Oily sensitive skin: A review of management options.

BACKGROUND: Due to the ever-increasing demands for the personalized care, people seek for the tailored management according to the accurate identification of their skin type. The Baumann Skin Type Indicator, which was proposed by Leslie Baumann, is composed of four parameters: oily or dry, resistant or sensitive, pigmented or nonpigmented, and wrinkled or tight. Among these, oily sensitive skin experiences significant discomfort and resists ordinary treatment. AIMS: In this article, we will review the clinical manifestations, underlying pathogenesis and recommendations on treatment options that may be utilized to help patients with oily sensitive skin. PATIENTS/METHODS: Literature search was conducted using PubMed. The literature concerning Baumann Skin Type Indicator and oily sensitive skin type were considered. RESULTS: Oily sensitive (OS)-type skin is a complex of oily and sensitive skin that causes significant discomfort and undergoes stubborn resistance to treatments. Sebum dysfunction and hypersensitivity may play a key role in the development of sensitive skin. Considering the pathogenesis of OS-type skin, treatment should focus on both seborrhea and hypersensitivity. CONCLUSION: Clinicians can effectively treat the oily sensitive skin by understanding underlying pathogenesis of it. Further investigations are necessary to reach a consensus on the basic pathophysiology and optimal management guidelines for oily sensitive skin.

Adult-onset lichen striatus versus adult blaschkitis: a clinicopathological review of 40 cases of acquired blaschkolinear inflammatory dermatosis.

BACKGROUND: Since the first description of adult blaschkitis (AB), the existence of this entity has been a matter of great debate. OBJECTIVES: To compare clinicopathological features of lichen striatus (LS) and AB cases. MATERIALS AND METHODS: We retrospectively reviewed the clinicopathological features of patients who clinically showed linear inflammatory dermatosis along Blaschko's lines based on a skin biopsy registry. RESULTS: Through a process of clinicopathological differential diagnosis, 27 cases of LS, three of AB, eight of linear lichen planus, and two of linear psoriasis were identified. Clinicopathological differences between LS and AB were mostly insignificant except for age at onset and multiple site involvement. In these cases, females were affected more frequently than males. The mean age at onset was 31.6 years, and the most common involved site was the leg. The lesions lasted approximately 8.3 months with few relapses. The most common histopathological finding was perivascular infiltration followed by peri-appendageal infiltration. CONCLUSION: Distinction between LS and AB appears to be unnecessary given their overlapping features.

Assessing Biophysical and Physiological Profiles of Scalp Seborrheic Dermatitis in the Thai Population.

BACKGROUND: Scalp seborrheic dermatitis (SD) is a common and chronic inflammatory skin disease which tends to recur over time. By measuring biophysical properties of the stratum corneum, many studies report abnormal biophysical profiles and their association in various dermatologic diseases. The aim of the study is to analyze the biophysical properties and skin barrier defects of scalp SD compared to healthy controls. MATERIALS AND METHODS: This study is a cross-sectional study assessing the correlation of various biophysical and physiological profiles in scalp SD. Forty-two Thai participants with scalp SD were enrolled in the study and 40 healthy participants were also enrolled as the control group. Both SD and control group were subjected to a one-time biophysical and physiological properties' measurement of transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin surface pH, skin surface lipid, and skin roughness. RESULTS: The mean TEWL of lesional skin of SD cases were significantly higher than those of control group (P<0.05). Relating to high mean TEWL, the mean SCH was found to be significantly lower in SD cases (P<0.05). Skin surface lipid was also found to be significantly higher in SD group (P<0.05). However, there were no differences in skin surface pH (P=0.104) and roughness (P=0.308) between the two groups. Pairwise comparison of each subgroup found that moderate and severe SD demonstrated significantly higher mean skin surface lipid than that of control group (P<0.05). CONCLUSION: Scalp SD may be associated with seborrhea in Thai population. Monitoring of SCH, TEWL, and skin surface lipid could be helpful in assessing severity and evaluating the treatment outcome in patients with scalp SD.

