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American Journal of Clinical Dermatology

, Volume 1, Issue 2, pp 75–80 | Cite as

Management of Seborrheic Dermatitis and Pityriasis Versicolor

  • Jan Faergemann
Disease Management

Abstract

Pityriasis (tinea) versicolor and seborrheic dermatitis are two very common skin diseases. Pityriasis versicolor is a chronic superficial fungal disease usually located on the upper trunk, neck, or upper arms. In pityriasis versicolor, the lipophilic yeast Malassezia (also know as Pityrosporum ovale or P. orbiculare) changes from the blastospore form to the mycelial form under the influence of predisposing factors. The most important exogenous factors are high temperatures and a high relative humidity which probably explain why pityriasis versicolor is more common in the tropics. The most important endogenous factors are greasy skin, hyperhidrosis, hereditary factors, corticosteroid treatment and immunodeficiency. There are many ways of treating pityriasis versicolor topically. Options include propylene glycol, ketoconazole shampoo, zinc pyrithione shampoo, ciclopiroxamine, selenium sulfide, and topical antifungals. In difficult cases, short term treatment with fluconazole or itraconazole is effective and well tolerated. To avoid recurrence a prophylactic treatment regimen is mandatory.

Seborrheic dermatitis is characterized by red scaly lesions predominantly located on the scalp, face and upper trunk. There are now many studies indicating that Malassezia plays an important role in this condition. Even a normal number of Malassezia will start an inflammatory reaction. Mild corticosteroids are effective in the treatment of seborrheic dermatitis. However, the disease recurs quickly, often within just a few days. Antifungal therapy is effective in the treatment of seborrheic dermatitis and, because it reduces the number of Malassezia, the time to recurrence is increased compared with treatment with corticosteroids. Antifungal therapy should be the primary treatment of this disease.

