Serum zinc levels in seborrheic dermatitis: a case-control study

Background/aim: Malassezia colonization, sebaceous gland activity, hormones, immune system defects, environmental factors, and the interactions between these factors are thought to contribute to the pathogenesis of seborrheic dermatitis (SD). Zinc, an essential element, is involved in many biological processes including the ones that contribute to the development of SD. The aim of this study is to evaluate serum zinc levels in patients with SD. Materials and methods: Forty-three patients with SD and 41 healthy controls were enrolled in the study. Disease activity was assessed by the Seborrheic Dermatitis Area and Severity Index by a single dermatologist. Serum zinc levels of all subjects were evaluated. Results: Statistically significantly lower serum zinc levels were noted in SD patients than in the control group (79.16 ± 12.17 vs. 84.88 ± 13.59, respectively; P = 0.045). Conclusion: The results of the study demonstrated that patients who had SD had lower levels of serum zinc levels than healthy subjects.

Prevalence of dermatologic manifestations and metabolic biomarkers in women with polycystic ovary syndrome in north China.

BACKGROUND: Cutaneous features of hyperandrogenism in polycystic ovary syndrome (PCOS) include acne, hirsutism, seborrhea, androgenic alopecia (AGA), and acanthosis nigricans (AN). However, the relationships have not been well known broadly in terms of clinical hyperandrogenism and biochemical markers. OBJECTIVES: The aim of this study was to investigate biochemical and metabolic parameters in relation to cutaneous characters women in with and without PCOS. METHODS: This was a cross-sectional retrospective study including 186 women with PCOS and 113 age-matched without PCOS women. Acne grade, hirsutism, seborrhea, AGA, and AN were recorded. Hormonal and metabolic parameters were measured. RESULTS: The most common finding was acne, and AN was the least dermatological manifestations between PCOS and non-PCOS groups. The severity location and type of acne did not differ in PCOS women compared to non-PCOS women. Significant differences were found with respect to free androgen index (FAI) (P = .036), sex hormone-binding globulin (SHBG) (P = .023), and body mass index (BMI) (P = .001) between PCOS with acne and PCOS without acne groups. Overall, age (P = .005) was significantly decreased, while BMI (P = .004) was significantly higher in PCOS with hirsutism. The mean serum total testosterone (TT), dehydroepiandrosterone sulfate, and FAI were significantly elevated, but SHBG was decreased between PCOS with and without hirsutism groups. There were significantly different BMI (P = .018) and triglyceride (P = .024) except other hormonal parameter of without AGA group. CONCLUSION: This study indicated a strong correlation between hirsutism and metabolic abnormalities. Hirsutism is the most common cutaneous finding in PCOS women. Acne and AGA are associated with other manifestations of clinical hyperandrogenism, but not obvious markers of biochemical hyperandrogenemia and metabolic dysfunction.

Preliminary study of histamine H4 receptor expressed on human CD4+ T cells and its immunomodulatory potency in the IL-17 pathway of psoriasis.

BACKGROUND: Previous studies have shown the expression of histamine H4 receptor (H4R) on CD4+ T cells, especially human CD4+ Th2-polarized T cells. OBJECTIVE: This study aimed to investigate the role of H4R on these effector T cells in psoriasis. METHODS: We enrolled three patients each with active psoriasis, inactive psoriasis, scalp seborrheic dermatitis, and three normal controls, and compared the basal expression of H4R mRNA in their peripheral blood CD4+ T cells. Then, we identified H4R expression in dermal CD4+ T cells. Furthermore, we investigated H4R expression after stimulating separated peripheral blood CD4+ T cells with several inflammatory cytokines. RESULTS: The results showed higher H4R expression in the active psoriasis group compared to the inactive psoriasis group. It was interesting that interleukin (IL)-23, which is a representative cytokine contributing to Th17 cell differentiation, stimulated H4R expression significantly. After adding a selective H4R antagonist (JNJ-7777120) while the CD4+ T cells were polarized into Th17 cells, we observed a tendency toward suppressed IL-17 secretion. CONCLUSIONS: Histamine stimulation influences the IL-17 pathway in psoriasis via the fourth histamine receptor subtype, H4R, on CD4+ T cells. The immunomodulatory roles of H4R suggest its potency as a new therapeutic target for obstinate psoriasis.

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

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

The association of oxidative stress and disease activity in seborrheic dermatitis.