Seborrheic Dermatitis in Skin of Color: Clinical Considerations

Seborrheic dermatitis is a common, relapsing, inflammatory skin condition of unclear etiology. The Malassezia yeast genus are believed to play a role. Seborrheic dermatitis commonly affects areas of the skin with high sebum production, including the scalp, nasolabial folds, glabella, eyebrows, beard, ears, retroauricular skin, sternum, and other skin folds. Seborrheic dermatitis may present differently in individuals with skin of color. Darker-skinned individuals may present with scaly, hypopigmented macules and patches in typical areas of involvement. Arcuate or petal-like patches may be seen, specifically termed petaloid seborrheic dermatitis. Children of color often do not experience the classic "cradle cap" appearance of seborrheic dermatitis, and have erythema, flaking, and hypopigmentation of the affected areas and folds of skin. Seborrheic dermatitis tends to respond well to conventional treatments, although it tends to recur. Skin of color patients may require a modified treatment approach which takes into account differences in hair texture and hair washing frequency. This paper aims to highlight these differences to help reduce disparities in the management of seborrheic dermatitis in patients of color. J Drugs Dermatol. 2019;18(1):24-27.

Activography reveals aberrant proteolysis in desquamating diseases of differing backgrounds.

The role of epidermal proteolysis in overdesquamation was revealed in Netherton syndrome, a rare ichthyosis due to genetic deficiency of the LEKTI inhibitor of serine proteases. Recently, we developed activography, a new histochemical method, to spatially localize and semiquantitatively assess proteolytic activities using activity-based probes. Activography provides specificity and versatility compared to in situ zymography, the only available method to determine enzymatic activities in tissue biopsies. Here, activography was validated in skin biopsies obtained from an array of distinct disorders and compared with in situ zymography. Activography provides a methodological advancement due to its simplicity and specificity and can be readily adapted as a routine diagnostic assay. Interestingly, the levels of epidermal proteolysis correlated with the degree of desquamation independent of skin pathology. Thus, deregulated epidermal proteolysis likely represents a universal mechanism underlying aberrant desquamation.

Analysis of gene expression profiles of multiple skin diseases identifies a conserved signature of disrupted homeostasis.

Triggers of skin disease pathogenesis vary, but events associated with the elicitation of a lesion share many features in common. Our objective was to examine gene expression patterns in skin disease to develop a molecular signature of disruption of cutaneous homeostasis. Gene expression data from common inflammatory skin diseases (eg psoriasis, atopic dermatitis, seborrhoeic dermatitis and acne) and a novel statistical algorithm were used to define a unifying molecular signature referred to as the "unhealthy skin signature" (USS). Using a pattern-matching algorithm, analysis of public data repositories revealed that the USS is found in diverse epithelial diseases. Studies of milder disruptions of epidermal homeostasis have also shown that these conditions converge, to varying degrees, on the USS and that the degree of convergence is related directly to the severity of homeostatic disruption. The USS contains genes that had no prior published association with skin, but that play important roles in many different disease processes, supporting the importance of the USS to homeostasis. Finally, we show through pattern matching that the USS can be used to discover new potential dermatologic therapeutics. The USS provides a new means to further interrogate epithelial homeostasis and potentially develop novel therapeutics with efficacy across a spectrum of skin conditions.

Incubatory environment of the scalp impacts pre-emergent hair to affect post-emergent hair cuticle integrity.

OBJECTIVES: To determine whether the oxidative stress transmitted to newly grown hair from an unhealthy scalp has physical consequences to the cuticular condition and function. METHODS: A uniquely designed 24-week clinical study included 8 weeks of pretreatment with a cosmetic shampoo and 16 weeks of treatment with either a potentiated zinc pyrithione (ZPT) antidandruff shampoo or a placebo cosmetic shampoo. This clinical design allowed the growth and acquisition of hair samples under conditions of varying but known scalp health as a result of treating a dandruff/seborrheic dermatitis (D/SD) population. Two complementary methods were used to characterize the integrity of the cuticular surface. Hair surface hydrophobicity was assessed by quantifying water wetting force using a Wilhelmy balance method. Surface structure and porosity were assessed using dynamic vapor sorption (DVS) to gravimetrically quantify water sorption. RESULTS: Chemical oxidative stress to pre-emergent hair has been shown to have negative consequences to hair surface structure. Compared to a placebo shampoo control, use of a potentiated ZPT shampoo improved scalp health and significantly improved the following attributes associated with healthy hair: hair surface hydrophobicity (surface energy) and cuticular moisture barrier effectiveness (dynamic vapor sorption). CONCLUSIONS: Pre-emergent hair can be negatively impacted by the oxidative stress that occurs with an unhealthy scalp, possibly due to metabolic activity of resident microbes. Manifestations of the oxidative stress include altered cuticle surface properties that are responsible for its protective function; these effects are similar in type to those observed by bleaching post-emergent hair. These alterations have the potential to make the hair, once emerged from the scalp, more susceptible to the cumulative physical and chemical insults responsible for hair feel and look, fiber integrity, and overall retention.

