Drugs

, Volume 41, Issue 2, pp 178–184

The Control of Seborrhoeic Dermatitis and Dandruff by Antipityrosporal Drugs

  • John A. McGrath
  • Gillian M. Murphy
Review Article

Summary

For many years the exact nature of the pathophysiology of seborrhoeic dermatitis and dandruff was in doubt. Different schools of thought debated whether Pityrosporum yeasts were of primary pathogenic significance or a secondary phenomenon, with epidermal hyperproliferation as the primary pathology.

Although effective therapy in seborrhoeic dermatitis and dandruff has for a long time been based on compounds whose only common link was antipityrosporal activity, proof of this relevance was lacking until the introduction of effective antifungal drugs, in particular ketoconazole.

This article charts the swing of opinion towards the primary pityrosporal aetiology of seborrhoeic dermatitis and dandruff, reviews the evidence that antipityrosporal activity is the common link to various compounds which benefit these conditions, and compares the efficacy of these substances in treatment.

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References

  1. Alexander S. Loss of hair and dandruff. British Journal of Dermatology 79: 549–552, 1967PubMedCrossRefGoogle Scholar
  2. Belew PW, Rosenberg EW, Jennings BR. Activation of the alternative pathway of complement by Malassezia ovalis (Pityrosporumovale). Mycopathologia 70: 187–191, 1980PubMedCrossRefGoogle Scholar
  3. Bergsma W, Roster M. Ketoconazole 2% cream in the treatment of seborrhoeic dermatitis. Proceedings of a satellite symposium to the 2nd International Skin Therapy Symposium, Antwerp, 1988, pp. 49–50, Janssen Pharmaceutica, 1988Google Scholar
  4. Blatchford NR. The pharmacokinetics of ketoconazole 2% cream and shampoo. Proceedings of a satellite symposium to the 2nd International Skin Therapy Symposium, Antwerp, 1988, pp. 46–48, Janssen Pharmaceutica, 1988Google Scholar
  5. Borges M. Ultrastructural correlates of antimycotic treatment. Current Topics in Medical Mycology 2: 1, 1986CrossRefGoogle Scholar
  6. Boughton K. Ketoconazole and hepatic reactions. South African Medical Journal 63: 955, 1983PubMedGoogle Scholar
  7. Boyle J, Burton JL, Faergemann J. Use of topical lithium succinate for seborrhoeic dermatitis. British Medical Journal 292: 28, 1986PubMedCrossRefGoogle Scholar
  8. Burton JL, Cunliffe WJ, Stafford I, Shuster S. The effect of facial nerve paresis on sebum excretion. British Journal of Dermatology 84: 135–138, 1971PubMedCrossRefGoogle Scholar
  9. Butterfield W. Sensitivities of Pityrosporum sp to selected commercial shampoos. British Journal of Dermatology 116: 233–235, 1987PubMedCrossRefGoogle Scholar
  10. Carr MM, Pryce DM, Ive FA. Treatment of seborrhoeic dermatitis with ketoconazole. 1. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole. British Journal of Dermatology 116: 213–216, 1987PubMedCrossRefGoogle Scholar
  11. Cauwenbergh G. International experience with ketoconazole shampoo in the treatment of seborrhoeic dermatitis and dandruff. In Shyster S & Blatchford N (Eds) Seborrhoeic dermatitis and dandruff: a fungal disease, Royal Society of Medicine International Congress and Symposium Series, No. 132, pp. 35–42, Royal Society of Medicine Services Ltd, 1988Google Scholar
  12. Chandler CJ, Segel IH. Mechanism of the antimicrobial action of pyrithione: effects on membrane transport, ATP levels, and protein synthesis. Antimicrobial Agents and Chemotherapy 14: 60–68, 1978PubMedCrossRefGoogle Scholar