The pathogenesis of seborrheic dermatitis (SD) has not been clearly identified, and many factors are thought to play a role in its development. Recently, new studies have focused on increased oxidative stress (OS) in T cell-mediated skin diseases like psoriasis, contact dermatitis, and atopic dermatitis. However, there is no study investigating the status of OS in SD. In this study, we aimed to determine the status of OS in SD and the correlation of disease severity with OS. Fifty-four patients who were clinically and/or histopathologically diagnosed with SD were included in the study. Fifty-four healthy volunteers constituted the control group. Disease severity in patients with SD was scored according to the Seborrheic Dermatitis Area and Severity Index (SDASI). Serum total antioxidant status (TAS) and total oxidative status (TOS) were measured, and the oxidative stress index (OSI) was calculated in all patients and control subjects. The mean TAS values were significantly lower in the patient group than in the control group (p = 0.024). However, patients had significantly higher TOS and OSI values than the controls (p < 0.05). There was no correlation between SDASI and TAS, TOS, and OSI values. In this study, the association of oxidative stress and disease activity has first investigated in seborrheic dermatitis. It was found that OS was significantly higher in SD patients than in healthy subjects. In conclusion, our findings point to the possible role of the OS for the etiopathogenesis of SD.

The expression of BAFF, APRIL and TWEAK is altered in eczema skin but not in the circulation of atopic and seborrheic eczema patients.

The TNF family cytokines BAFF (B-cell activating factor of the TNF family) and APRIL (a proliferation-inducing ligand) are crucial survival factors for B-cell development and activation. B-cell directed treatments have been shown to improve atopic eczema (AE), suggesting the involvement of these cytokines in the pathogenesis of AE. We therefore analyzed the expression of these TNF cytokines in AE, seborrheic eczema (SE) and healthy controls (HC). The serum/plasma concentration of BAFF, APRIL and a close TNF member TWEAK (TNF-like weak inducer of apoptosis) was measured by ELISA. The expression of these cytokines and their receptors in skin was analyzed by quantitative RT-PCR and immunofluorescence. Unlike other inflammatory diseases including autoimmune diseases and asthma, the circulating levels of BAFF, APRIL and TWEAK were not elevated in AE or SE patients compared with HCs and did not correlate with the disease severity or systemic IgE levels in AE patients. Interestingly, we found that the expression of these cytokines and their receptors was altered in positive atopy patch test reactions in AE patients (APT-AE) and in lesional skin of AE and SE patients. The expression of APRIL was decreased and the expression of BAFF was increased in eczema skin of AE and SE, which could contribute to a reduced negative regulatory input on B-cells. This was found to be more pronounced in APT-AE, the initiating acute stage of AE, which may result in dysregulation of over-activated B-cells. Furthermore, the expression levels of TWEAK and its receptor positively correlated to each other in SE lesions, but inversely correlated in AE lesions. These results shed light on potential pathogenic roles of these TNF factors in AE and SE, and pinpoint a potential of tailored treatments towards these factors in AE and SE.

Effects of two estroprogestins containing ethynilestradiol 30 microg and drospirenone 3 mg and ethynilestradiol 30 microg and chlormadinone 2 mg on skin and hormonal hyperandrogenic manifestations.

Hyperandrogenic manifestation in women, such as seborrhea, acne and increased hair growth are common reasons of psychological distress. Skin appearance is very important for young women. This study evaluated the hormonal and skin effects of two estroprogestins (EPs) containing ethinyl-estradiol (EE) 30 microg associated with drospirenone (DRSP) 3 mg or chlormadinone acetate (CMA) 2 mg, respectively. Fifty-five women with signs and symptoms of hyperandrogenism (seborrhea, acne and increased hair growth) were enrolled in the study; randomly, 30 women were treated with EE 30 microg + DRSP 3 mg and 25 with EE 30 microg + CMA 2 mg. Follicle-stimulating hormone (FSH), luteinising hormone (LH), 17-hydroxyprogesterone (17OHP), androstenedione (A), testosterone (T), dehydroepiandrosterone sulfate (DHEAS), sex hormone binding globulin (SHBG) and free androgen index (T x 100/SHBG, FAI) were assessed at baseline, and after 3 and 6 months of treatment with EPs. Effects on seborrhea, acne and increased hair growth (as Ferriman-Gallwey score) were also evaluated at the same time points. Finally, skin hydration, transepidermal water loss (TEWL) and skin homogeneity were studied with non-invasive technique during the study. Treatment for 6 months with both EPs decreased significantly the circulating androgen levels (A, T, DHEAS) and FAI, and increased SHBG levels; also skin pattern was improved. EP containing EE and DRSP was better than EP containing EE and CMA as for skin changes, as seborrhea, acne, increased hair, hydration, homogeneity and overall quality of the skin; moreover, hormonal changes (as FAI) under therapy were more pronounced with EE/DRSP than EE/CMA. These effects may be considered in EP choice and could be important in improving patient's compliance and quality of life in hyperandrogenic women.

Elevated serum levels of soluble CD30 in patients with atopic dermatitis (AD).

