Diffuse HIV-associated seborrheic dermatitis – a case series

Forrestel, Amy; Kovarik, Carrie L.; Mosam, Anisa; Gupta, Deepti; Maurer, Toby; Micheletti, Robert G.

doi:10.1177/0956462416641816

Cited by 34 publications

(28 citation statements)

References 14 publications

(26 reference statements)

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“…Several studies have challenged the role of Malassezia in SD in HIV‐infected patients. One study done in HIV‐positive patients showed either negative or limited growth of Malassezia . On the other hand, a significantly higher number of Malassezia was cultured from HIV‐negative patients with SD.…”

Section: A Complex Relationship With Systemic Diseasesmentioning

confidence: 99%

“…These studies suggest that HIV‐positive patients may have a different pathogenic mechanism than SD in individuals with an intact immune system. These patients are also often refractory to standard SD treatments, requiring prolonged courses of topicals and systemic antifungals, and treatment failure is common …”

Section: A Complex Relationship With Systemic Diseasesmentioning

confidence: 99%

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An update on the microbiology, immunology and genetics of seborrheic dermatitis

Aðalsteinsson

Kaushik

Muzumdar

et al. 2020

Experimental Dermatology

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The underlying mechanism of seborrheic dermatitis (SD) is poorly understood but major scientific progress has been made in recent years related to microbiology, immunology and genetics. In light of this, the major goal of this article was to summarize the most recent articles on SD, specifically related to underlying pathophysiology. SD results from Malassezia hydrolysation of free fatty acids with activation of the immune system by the way of pattern recognition receptors, inflammasome, IL-1β and NF-kB. M. restricta and M. globosa are likely the most virulent subspecies, producing large quantities of irritating oleic acids, leading to IL-8 and IL-17 activation. IL-17 and IL-4 might play a big role in pathogenesis, but this needs to be further studied using novel biologics. No clear genetic predisposition has been established; however, recent studies implicated certain increased-risk human leucocyte antigen (HLA) alleles, such as A*32, DQB1*05 and DRB1*01 as well as possible associations with psoriasis and atopic dermatitis (AD) through the LCE3 gene cluster while SD, and SD-like syndromes, shares genetic mutations that appear to impair the ability of the immune system to restrict Malassezia growth, partially due to complement system dysfunction. A paucity of studies exists looking at the relationship between SD and systemic disease. In HIV, SD is thought to be secondary to a combination of immune dysregulation and disruption in skin microbiota with unhindered Malassezia proliferation. In Parkinson's disease, SD is most likely secondary to parasympathetic hyperactivity with increased sebum production as well as facial immobility which leads to sebum accumulation. K E Y W O R D Sinflammasome, Malassezia, sebaceous glands, seborrheic dermatitis, systemic disease While the order of events is unclear regarding the pathophysiology of SD, it is agreed upon by most sources that the three main prerequisites are as follows: Malassezia colonization, lipid secretion by sebaceous glands and an underlying immune system susceptibility. [1,5,7,38] The pathogenesis can be categorized into five different phases.

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Section: A Complex Relationship With Systemic Diseasesmentioning

confidence: 99%

Section: A Complex Relationship With Systemic Diseasesmentioning

confidence: 99%

An update on the microbiology, immunology and genetics of seborrheic dermatitis

Aðalsteinsson

Kaushik

Muzumdar

et al. 2020

Experimental Dermatology

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“…Humoral and cellular immunity have been studied in patients with SD, though with conflicting results. 5,6 Nonetheless, an alteration of immune responses has been described: NKs increase, low IgG titers, IL-2 and INFγ reduction. 6 Plasmatic polyunsaturated fatty acid (PUFA) deficits, sebaceous squalene and waxes reduction have often been found in patients with the copresence of HIV and SD.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 Nonetheless, an alteration of immune responses has been described: NKs increase, low IgG titers, IL-2 and INFγ reduction. 6 Plasmatic polyunsaturated fatty acid (PUFA) deficits, sebaceous squalene and waxes reduction have often been found in patients with the copresence of HIV and SD. The plasma deficit of PL-PUFA is closely associated with reduced blood levels of vitamin E, glutathione peroxidase and ubiquinone, 7 suggesting a possible role of oxidative stress in SD development.…”

Section: Introductionmentioning

confidence: 99%

<p>The Effectiveness of a New Topical Formulation Containing GSH-C4 and Hyaluronic Acid in Seborrheic Dermatitis: Preliminary Results of an Exploratory Pilot Study</p>