Keywords

Itraconazole Ketoconazole Terbinafine Seborrheic Dermatitis Bifonazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Gordon M.A. The lipophilic microflora of the skin. Mycologia 1951; 43: 524–534CrossRefGoogle Scholar
  2. 2.
    Roberts S.O.B. Pityrosporum orbiculare: incidence and distribution on clinical normal skin. Br J Dermatol 1969; 81: 264–269PubMedCrossRefGoogle Scholar
  3. 3.
    Faergemann J, Aly R, Maibach HI. Quantitative variations in distribution of Pityrosporum orbiculare on clinically normal skin. Acta Derm Venereol (Stockh) 983; 63: 346–8Google Scholar
  4. 4.
    Faergemann J., Fredriksson T. Age incidence of Pityrosporum orbiculare on human skin. Acta Derm Venereol (Stockh) 1980; 60: 531–533Google Scholar
  5. 5.
    Gueho E., Midgley G., Guillot J. The genus Malassezia with description of four new species. Antonie v Leuwenhoek 1996; 69: 337–355CrossRefGoogle Scholar
  6. 6.
    Guillot J., Guého E., Lesourd M., et al. Identification of Malassezia species — a practical approach. J Mycol Méd 1996; 6: 103–110Google Scholar
  7. 7.
    Faergemann J. Lipophilic yeasts in skin disease. Semin Dermatol 1985; 4: 173–184Google Scholar
  8. 8.
    Faergemann J. Pityrosporum yeasts — what’s new? Mycoses 1997; 40 Suppl. 1: 29–32PubMedCrossRefGoogle Scholar
  9. 9.
    Faergemann J. Pityrosporum infections. In: Elewski B.E., editor. Cutaneous fungal infections. New York: Igaku-Shoin, 1992: 69–83Google Scholar
  10. 10.
    Faergemann J. Tinea versicolor (Pityriasis versicolor). In: Demis D.J., editor. Clinical Dermatology. Philadelphia: Lippincott-Raven, 1995: 1–9Google Scholar
  11. 11.
    Faergemann J., Fredriksson T. Propylene glycol in the treatment of tinea versicolor. Acta Derm Venereol (Stockh) 1989; 60: 92–93Google Scholar
  12. 12.
    Fredriksson T. Topical treatment with BAY b 5097, a new broad spectrum antimycotic agent. Br J Dermatol 1972; 86: 628–630PubMedCrossRefGoogle Scholar
  13. 13.
    Svejgaard E. Double-blind trial of miconazole in dermatomycosis. Acta Derma Venereol (Stockh) 1973; 53: 497–499Google Scholar
  14. 14.
    Swartz K.J., Moch T.H., Kenzelmann M. Poloklinische Prüfung von Econazole bei 594 Fallen von Hautmykosen. Dtsch Med Wochenschr 1975; 100: 1497–1500CrossRefGoogle Scholar
  15. 15.
    Faergemann J., Fredriksson T. An open trial of the effect of a zinc pyrithione shampoo in tinea versicolor. Cutis 1980; 25: 667–669PubMedGoogle Scholar
  16. 16.
    Albright S.D., Hitch J.M. Rabbit treatment of tinea versicolor with selenium sulphide. Arch Dermatol 1966; 93: 460–461PubMedCrossRefGoogle Scholar
  17. 17.
    Hernandez-Perez E. A comparison between one and two week’s treatment with bifonazole in pityriasis versicolor. J Am Acad Dermatol 1986; 14: 561–564PubMedCrossRefGoogle Scholar
  18. 18.
    Savin R.C., Horwitz S.N. Double-blind comparison of 2% ketoconazole cream and placebo in the treatment of tinea versicolor. J Am Acad Dermatol 1986; 15: 500–503PubMedCrossRefGoogle Scholar
  19. 19.
    Aste N., Pau M., Pinna A.L., et al. Clinical efficacy and tolerability of terbinafine in patients with pityriasis versicolor. Mycoses 1991; 34: 353–357PubMedCrossRefGoogle Scholar
  20. 20.
    Faergemann J., Hersle K., Nordin P. Pityriasis versicolor: clinical experience with Lamisil cream and Lamisil DermGel. Dermatol 1997; 194 Suppl. 1: 19–21CrossRefGoogle Scholar
  21. 21.
    Vermeer B.J., Staats C.C.G. The efficacy of a topical application application of terbinafine 1% solution in subjects with pityriasis versicolor: a placebo controlled study. Dermatol 1997; 194 Suppl. 1: 22–24CrossRefGoogle Scholar
  22. 22.
    Corte M., Jung K., Linker U., et al. Topical application of a 0.1% ciclopiroxolamine solution for the treatment of pityriasis versicolor. Mycoses 1989; 32: 200–203PubMedCrossRefGoogle Scholar
  23. 23.