The immunopathology of AD is still unclear, but evidence for an immune response polarized towards Th2 activity has been provided. The CD30 molecule belongs to the tumour necrosis factor (TNF) receptor family and is expressed on activated T cells with a sustained expression in Th2 cells. This molecule also exists in a soluble form (sCD30). Elevated serum levels of sCD30 have been found in patients with Hodgkin's disease, chronic hepatitis B infection and HIV infection. Studies were undertaken to compare the serum levels of sCD30 in patients with AD (n=49) and healthy non-atopic controls (n=94). The presence of sCD30 was analysed with ELISA. A significantly higher concentration of sCD30 was noted in AD patients, median sCD30 level 29 U/ml (range 1-708 U/ml), compared with healthy non-atopic controls (P<0.001), where the median level was 11 U/ml with a range of 1-1042 U/ml. No correlation was found between sCD30 levels and total serum IgE, or between the AD patients' SCORAD values and concentration of sCD30. sCD30 levels were also analysed in 20 AD patients, which during ketoconazole treatment had improved their clinical scores and reduced their serum IgE and eosinophil cationic protein levels. However, no significant decrease in sCD30 levels was noted after treatment. The results show that patients with AD have elevated levels of sCD30, but without correlation to total serum IgE or disease activity.

Essential fatty acids in infantile seborrheic dermatitis.

BACKGROUND: In infantile seborrheic dermatitis (ISD) several different pathogenetic mechanisms have been proposed. OBJECTIVE: The purpose of the study was to investigate the importance of essential fatty acids (EFAs) and their metabolites in the origin of ISD. METHODS: The serum EFA patterns of 30 children with ISD, 1 to 6 months of age, were studied for 2 to 5 months. Blood samples were obtained at the time of diagnosis and after spontaneous recovery. Control samples were taken from age-matched healthy children. RESULTS: In children with active dermatitis levels of EFA 18:1w9 were increased and levels of 18:2w6 were decreased, whereas 20:4w6 levels remained normal. The rare fatty acid 20:2w6 was found in significant amounts in 20 patients, but at only barely detectable levels in the controls. All deviant values but the levels of 20:2w6 were normal at the time of recovery. Breast milk samples were obtained at the time of diagnosis from the patients' mothers and from a control group consisting of healthy nursing mothers. The EFA patterns were identical. The differences in EFA pattern between children with ISD and those free of skin disease were significant. The normalization of the deviation in ISD paralleled the recovery at any age it occurred. CONCLUSION: The laboratory findings suggest a transient impaired function of the enzyme delta-6-desaturase. The altered EFA pattern in ISD may be important in the pathogenesis of the disease.

Penetration of tinidazole into skin blister fluid following its oral administration.

Plasma and skin blister fluid concentrations of tinidazole following a single oral dose of 2 g drug, and after multiple doses of 0.25 g every 12 h, were determined. Skin blisters were produced by direct application of 0.25% cantharidin ointment to the skin. The maximum concentration in plasma of about 36 mg.l-1 was observed after about 2 h, whereas in skin blister fluid the peak occurred after about 6 h and was 30 mg.l-1. The half-life in plasma was slightly shorter than in blister fluid at 17 and 19 h, respectively, but the difference was not significant. The penetration of tinidazole into cantharidin-induced skin blister fluid, defined according to Wise as the ratio of the AUCs in blister fluid and plasma was 1.00. During routine treatment with tinidazole (0.25 g every 12 h), the concentrations in plasma and blister fluid collected before and 3 h after the morning dose exceeded the minimal inhibitory concentrations for susceptible pathogens. The results provide a pharmacokinetic basis for the proven efficacy of tinidazole in the treatment of protozoal and anaerobic infections.

Blood levels of vitamin E, polyunsaturated fatty acids of phospholipids, lipoperoxides and glutathione peroxidase in patients affected with seborrheic dermatitis.

Plasma levels of vitamin E (Vit E) and polyunsaturated fatty acids of phospholipids (PUFA-PL) as well as erythrocyte glutathione peroxidase (GSH-Px) activity are significantly lower (P less than 0.001) in patients with seborrheic dermatitis (SD). both HIV seropositive or HIV sero-negative, than in control subjects. No differences are found between HIV sero-positive and sero-negative individuals with SD. The deficiency of PUFA-PL (mainly C20: 3 n-6, C20: 4 n-6 and C22: 6 n-3) which is accompanied by a significant increase of saturated palmitic and stearic acids (P less than 0.001), does not appear to be associated with an active lipoperoxidative process in the plasma. The significant blood deficiency of Vit E, GSH-Px, and particularly of PUFA-PL, may play a pathogenetic role in seborrheic dermatitis.

[Long-term studies with an anti-androgen/estrogen combination preparation of its effectiveness, liver tolerance and lipid metabolism in females]. / Langzeituntersuchungen mit einem Antiandrogen/Ostrogen-Kombinationspräparat zur Wirksamkeit, Leberverträglichkeit und Fettstoffwechsel bei Frauen.