Dermatitis seborreica como manifestación cutánea de sífilis primaria en paciente con SIDA / Seborrheic dermatitis as a cutaneous manifestation of syphilis in patient a with AIDS

Existe una asociación epidemiológica entre sífilis e infección por VIH; las úlceras genitales favorecen la transmisión de Treponema pallidum y éste a su vez, la transmisión del VIH. La dermatitis seborreica (DS) se presenta en 2 a 4% de la población general; sin embargo, en los pacientes con infección por VIH/SIDA y SIFILIS es significativamente mayor, llegando a 85% en algunas series. Se presenta el caso de un paciente masculino de 22 años de edad, natural y procedente del Distrito Capital, Venezuela, sin otras patologías conocidas, quien acude a la emergencia por presentar periodos de hetero agresividad y desorientación témporo ­ espacial., El familiar refiere aparición de lesiones descamativas de fondo eritematoso en región facial desde hace 6 meses, no pruriginosas y a la exploración física se evidencia parafasia y pupila de Argyll- Robertson. Se reportan serologías Positivas para HIV por ELISA de 4ta Generación, VDRL Reactivo a 4 diluciones y FTA-ABS Reactivo, La punción Lumbar evidenció pleocitosis, hiperproteinorraquia, hipoglucorraquia y VDRL REACTIVO. La biopsia cutánea con coloración argéntica de Fontana fué positiva para Treponema pallidum, con mejoría clínica significativa posterior al cumplimiento del esquema de Penicilina Cristalina. La dermatitis seborreica puede ser uno de los primeros indicadores de infección por VIH, por lo cual en toda dermatitis seborreica atípica, extensa o que no responda a tratamiento debe solicitarse serología para VIH y VDRL(AU)

There is an epidemiological association between syphilis and HIV infection; genital ulcers facilitatethe transmission of Treponema pallidum and this in turn, the transmission of HIV. Seborrheic dermatitis (SD) occurs in 2 to 4% of the general population; however, in patients with HIV / AIDS and SIFILIS infection it is significantly higher, reaching 85% in some series. We present the case of a male patient, of a 22 years-old , natural from the Caracas, Venezuela, without other known pathologies, who came to the emergency ward due to periods of aggressiveness and temporo - spatial disorientation. Desquamative lesions with an erythematous background in in his face appeared 6 months earlier.The neurological examination showeds paraphasia and Argyll-Robertson´ pupil. Positive serologies for HIV by 4th Generation ELISA and VDRL reactive at 4 dilutions as well as positive FTA-ABS were reported, Lumbar tab evidenced pleocytosis, hyperproteinorrachia, hypoglucorraquia and reagent VDRL . The skin biopsy with Fontana silver coloration was positive for Treponema pallidum and he improved clinically after treatment with a Crystalline Penicillin scheme. Seborrheic dermatitis may be one of the first indicators of HIV infection, so in all atypical seborrheic dermatitis, extensive or unresponsive to treatment, serology for HIV and VDRL should be determined(AU)

Diagnosis and treatment of seborrheic dermatitis.

Seborrheic dermatitis is a common skin condition in infants, adolescents, and adults. The characteristic symptoms-scaling, erythema, and itching-occur most often on the scalp, face, chest, back, axilla, and groin. Seborrheic dermatitis is a clinical diagnosis based on the location and appearance of the lesions. The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast. Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body. Because of possible adverse effects, anti-inflammatory agents such as topical corticosteroids and calcineurin inhibitors should be used only for short durations. Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents. Antifungal shampoos (long-term) and topical corticosteroids (short-term) can be used as second-line agents for treatment of scalp seborrheic dermatitis.

Quality of life and emotional state in chronic skin disease.