    Rekacewicz I., Guillaume J.C., Benkhraba F., et al. A double-blind placebo-controlled study of a 2 percent foaming lotion of ketoconazole in a single application in the treatment of pityriasis versicolor. Ann Dermatol Venereol 1990; 117: 709–711PubMedGoogle Scholar
  24. 24.
    Lange D.S., Richards H.M., Guarnieri J, et al. Ketoconazole 2% shampoo in the treatment of tinea versicolor: a multicenter, randomized, double-blind, placebo- controlled study. J Am Acad Dermatol 1998; 39: 944–950PubMedCrossRefGoogle Scholar
  25. 25.
    Jones H.E. Ketoconazole today. A review of clinical experience. Manchester, England: ADIS Press, 1987Google Scholar
  26. 26.
    Faergemann J., Djärv L.: Tinea versicolor: treatment and prophylaxis with ketoconazole. Cutis 1982; 30: 542–545PubMedGoogle Scholar
  27. 27.
    Hay R.J., Midgley G. Short course ketoconazole therapy in pityriasis versicolor. Clin Exp Dermatol 1984; 9: 571–573PubMedCrossRefGoogle Scholar
  28. 28.
    Rausch L.J., Jacobs P.H. Tinea versicolor: treatment and prophylaxis with monthly administration of ketoconazole. Cutis 1964; 34: 470–471Google Scholar
  29. 29.
    Shemer A., Nathansohn N., Kaplan B., et al. Itraconazole versus ketoconazole in the treatment of tinea versicolor. J Dermatol Treat 1999; 10: 19–23CrossRefGoogle Scholar
  30. 30.
    Delescluse J. Itraconazole in tinea versicolor. A review. J Am Acad Dermatol 1990; 23: 551–554PubMedCrossRefGoogle Scholar
  31. 31.
    Faergemann J. Treatment of pityriasis versicolor with itraconazole. A doubleblind placebo-controlled study. Mykoses 1988; 31: 377–379CrossRefGoogle Scholar
  32. 32.
    Faergemann J. Treatment of pityriasis versicolor with a single dose of fluconazole. Acta Derm Venereol (Stockh) 1992; 72: 74–75Google Scholar
  33. 33.
    Amer M.A. Fluconazole in the treatment of tinea versicolor. Int J Dermatol 1997; 36: 938–946CrossRefGoogle Scholar
  34. 34.
    Burton J.L., Holden C.A. Seborrhoeic dermatitis. In: Champion R.H., Burton J.L., Burna D.A., et al., editors. Textbook of Dermatology (ed 6). Oxford: Blackwell Scientific Publications, 1998: pp 638–643Google Scholar
  35. 35.
    Faergemann J. Seborrhoeic dermatitis and Pityrosporum orbiculare: treatment of seborrhoeic dermatitis of the scalp with miconazole-hydrocortisone (Dactacort), miconazole and hydrocrotisone. Br J Dermatol 1986; 114: 695–700PubMedCrossRefGoogle Scholar
  36. 36.
    Bergbrant I.-M. Seborrhoeic dermatitis and Pityrosporum ovale: cultural, immunological and clinical studies. Acta Derm Venereol Suppl (Stockh) 1991; 167: 1–36Google Scholar
  37. 37.
    Sohnle P.G., Collins-Lech C. Activation of complement by Pityrosporum orbiculare. J Invest Dermatol 1983; 80: 93–97PubMedCrossRefGoogle Scholar
  38. 38.
    Midgley G., Hay R.J. Serological responses to Pityrosporum (Malassezia) in seborrhoeic dermatitis demonstrated by ELISA and Western blotting. Bull Soc Fr Mycol Méd 1988; 17: 267–276Google Scholar
  39. 39.
    Neuber K., Kröger S., Gruseck E., et al. Effects of Pityrosporum ovale on proliferation, immunoglobulin (IgA, G, M) synthesis and cytokine (IL-2, IL-10, IFN?) production of peripheral blood mononuclear cells from patients with seborrhoeic dermatitis. Arch Dermatol Res 1996; 288: 532–536PubMedGoogle Scholar
  40. 40.
    Wikler J.R., Trago E., de Haan P., et al. Cell-mediated deficiency to Pityrosporum orbiculare in patients with seborrhoeic dermatitis [abstract]. ESDR-JSID-SID Tricontinental Meeting; 1989 Apr 26-30; Washington DCGoogle Scholar
  41. 41.
    Ashbee H.R., Ingham E., Holland K.T, et al. Cell-mediated immune responses to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrhoeic dermatitis and controls. Exp Dermatol 1994; 3: 106–112PubMedCrossRefGoogle Scholar
  42. 42.
    Bergbrant I.-M., Andersson B., Faergemann J. Cell-mediated immunity to Pityrosporum ovale in patients with seborrhoeic dermatitis and pityriasis versicolor. Cin Exp Dermatol 1999; 24: 402–406CrossRefGoogle Scholar
  43. 43.