  13. Cowley NC, Farr PM, Shuster S The permissive effect of sebum in seborrhoeic dermatitis: an explanation of the rash in neu-rological disorders. British Journal of Dermatology 122: 71–76, 1990PubMedCrossRefGoogle Scholar
  14. Cunliffe WJ. A double blind placebo-controlled crossover study to determine the incidence and severity of dermal irritaricy of ketoconazole 2% cream. Clinical Research Report, Janssen Pharmaceutica, 1982Google Scholar
  15. De Doncker P, Legendre B, Van Lint J, Woestenborghs R, Hueb-’ ner G, et al. Chronic use of ketoconazole 2% shampoo in patients with seborrhoeic dermatitis and dandruff. 2nd International Skin Therapy Symposium, Antwerp, May 5 1988, pp. 59–60, Janssen Pharmaceutica, 1988Google Scholar
  16. Faergemann J. In vitro and in vivo activities of ketoconazole and itraconazole against Pityrosporum ovale. Antimicrobial Agents and Chemotherapy 26: 773–775, 1984PubMedCrossRefGoogle Scholar
  17. Faergemann J. Seborrhoeic dermatitis and Pityrosporum orbiculare: treatment of seborrhoeic dermatitis of the scalp with miconazole-hydrocortisone (Daktacort), miconazole md hydro* cortisone. British Journal of Dermatology 114: 695–700, 1986PubMedCrossRefGoogle Scholar
  18. Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with topical ketoconazole. Lancet 2: 1271–1272, 1984PubMedCrossRefGoogle Scholar
  19. Ford GP, Farr PM, Ive FA, Shuster S. The response of seborrhoeic dermatitis to ketoconazole. British Journal of Dermatology 111: 603–607,1984PubMedCrossRefGoogle Scholar
  20. Fredriksson T. Controlled comparison of Clinitar shampoo and Selsun shampoo in the treatment of seborrhoeic dermatitis of the scalp. British Journal of Clinical Practice 39: 25–28, 1985PubMedGoogle Scholar
  21. Gosse RM, Vanderwyk RW. The relationship of a nystatin-resistant strain of Pityrosporum ovale to dandruff. Journal of the Society of Cosmetic Chemists 20: 603–613, 1969Google Scholar
  22. Green CA, Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with ketoconazole: II. Response of seborrhoeic dermatitis of the face, scalp and trunk to topical ketoconazole. British Journal of Dermatology 116: 217–221, 98rh Google Scholar
  23. Grossier D, Bottone EJ, Lebwohl M. Association of Pityrosporum orbiculare (Malassezia furfur) with seborrhoeic dermatitis in patients with acquired immunodeficiency syndrome. Journal of the American Academy of Dermatology 20(5): 770–773, 1989CrossRefGoogle Scholar
  24. Guin JD. Double-blind comparison of 2% ketoconazole cream in the treatment of seborrhoeic dermatitis. Clinical Research Report R 41 400/139, Janssen Pharmacutica, 1985Google Scholar
  25. Hickman J. A randomized double-blind placebo controlled comparison of ketoconazole 2% shampoo and selenium sulphide 2.5% shampoo in the treatment of moderate to severe dandruff. Clinical Research Report R 41 400, Janssen Pharmaceutica, 1988Google Scholar
  26. Hull PR, Presbury DGC. Ketoconazole in the treatment of seborrhoeic dermatitis: a double blind placebo controlled study. Clinical Research Report R 41 400/165, Janssen Pharmaceutica, 1988Google Scholar
  27. Jacobs PH. Seborrhoeic dermatitis; causes and management. Cutis 41: 182–184, 1988Google Scholar
  28. Kantor I. Medicated anti-dandruff shampoo with 1% ketoconazole: clinical efficacy study vs Head and Shoulders shampoo. Research Report, Johnson and Johnson Baby Products Co, pp. 87–102, 1987Google Scholar
  29. Kligman AM, McGinley KJ, Leyden JJ. The nature of dandruff. Journal of the Society of Cosmetic Chemists 27: 111–139, 1979Google Scholar