The aim of this study was to evaluate the associations between chronic inflammatory skin conditions and patients' emotional state and quality of life. The following self-rated questionnaires were used: Emotional State Questionnaire, a self-report scale assessing depression and anxiety symptoms; Dermatology Life Quality Index (DLQI); and RAND-36, a measure of health-related quality of life. The study group comprised 40 patients with psoriasis, 40 with eczema, 40 with acne, 15 with seborrhoeic dermatitis and 40 healthy controls. Patients with chronic skin diseases had lower DLQI and lower RAND-36 physical functioning scores, more perceived physical limitations and pain, and lower emotional well-being and general health ratings compared with the control group. In conclusion, chronic skin diseases are associated with symptoms of emotional distress, in particular insomnia and general anxiety.

Producción de fosfolipasa y proteinasa en cepas de Malassezia pachydermatis aisladas de perros con otitis y sin otitis / Phospholipase and proteinase production by Malassezia pachydermatis isolated in dogs with and without otitis

Antecedentes. Malassezia pachydermatis forma parte de la microbiota cutánea de perros y gatos. M. pachydermatis se ha asociado frecuentemente a otitis externa y dermatitis seborreicas, sobre todo en el perro, y con menor frecuencia en el gato. M. pachydermatis podría actuar como patógeno cuando existen alteraciones en los mecanismos físicos, químicos o inmunológicos de la piel. Se han identificado diversos factores de virulencia como la capacidad de producir estearasas, lipasas, lipooxigenasas, proteinasas, condroitinsulfatasas e hialuronidasas. Objetivos. Se ha estudiado la actividad fosfolipasa medida a pH 6,3 y la actividad proteinasa medida a pH 6,3 y pH 6,8 (pH de oídos de perros con otitis) de cepas de M. pachydermatis aisladas de perros con otitis y sin otitis. Métodos. Se ha estudiado la actividad fosfolipasa mediante un método semicuantitativo con yema de huevo y la actividad proteinasa mediante un método semicuantitativo con agar albúmina sérica bovina. Se ha realizado el estudio en 96 aislamientos de M. pachydermatis, 43 de ellos aislados de perros sin sintomatología clínica de otitis y 52 aislados de perros con otitis. Resultados. Se observó que el 75,8% de los aislamientos presentaron actividad fosfolipasa a pH 6,3 y el 81% presentaron actividad proteinasa medida a pH 6,3, y el 97,9% a pH 6,8. Se detectó una mayor actividad fosfolipasa en cepas aisladas de perros con otitis. Con respecto a la actividad proteinasa, esta fue mayor a pH 6,8. Conclusiones. Estos hallazgos sugieren que la actividad fosfolipasa podría jugar un papel importante en la invasión de los tejidos del hospedador, por lo menos en la otitis crónica canina. Con respecto a la actividad proteinasa, estos hallazgos podrían ayudar a mejorar la terapéutica de la otitis cuando está implicada M. pachydermatis en el proceso, ajustando a pH bajos los tratamientos aplicados (AU)

Prevalence of Malassezia species associated with seborrheic dermatitis lesions in patients in Argentina

Background. Visceral toxocariasis is a parasitic zoonosis caused by Toxocara canis. The prevalence of this parasite in dogs, soil contamination and the resistance of eggs increase human exposure to the disease. Moreover, the difficulties of the control measures justify the need for alternative ones. Aims. The objective of this study was to evaluate the in vitro ovicidal activity of fungi isolated from soils from public places in the city of Pelotas, Rio Grande do Sul, Brazil, on Toxocara canis. Methods. Samples of soil from ten localities were inoculated onto Petri dishes with 2% water–agar (WA) that contained antibiotics, and incubated at 25 °C/21 days. Isolated fungi were tested in vitro for ovicidal activity, with five replicates. One mL of an embryonated Toxocara canis egg suspension (103 eggs) was poured over the fungal cultures after 10 days of growth. At intervals of 7, 14 and 21 days, 100 eggs were removed from each plaque and evaluated by optical microscopy. Results. Acremonium, Aspergillus, Bipolaris, Fusarium, Gliocladium, Mucor and Trichoderma were isolated from the soil. A significant ovicidal type 3 effect was observed in Trichoderma, Fusarium solani complex and Acremonium. Those isolates from the genus Trichoderma showed their ovicidal effect on the 14th day of fungus–egg interaction. The other fungal genera tested showed a type 2 effect. Conclusions. These results suggest that the use of Trichoderma and Fusarium solani complex in biological control of T. canis is promising; however, further studies should be performed (AU)

Sympathetic skin responses from the scalp evoked by electrical stimulation in seborrheic dermatitis.

