Ketoconazole 2% cream alters the skin fungal microbiome in seborrhoeic dermatitis: a cohort study

Abstract

Summary Background Seborrhoeic dermatitis (SD) is a common chronic inflammatory dermatosis. Current theories on the pathogenesis of SD highlight the role of microbes on the skin surface. Ketoconazole is commonly used for the treatment of SD; however, there are limited data focusing on the effects of ketoconazole in shaping the skin microbiome in patients with SD. Aim In this prospective cohort study, we used a high‐throughput DNA sequencing method to characterize the cutaneous microbial communities of patients with SD before and after topical ketoconazole treatment. Methods In total, 30 patients with facial SD and 15 age‐ and sex‐matched healthy controls (HCs) were enrolled in this study. Skin swabs were collected from SD lesional sites of the cheek at baseline, after ketoconazole treatment and 2 weeks post‐treatment. DNA was extracted from skin samples. The bacterial 16S V3V4 rRNA and fungal internal transcribed spacer 1–5F regions were sequenced, and the microbial community compositions were analysed. Results Significantly lower bacterial and fungal diversities were detected at the lesional sites of facial SD compared with HCs. A decreased relative abundance of Cutibacterium and increased abundances of Malassezia and Staphylococcus were found in facial SD. Disease diversity was positively correlated with the relative abundances of Malassezia, Staphylococcus and Corynebacterium, while transepidermal water loss was negatively associated with the relative abundance of Cutibacterium. After ketoconazole treatment, fungal Shannon diversity and the relative abundances of Candida and Aspergillus were significantly increased at the lesional sites, and the relative abundance of Malassezia showed a decreasing trend. These changing trends were maintained until 2 weeks post‐treatment. Conclusion Facial SD showed lower fungal diversity accompanied by increased relative abundances of Malassezia and Staphylococcus and decreased relative abundance of Cutibacterium. Ketoconazole treatment reduced Malassezia and increased fungal diversity to restore skin microbial communities.

Detection Of Some Immunological And Biochemical Markers In Seborrheic Dermatitis Patients

“…This might be because of an aberrant or inflammatory immunological response to these yeasts. Laboratory diagnosis revealed that Malassezia globosa and Malassezia sympodialis caused 34% and 22% of the infections, respectively, while Malassezia furfur and Malassezia restricta caused 20% and 16% of the infections, respectively, and mixed infections emerged in 8% of cases, as shown in Figure (1) . According to this study, 58% of seborrheic dermatitis patients have recurring infections with the yeasts listed in Table 2.…”

“…Seborrheic dermatitis is affects About 3-5% of adults [1,2] suffer from sebum-rich areas like the scalp when they have seborrheic dermatitis, a chronic dermatosis marked by dandruff, itching, and occasionally mild to severe erythema. Despite its great incidence, the pathophysiology of SD is poorly known [3].…”

Study of Hypersensitivity to Malassezia furfur in Patients with Atopic Dermatitis with Head and Neck Pattern: Is It Useful as a Biomarker and Therapeutic Indicator in These Patients?

“…The determination of this biomarker could be considered an interesting analytical tool to differentiate those cases of AD with H&N pattern from true DS. In facial DS, decreased diversity of the microbiome has been demonstrated with an increased Malassezia population [14]. This change in the skin microbiome is responsible for the inflammatory reaction mediated mainly by the innate immune system.…”

An Overview of the Diagnosis and Management of Seborrheic Dermatitis

“…51,54 Recently, an in vivo and in vitro study has shown significant reduction of Malassezia count by KTZ using Polymerase Chain Reaction (PCR)-based investigations. 55 Ciclopirox 1% cream (Level A) showed significantly higher clinical efficacy vs vehicle when applied twice daily for 29 days and no significant difference vs 2% KTZ foaming gel when applied twice daily for 28 days followed by oncedaily for another 28 days (maintenance phase). 56,57 The antiinflammatory properties in facial SD of 1% clotrimazole cream (Level A) vs corticosteroids vs Emu oil (a natural antiinflammatory/antioxidant agent) has been evaluated in a randomized intra-patient controlled study, showing a significant improvement of scaling in both groups.…”

“… 51 , 54 Recently, an in vivo and in vitro study has shown significant reduction of Malassezia count by KTZ using Polymerase Chain Reaction (PCR)-based investigations. 55 …”