case-control study included 289 patients (118 with psoriasis and 171 sex- and age-matched control subjects) from the outpatient clinic of two hospital dermatology departments in the west of Mazandaran province, Iran. All patients and control subjects were studied during one season to avoid seasonal variations in vitamin D levels. Serum mean ± standard deviation of 25(OH)D levels were significantly lower in seborrheic dermatitis patients than in control subjects (20.71 ± 8.16 vs. 23.91 ± 7.78, P = 0.007). Serum 25(OH)D levels were negatively associated with the risk of developing seborrheic dermatitis (odds ratio (OR): 0.898, 95% confidence interval (Cl): 0.840-0.960, P = 0.002). Also, vitamin D under 30 ng/ml was associated with OR: 4.22 (95% Cl: 1.077-16.534, P = 0.039) for seborrheic dermatitis. The severity of scalp disease was significantly associated with serum 25(OH)D level (P = 0.003). Cases with severe scalp scores had significantly lower serum 25(OH)D level compared to moderate OR score (P = 0.036). A similar trend was not seen in the facial disease. The 25(OH)D values are significantly lower in seborrheic dermatitis patients than in healthy subjects. Furthermore, the scalp disease severity was associated with lower serum 25(OH)D level. Our results may suggest that vitamin D may play a role in the pathogenesis of seborrheic dermatitis.

Validating Differential Volatilome Profiles in Parkinson's Disease

Parkinson's disease (PD) is a progressive neurodegenerative disorder that does not currently have a robust clinical diagnostic test. Nonmotor symptoms such as skin disorders have long since been associated with the disease, and more recently a characteristic odor emanating from the skin of people with Parkinson's has been identified. Here, dynamic head space (DHS) thermal desorption (TD) gas chromatography-mass spectrometry (GC-MS) is implemented to directly measure the volatile components of sebum on swabs sampled from people with Parkinson's-both drug naïve and those on PD medications (n = 100) and control subjects (n = 29). Supervised multivariate analyses of data showed 84.4% correct classification of PD cases using all detected volatile compounds. Variable importance in projection (VIP) scores were generated from these data, which revealed eight features with VIP > 1 and p < 0.05 which all presented a downregulation within the control cohorts. Purified standards based on previously annotated analytes of interest eicosane and octadecanal did not match to patient sample data, although multiple metabolite features are annotated with these compounds all with high spectral matches indicating the presence of a series of similar structured species. DHS-TD-GC-MS analysis of a range of lipid standards has revealed the presence of common hydrocarbon species rather than differentiated intact compounds which are hypothesized to be breakdown products of lipids. This replication study validates that a differential volatile profile between control and PD cohorts can be measured using an analytical method that measures volatile compounds directly from skin swabs.

Antifungal Properties of Essential Oils and Their Compounds for Application in Skin Fungal Infections: Conventional and Nonconventional Approaches

Essential oils (EOs) are known to have varying degrees of antimicrobial properties that are mainly due to the presence of bioactive compounds. These include antiviral, nematicidal, antifungal, insecticidal and antioxidant properties. This review highlights the potential of EOs and their compounds for application as antifungal agents for the treatment of skin diseases via conventional and nonconventional approaches. A search was conducted using three databases (Scopus, Web of Science, Google Scholar), and all relevant articles from the period of 2010-2020 that are freely available in English were extracted. In our findings, EOs with a high percentage of monoterpenes showed strong ability as potential antifungal agents. Lavandula sp., Salvia sp., Thymus sp., Citrus sp., and Cymbopogon sp. were among the various species found to show excellent antifungal properties against various skin diseases. Some researchers developed advanced formulations such as gel, semi-solid, and ointment bases to further evaluate the effectiveness of EOs as antifungal agents. To date, most studies on the application of EOs as antifungal agents were performed using in vitro techniques, and only a limited number pursued in vivo and intervention-based research.

Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions

The microbiome plays an important role in a wide variety of skin disorders. Not only is the skin microbiome altered, but also surprisingly many skin diseases are accompanied by an altered gut microbiome. The microbiome is a key regulator for the immune system, as it aims to maintain homeostasis by communicating with tissues and organs in a bidirectional manner. Hence, dysbiosis in the skin and/or gut microbiome is associated with an altered immune response, promoting the development of skin diseases, such as atopic dermatitis, psoriasis, acne vulgaris, dandruff, and even skin cancer. Here, we focus on the associations between the microbiome, diet, metabolites, and immune responses in skin pathologies. This review describes an exhaustive list of common skin conditions with associated dysbiosis in the skin microbiome as well as the current body of evidence on gut microbiome dysbiosis, dietary links, and their interplay with skin conditions. An enhanced understanding of the local skin and gut microbiome including the underlying mechanisms is necessary to shed light on the microbial involvement in human skin diseases and to develop new therapeutic approaches.

Bitemporal Scalp Hair Loss: Differential Diagnosis of Nonscarring and Scarring Conditions

BACKGROUND: Bitemporal hair loss can be a diagnostic challenge because several entities may affect this region of the scalp, including both scarring and nonscarring conditions. Although traction alopecia is the most common cause of bitemporal hair loss, no studies to date have outlined all of the potential causes. OBJECTIVE: We sought to review nonscarring and scarring conditions that have a clinical presentation of bitemporal hair loss, including traction alopecia, telogen effluvium, female pattern hair loss, frontal fibrosing alopecia, central centrifugal cicatricial alopecia, and seborrheic dermatitis. METHODS: A Google Scholar and PubMed literature search were conducted for this review. The keywords used in the search included the following: "traction alopecia", "telogen effluvium", "androgenic alopecia", "androgenetic alopecia", "female pattern hair loss", "alopecia areata", "frontal fibrosing alopecia", "central centrifugal cicatricial alopecia", and "seborrheic dermatitis". The scope of our search included all research articles published from 1957 to February 2019. In total, 94 articles regarding non-scarring and scarring hair loss were selected and included according to topic relevance. Exclusion criteria included articles that did not address the epidemiology and/or clinicopathologic or dermatoscopic findings of non-scarring and scarring forms of alopecia. Inclusion criteria included articles that addressed a clinical presentation of bitemporal hair loss; or addressed epidemiology, clinical presentation, dermatoscopic findings, and/or treatment. RESULTS: Bitemporal hair loss is a common and often distressing condition with a broad differential. CONCLUSION: Clinicians must be aware of the potential causes of bitemporal hair loss. Prompt diagnosis is essential to prevent further hair loss, especially in scarring conditions.