Although the role of autonomic nervous system in seborrheic dermatitis (SD) is still unclear, seborrhea is sometimes accepted as a sign of autonomic dysfunction in several nervous system diseases. Therefore, we aimed to investigate the sympathetic nervous system (SNS) activity in SD by recording sympathetic skin responses (SSR) from the scalp (S-SSR). Thirty-one control subjects and 22 SD patients were studied by evoking right and left S-SSR with electrical stimulation of the right median nerve at the wrist. Mean latencies and maximum amplitudes were calculated for both sides in each group. In seven out of 31 control subjects and in 13 out of 22 patients, the S-SSR could not be elicited on either side. There were four subjects with unilateral response in the patient group. There were significantly more non-responders among the patients with SD (P < 0.000). This study suggests that in SD, the autonomic nervous system may be involved. The S-SSR is a new site for recording SSR. The responses are relatively symmetrical and can be evoked easily by electrical stimulation, and may be used to evaluate the SNS function in SD patients and also in healthy subjects.

A comprehensive pathophysiology of dandruff and seborrheic dermatitis - towards a more precise definition of scalp health.

Despite an increasing knowledge of dandruff and seborrheic dermatitis (D/SD), the pathophysiological understanding is still incomplete but suggests a role of Malassezia yeasts in triggering inflammatory and hyper-proliferative epidermal responses. The objective of this report is to review published literature from in vivo studies of D/SD populations to provide a more complete description of overall scalp health. New biomolecular capabilities establish a depth of pathophysiological understanding not previously achievable with traditional means of investigation. Biomarkers representing inflammation, hyper-proliferation and barrier function are all perturbed by the D/SD condition and robustly respond to therapeutic resolution. These biomarkers can be sampled noninvasively, enabling their use in routine clinical evaluations as either surrogate endpoints or complementary ones to classical signs/symptoms to broaden the etiological learning.

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.

[Meibomian gland dysfunction--review]. / Dysfunkcja gruczolów Meiboma--przeglad pismiennictwa.

Meibomian gland dysfunction is a common ocular disorder affecting from 39 to 50% of population. Despite that, so far a pathophysiology path of the disease remains unknown, moreover there is no distinct border between physiology and the disease. There has been no clear diagnostic criteria. The purpose of this review was to combine a current knowledge of Meibomian gland anatomy, Meibomian gland dysfunction epidemiology, as well as presenting current definition, nomenclature, classification and diagnostic criteria. The importance of diagnosis associated with conditions such as aqueous tear deficiency, seborrheic dermatitis, and rosacea is emphasized. The available treatment methods are discussed. Meibomian gland dysfunction, blepharitis, dry eye syndrome.

Retrospective, observational study on the effects and tolerability of flutamide in a large population of patients with acne and seborrhea over a 15-year period.

The long-term effects and tolerability of flutamide (Flu) in women with acne and seborrhea were evaluated. Over the 15-year period, which spans from January 1991 to January 2006, a total of 230 Caucasian women with acne, 211 of which also with seborrhea, received yearly reducing doses (250, 125, and 62.5 mg/day) of Flu alone or combined with oral contraceptive for a period varying from 3 to 6 years and more. Clinical and endocrine evaluations were performed half-yearly and yearly, respectively, in the first 3 years of the study, and yearly in the following years. Liver function evaluations were performed quarterly. Both the groups of patients under Flu therapy showed a similar, marked decrease in acne and seborrhea scores after 6 months of treatment compared with basal values. The maximum drug effect was observed after 1 year, and it was maintained during the following years of treatment. Androgens were strongly suppressed during treatment. During the first year of treatment with 250 mg/day, 4.8% of patients interrupted the study due to hepatic disorders. During the following years on the 125 and 62.5 mg/day doses, no transaminase elevation was observed. The study supports very low-dose Flu as a first-line therapy for women with acne and seborrhea.