  30. Leeming JP, Burton JL. Lithium succinate and seborrhoeic dermatitis: an antifungal mode of action? Correspondence. British Journal of Dermatology 122: 718–719, 1990PubMedCrossRefGoogle Scholar
  31. Malassez L. Note sur le champignon du pityriasis simple. Archives de Physiologie 2: 451, 1874Google Scholar
  32. Marks R, Pearse AD, Walker AP. The effects of a shampoo containing the zinc pyrithione on the control of dandruff. British Journal of Dermatology 112: 415–422, 1985PubMedCrossRefGoogle Scholar
  33. Mathes BN, Douglass MC. Seborrhoeic dermatitis in patients with AIDS. Journal of the American Academy of Dermatology 13: 947–951, 1985PubMedCrossRefGoogle Scholar
  34. McGinley KJ, Leyden JJ, Marples BN, Kligman AM. Quantitative microbiology in non-dandruff and seborrhoeic dermatitis. Journal of Investigative Dermatology 64: 401–404, 1975PubMedCrossRefGoogle Scholar
  35. McLeod JMH, Dowling GB. An experimental study of the pityrosporum of Malassez: its morphology, cultivation and pathogenicity. British Journal of Dermatology XL: 139–148, 1928CrossRefGoogle Scholar
  36. Mertens R, Vankeerberghen R, Van Lint J. Ketoconazole 2% shampoo in the treatment of dandruff and for seborrhoeic dermatitis: a double-blind placebo controlled study. Clinical Research Report R 41 400/162, Janssen Pharmaceutica, 1987Google Scholar
  37. Midgley G, Hay RJ. Detection of antibodies to Pityrosporum in human serum. British Journal of Dermatology 116: 457, 1987Google Scholar
  38. Moore M, Kile RL, Engman JR, Engman MF. Pityrosporum ovale (bottle bacillus of unna, spore of malassez) cultivation and possible role in seborrhoeic dermatitis. Archives of Dermatology of Syphilology 33: 457–472, 1936CrossRefGoogle Scholar
  39. Peereboom-Wynia JDR, Koster M. Treatment of seborrhoeic dermatitis of the scalp and dandruff with ketoconazole 2% scalp gel. Proceedings of a satellite symposium to the 2nd International Skin Therapy Symposium, Antwerp, 1988, pp. 51–52, Janssen Pharmaceutica, 1988Google Scholar
  40. Pochi PE, Strauss JS, Mescon H. Sebum production and fractional 17 ketosteroid excretion in Parkinsonism. Journal of Investigative Dermatology 38: 45–51, 1962PubMedGoogle Scholar
  41. Rappaport M. A randomized, controlled clinical trial of four anti-dandruff shampoos. Journal of International Medical Research 9: 152–156, 1981Google Scholar
  42. Rivolta S. Parasitti vegetali, 1st ed., pp. 469–471, Giulio Speirani, Torino, 1873Google Scholar
  43. Rosenberg EW. Double-blind comparison of 2% ketoconazole cream in the treatment of seborrhoeic dermatitis. Clinical Research Report R41 400/138, Janssen Pharmaceutica, 1985Google Scholar
  44. Sabouraud R. Pityriasis et alopecies peliculaires. In Les maladies desquamatives, 1st ed., p. 295, Masson et Cie, Paris, 1904Google Scholar
  45. Schrooten P, Cauwenbergh G. Ketoconazole shampoo in the treatment of dandruff or seborrhoeic dermatitis; a double-blind placebo controlled study. Clinical Research Report R 41 400/ 157, Janssen Pharmaceutica, 1986Google Scholar
  46. Shifrine M, Marr AG. The requirement of fatty acids by Pityrosporum ovale. Journal of General Microbiology 32: 263, 1963PubMedCrossRefGoogle Scholar
  47. Shuster S. The aetiology of dandruff and the mode of action of therapeutic agents. British Journal of Dermatology 111: 235–242, 1984PubMedCrossRefGoogle Scholar
  48. Shuster S. Introduction: a history. In Shuster S & Blatchford N (Eds) Seborrhoeic dermatitis and dandruff: a fungal disease, Royal Society of Medicine International Congress and Symposium Series, No. 132, pp. 1–4, Royal Society of Medicine Services Ltd, 1988Google Scholar