    Pearry M.E., Sharpe G.R. Seborrhoeic dermatitis is not caused by an altered immune response to Malassezia yeast. Br J Dermatol 1998; 139: 254–263CrossRefGoogle Scholar
  44. 44.
    Bergbrant I.-M., Johansson S., Robbins D., et al. An immunological study in patients with seborrhoeic dermatitis. Clin Exp Dermatol 1991; 16: 331–338PubMedCrossRefGoogle Scholar
  45. 45.
    Kieffer M., Bergbrant I.-M., Faergemann J., et al. Skov patients with atopic dermatitis and seborrhoeic dermatitis. J Am Acad Dermatol 1990; 22: 739–742PubMedCrossRefGoogle Scholar
  46. 46.
    Kesavan S., Walters C.E., Holland K.T, et al. The effects of Malassezia on pro-inflammatory cytokine production by human peripheral blood mononuclear cells in vitro. Med Mycol 1998; 36: 97–106PubMedGoogle Scholar
  47. 47.
    Piérard-Franshimont C., Arrese J.E., Piérard G.E. Immunohistochemical aspects of the link between Malassezia ovalis and seborrhoeic dermatitis. J Eur Acad Dermatol Venereol 1995; 4: 14–49CrossRefGoogle Scholar
  48. 48.
    Romani L., Bistoni F., Puccetti P. Initiation of T-helper cell immunity to Candida albicans by IL-12: the role of neutrophils. Chem Immunol 1997; 68: 110–135PubMedCrossRefGoogle Scholar
  49. 49.
    Gulay Z., Imir T. Anti-candidial activity of natural killer (NK) an lymphokine activated killer (LAK) lymphocytes in vitro. Immunobiol 1996; 95: 220–230CrossRefGoogle Scholar
  50. 50.
    Shuster S. The aetiology of dandruff and the mode of action of therapeutic agents. Br J Dermatol 1984; 111: 235–242PubMedCrossRefGoogle Scholar
  51. 51.
    Skinner R.B., Noah P.W., Taylor R.M., et al. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol 1985; 2: 852–857CrossRefGoogle Scholar
  52. 52.
    Faergemann J. Treatment of seborrhoeic dermatitis of the scalp with ketoconazole shampoo. Acta Dermato Venereol (Stockh) 1990; 70: 171–172Google Scholar
  53. 53.
    Ford G.P., Farr P.M., Ive F.A., et al. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol 1984; 111: 603–607PubMedCrossRefGoogle Scholar
  54. 54.
    Stratigos I.D., Katamboas A., Antoniu C.H., et al. Ketoconazole 2% cream versus 1% hydrocortisone cream in the treatment of seborrhoeic dermatitis: a doubleblind comparative study. J Am Acad Dermatol 1988; 19: 850–853PubMedCrossRefGoogle Scholar
  55. 55.
    Marks R., Pears A.D., Walker A.P. The effects of a shampoo containing zinc pyrithione on the control of dandruff. Br J Dermatol 1985; 112: 415–422PubMedCrossRefGoogle Scholar
  56. 56.
    Faergemann J. Propylene glycol in the treatment of seborrheic dermatitis of the scalp: a double-blind study. Cutis 1988; 42: 69–71PubMedGoogle Scholar
  57. 57.
    Faergemann J. Treatment of seborrhoeic dermatitis with bifonazole. Mycoses 1989; 32: 309–311PubMedCrossRefGoogle Scholar
  58. 58.
    Shuttleworth D., Squire R.A., Boorman G.C., et al. Comparative clinical efficacy of shampoos containing ciclopirox olamine (1.5%) or ketoconazole (2%; Nizoral) for the control of dandruff/seborrhoeic dermatitis. J Dermatol Treat 1998; 9: 157–162CrossRefGoogle Scholar
  59. 59.
    Zeharia A., Mimouni M., Fogel D. Treatment with bifonazole shampoo for scalp seborrhea in infants and young children. Ped Dermatol 1996; 13: 151–153CrossRefGoogle Scholar
  60. 60.
    Pari T., Pulimood S., Jacob M., et al. Randomised double blind controlled trial of 2% ketoconazole cream versus 0.05% clobetasol 17-butyrate cream in seborrhoeic dermatitis. J Eur Acad Dermatol Venereol 1998; 10: 89–90PubMedCrossRefGoogle Scholar
  61. 61.
    Veen A.J., Prevoo R.L.M.A., Velders A.J., et al. Betamethasone-17-valerate compared with ketoconazole for topical treatment of seborrhoeic dermatitis of the scalp in adults. J Dermatol Treat 1998; 9: 239–245CrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.Department of DermatologySahlgrenska University HospitalGothenburgSweden

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