Campione

Mazzilli

Lanna

et al. 2019

CCID

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Introduction: Seborrheic dermatitis is a common skin disease with clinical aspects similar to those of psoriasis, eczema or allergic reactions, appearing on the sebum-rich areas of the scalp, face, and trunk. Yeast like Malassezia species, immunologic abnormalities and activation of complement are recognized as a crucial pathogen for the onset of seborrheic dermatitis. Intermittent and active phases are characterized by burning, scaling and itching, then followed by inactive periods. The disease is sometimes severe up to the erythrodermia; thus, it has a great influence on the patient's quality of life. In vitro and vivo studies have shown that the exogenous intake of glutathione-GSH-C4 and tocopherol inhibits lipid peroxidation and effectively fights and reduces oxidative stress in inflammatory disorders. Methods: We have carried out a study enrolling 20 patients affected by SD to evaluate the effectiveness and tolerability of a new topical formulation in cream (hereinafter SEB) containing GSH-C4 0.4% in hyaluronic acid 0.25%a new synthetic glutathione derivate called INCI (butyroyl glutathione)-assigned by the Personal Care Council. Investigator Global Assessment score and Patient Global Assessment of Treatment scales were used to test the efficacy of this new formulation. Results: All patients showed a good clinical response to the treatment with topical SEB demonstrated by the gradual reduction in inflammatory skin lesions. Discussion: The results of our pilot study confirm the efficacy and tolerability of this new topical formulation in a real-life assessment and patients showed strong adherence to therapy. These promising resultsstill to be confirmed on a larger number of patientsemphasize the potential SEB has in controlling the chronic inflammation of seborrheic dermatitis.

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“…While established associations such as human immunodeficiency virus (HIV) and parkinsonism are important and point towards aetiological hypotheses for the disease, other associations have been described and investigated only in either small samples or in specialized, nongeneralizable populations. The present study utilizes data from the Rotterdam Study, a large prospective cohort study.…”

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confidence: 99%

Understanding common but understudied diseases in dermatology

Drucker

Doiron

2018

Br J Dermatol

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Linked Article: Gordon et al. Br J Dermatol 2018; 178:132-139.During prehistoric periods, humans rarely experienced technological change. For nearly all of recorded human history, most humans experienced no major technological advances over their entire lives. We live in far more interesting times! Over the past few hundred years, humans began to experience multiple technological changes over the course of their lives, and now we take for granted that there will be a major update to our iPhones every year. New technologies come so fast that what was new and hot a short while ago (records, CDs, videotapes, DVD stores, AOL, MySpace) may already be superseded. This is happening in medicine too. When etanercept was approved for psoriasis 15 odd years ago, I thought I would never see that kind of revolutionary quantum leap forward in psoriasis treatment again in my lifetime; now I rarely prescribe the drug because of products that seem at least as safe and considerably more effective.The current rage in psoriasis treatment consists of drugs blocking the interleukin (IL)-23/IL-17 pathway.1 Ustekinumab, an antibody against the p40 subunit contained in both IL-12 and IL-23, hits a sweet spot: few injections, high efficacy and minimal, if any, risk.2 Several IL-17 antagonists are, in head-tohead trials, even more effective. The newest treatment, guselkumab, binds the p19 subunit of IL-23, thereby leaving IL-12 unaffected. In head-to-head trials against adalimumab, a highly effective psoriasis treatment, guselkumab was more effective. 3,4Guselkumab requires few injections (every 2 months in the maintenance phase) and, if we can extrapolate from our experience with the IL-12/IL-23 blocker ustekinumab (which we really shouldn't do), we can expect it should be very safe. The current issue of the British Journal of Dermatology features an analysis by Gordon et al. of the effectiveness of guselkumab in patient subpopulations. 5 The authors compile data from 1829 subjects enrolled in the two large, randomized, placebo-controlled, blinded, head-to-head trials -Voyage 1 and Voyage 2 -of guselkumab vs. adalimumab. The primary efficacy outcome was assessed at week 16 (the primary endpoint in adalimumab's package insert). At that point, patients would have been treated with only three injections (baseline, week 4 and week 12) of guselkumab. Not surprisingly, regardless of baseline characteristics, more patients achieved standard measures of success [Psoriasis Area and Severity Index 75% improvement over baseline (PASI 75) and clear/almost clear] with guselkumab than with adalimumab, and more patients achieved high levels of success (PASI 90, clear) with guselkumab than with adalimumab. At this point, it's getting harder and harder to identify psoriasis patient populations for which a tumour necrosis factor inhibitor would be the clear first choice of treatment. The levels of success achievable with inhibitors of the IL-23/IL-17 axis, along with their safety and injection frequency, seem to make them the more rational choice, except...

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Diffuse HIV-associated seborrheic dermatitis – a case series

Cited by 34 publications

References 14 publications

An update on the microbiology, immunology and genetics of seborrheic dermatitis

An update on the microbiology, immunology and genetics of seborrheic dermatitis

<p>The Effectiveness of a New Topical Formulation Containing GSH-C4 and Hyaluronic Acid in Seborrheic Dermatitis: Preliminary Results of an Exploratory Pilot Study</p>

Understanding common but understudied diseases in dermatology

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