  49. Skinner RB, Noah PW, Taylor RM, Zanolli MD, West S, et al. Double-blind treatment with 2% ketoconazole cream. Journal of the American Academy of Dermatology 12: 852–856, 1985PubMedCrossRefGoogle Scholar
  50. Stoppie P, Cauwenbergh G, Van de Heyning-Meier J, De Greef H, Borgers M. An autoradiographic study of the penetration of a 2% ketoconazole formulation into human skin. Advances in Therapy 4: 219, 1987Google Scholar
  51. Stratigos JS, Katsambas A, Antoniou CH, Argerinou G, Michailides D. Ketoconazole 2% cream v hydrocortisone 1% cream in the treatment of seborrhoeic dermatitis; a double-blind comparative study. Proceedings of a satellite symposium to the 2nd International Skin Therapy Symposium, Antwerp, 1988, pp. 54–55, Janssen Pharmaceutica, 1988Google Scholar
  52. Tanew A. A randomized study with ketoconazole shampoo 2% or Selsun R (selenium sulphide 2.5%) in the treatment of seborrhoeic dermatitis and/or dandruff. Clinical Research Report R41 400/172, Janssen Pharmaceutica, 1987Google Scholar
  53. Thody AJ, Shuster S. Control and function of sebaceous glands. Physiological Reviews 69: 283–416, 1989Google Scholar
  54. Thulliez M, Cornelis H, Schiettekatte L, Vankeerberghen R, Of-fermans W, et al. Comparison of 4 concentrations of a ketoconazole shampoo with a placebo shampoo in dandruff and/ or seborrhoeic dermatitis. Clinical Research Report R41 400/ 161, Janssen Pharmaceutica, 1987Google Scholar
  55. Tooley PJH, Naismith D, Nijjar AS, Collins K, Brown A, et al. An open, parallel group comparative study of ketoconazole 2% shampoo and selenium sulphide 2.5% shampoo in the treatment of dandruff. Clinical Research Report, Janssen Pharmaceutica, 1989Google Scholar
  56. Unna PG. Seborrhoeic eczema. Journal of Cutaneous and Genitourinary Disorders 5: 449–453, 1887Google Scholar
  57. Van Cutsem J, Van Gerven F, Van Peer A, Woestenborghs R, Fransen J, et al. Ketoconazole concentration in plasma and hair samples from volunteers after 8 weeks application of a ketoconazole 2% shampoo. Clinical Research Report R41 400/ 152, Janssen Pharmaceutica, 1986Google Scholar
  58. Van Derheyden D, Cauwenbergh G, Thulliez M, Cornelis H, Schiettekatte L, et al. Ketoconazole shampoo in the treatment of dandruff and/or seborrhoeic dermatitis: a randomized double-blind placebo controlled comparison of different concentrations. Clinical Research Report R41 400/163, Janssen Pharmaceutica, 1987Google Scholar
  59. Vanderwyk RW, Hechemy KE. A comparison of the bacterial and yeast flora of the human scalp and their effects upon dandruff production. Journal of the Society of Cosmetic Chemists 18: 629–639, 1967Google Scholar
  60. Weary PE. Pityrosporum ovale: observations on some aspects of host-parasite interrelationships. Archives of Dermatology 98: 408, 1968CrossRefGoogle Scholar
  61. Whitmore MC. Double-blind comparison of 2% ketoconazole cream in the treatment of seborrhoeic dermatitis. Clinical Research Report R41 400/136, Janssen Pharmaceutica, 1985Google Scholar
  62. Wilson CL, Walshe M. Incidence of seborrhoeic dermatitis in spinal injury patients. British Journal of Dermatology 119: 485, 1988Google Scholar

Copyright information

© Adis International Limited 1991

Authors and Affiliations

  • John A. McGrath
    • 1
  • Gillian M. Murphy
    • 1
  1. 1.Institute of DermatologySt Thomas’ HospitalLondonEngland

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