The usefulness of antiandrogenic therapy with cyproterone acetate for androgenisation signs and symptoms in women, when tumours are definitely not the cause, has now been confirmed world-wide in about 100,000,000 therapy cycles using the hormonal contraceptive Diane and its follow-up preparation Diane-35, which contains a lower level of oestrogen. Nowadays, low-dose hormonal contraceptives are preferred in order to minimise the so-called "internal" risk by reducing the level of the oestrogen component and, by careful selection of the progestin, minimising the residual androgenic effect. In an open study on 150 women with moderately severe symptoms of androgenisation, we assessed, for treatment periods of up to 36 cycles, the effect of the only oestrogen-reduced hormonal contraceptive with anti-androgenic activity (Diane-35), and also monitored biochemical parameters, which are indicative of high risk metabolic activity and permit an accurate characterisation of the hormonal contraceptive, especially with long-term use. Although the parameters of liver and fat metabolism occasionally yielded values close to the limit of the normal range, it was particularly favourable to note, that the lipoprotein fraction HDL exhibited a slightly rising tendency, whereas, at the same time, the LDL fraction dropped. Special attention has been paid to ultrasonographic monitoring of the liver, since the influence on the function of this organ has been frequently discussed in conjunction with prolonged use of 17-alpha-alkylated steroidal compounds, and because a possible connection between sex steroids and the development of liver tumours has been a point of discussions.(ABSTRACT TRUNCATED AT 250 WORDS)

Neutrophil zinc levels in psoriasis and seborrhoeic dermatitis.

The median zinc content of neutrophils was significantly reduced in 16 patients with psoriasis in comparison to both normal controls and six patients with seborrhoeic dermatitis (P less than 0.05). This reduction was unrelated to the extent of skin involvement. Plasma and erythrocyte zinc levels were unchanged.

Topical ketoconazole for infantile seborrhoeic dermatitis.

In an open study, 19 infants with a bipolar seborrhoeic rash were treated with ketoconazole 2% in cream once a day and evaluated over 10 days of treatment. At day 10, 78.9% of patients were almost cleared. Percutaneous absorption peaked 1-3 h after topical treatment, and was minimal. No plasma ketoconazole accumulation over the 10-day treatment was detected. Treatment failures corresponded to histologically psoriasiform eruptions and probable atopic dermatitis.

[Seborrhea-like dermatitis in the acquired immunodeficiency syndrome. Clinical, histological, and microbiological aspects and biochemical findings]. / La dermatite seborroica-like nella sindrome da immunodeficienza acquisita. Aspetti clinici, istologici, microbiologici e rilievi biochimici.

Seventy-six patients diagnosed as having seborrheic dermatitis (SD) were divided into two groups: group A (n = 22) otherwise healthy subjects (HIV negative) and group B (n = 54) HIV positive (ARC and AIDS cases). Thirty normal healthy subjects without SD were considered as control (group C). The three groups were subjected to the following analyses: A) skin surface lipids (SSL) and fatty acid pattern of cholesterol esters, wax esters, triglycerides and free fatty acids fractions in the affected areas; B) plasma levels of Vitamin E and fatty acids of phospholipids; C) erythrocyte glutathione peroxidase (3 cases for each group); D) frequency of Pityrosporum species in the affected areas; E) skin biopsy in the affected areas (2 cases for each group). Histological findings paralleled those reported in the Literature. SSL composition, fatty acid pattern and frequency of Pityrosporum species did not show significant variation among the 3 groups. On the contrary the blood levels of Vitamin E, polyunsaturated fatty acids of phospholipids and glutathione peroxidase were found significantly lower in A and B groups than in the controls.

Effect of percutaneous absorption of hydrocortisone on adrenocortical responsiveness in infants with severe skin disease.

Percutaneous absorption of hydrocortisone was studied in 18 children (aged from 6 weeks to 14 1/2 years) with atopic or seborrhoeic dermatitis, by measuring their serum cortisol before and after application of 1% hydrocortisone cream. Endogenous secretion of cortisol was suppressed with dexamethasone. A 24 h absorption test was performed on nine children. In six, percutaneous absorption was detected. The highest serum cortisol level was reached within the first 6 h. A 4 h absorption test was developed on the basis of the 24 h test. This short absorption test was performed on nine children, and in eight of them absorption of hydrocortisone was detected. The rise of serum cortisol ranged from 98 to 2669 nmol/l. The 2 h ACTH test was performed to evaluate the effect of previous treatment with topical glucocorticoids. Suppressed adrenocortical function was found in five of 13 children, and was associated significantly with high post-application serum cortisol levels. This occurred more often in infants with a severe skin disorder than in older children or in those with mild or moderate skin disease.