Topical antifungals for seborrhoeic dermatitis

Abstract

Background Seborrhoeic dermatitis is a chronic inflammatory skin condition that is distributed worldwide. It commonly affects the scalp, face and flexures of the body. Treatment options include antifungal drugs, steroids, calcineurin inhibitors, keratolytic agents and phototherapy. Objectives To assess the effects of antifungal agents for seborrhoeic dermatitis of the face and scalp in adolescents and adults. A secondary objective is to assess whether the same interventions are effective in the management of seborrhoeic dermatitis in patients with HIV/AIDS. Search methods We searched the following databases up to December 2014: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 11), MEDLINE (from 1946), EMBASE (from 1974) and Latin American Caribbean Health Sciences Literature (LILACS) (from 1982). We also searched trials registries and checked the bibliographies of published studies for further trials. Selection criteria Randomised controlled trials of topical antifungals used for treatment of seborrhoeic dermatitis in adolescents and adults, with primary outcome measures of complete clearance of symptoms and improved quality of life. Data collection and analysis Review author pairs independently assessed eligibility for inclusion, extracted study data and assessed risk of bias of included studies. We performed fixed-effect meta-analysis for studies with low statistical heterogeneity and used a random-effects model when heterogeneity was high. Main results We included 51 studies with 9052 participants. Of these, 45 trials assessed treatment outcomes at five weeks or less after commencement of treatment, and six trials assessed outcomes over a longer time frame. We believe that 24 trials had some form of conflict of interest, such as funding by pharmaceutical companies. Among the included studies were 12 ketoconazole trials (N = 3253), 11 ciclopirox trials (N = 3029), two lithium trials (N = 141), two bifonazole trials (N = 136) and one clotrimazole trial (N = 126) that compared the effectiveness of these treatments versus placebo or vehicle. Nine ketoconazole trials (N = 632) and one miconazole trial (N = 47) compared these treatments versus steroids. Fourteen studies (N = 1541) compared one antifungal versus another or compared different doses or schedules of administration of the same agent versus one another. Ketoconazole Topical ketoconazole 2% treatment showed a 31% lower risk of failed clearance of rashes compared with placebo (risk ratio (RR) 0.69, 95% confidence interval (CI) 0.59 to 0.81, eight studies, low-quality evidence) at four weeks of follow-up, but the effect on side effects was uncertain because evidence was of very low quality (RR 0.97, 95% CI 0.58 to 1.64, six studies); heterogeneity between studies was substantial ...

Preparation Process and Regulation on Scalp Microecology Study of Total Flavonoids from Lamiophlomis rotata (Benth.) Kudo

“…47 Regular shampooing and the use of antifungal shampoos can improve scalp conditions. [48][49][50] Plant-derived bioactive compounds with antifungal, anti-inflammatory, and antioxidant properties can improve scalp health. Wang et al 51 demonstrated that treatment with 4% glycyrrhetinic acid complex gel rapidly relieved symptoms of seborrheic scalp dermatitis and resulted in significant improvement in clinical scores and patientreported quality of life.…”

Preparation Process and Regulation on Scalp Microecology Study of Total Flavonoids from Lamiophlomis rotata (Benth.) Kudo

“…47 Regular shampooing and the use of antifungal shampoos can improve scalp conditions. [48][49][50] Plant-derived bioactive compounds with antifungal, anti-inflammatory, and antioxidant properties can improve scalp health. Wang et al 51 demonstrated that treatment with 4% glycyrrhetinic acid complex gel rapidly relieved symptoms of seborrheic scalp dermatitis and resulted in significant improvement in clinical scores and patientreported quality of life.…”

Comparison of the Effectiveness of Ivermectin 1% Cream and Ketoconazole 2% Cream in Treating Facial Seborrheic Dermatitis: A Double‐Blind, Randomized, Controlled Clinical Trial

“…Topical antifungal agents, especially azoles like ketoconazole, are commonly used in SD due to their antifungal effects on Malassezia species. However, the exclusive focus on Malassezia has been challenged, with studies suggesting additional immunological and barrier dysfunction components in SD pathogenesis [22, 23]. This evolving understanding supports the exploration of agents like ivermectin that offer broader mechanisms of action.…”

A synergistic herbal formulation targeting Malassezia furfur and Staphylococcus epidermidis for effective dandruff management

“…These efforts include the application of several synthetic formulations based on ketoconazole, fluconazole, and itraconazole ( Leong et al, 2021 ; Godge et al, 2023 ); chemical polypeptides such as zinc pyrithione ( Reeder et al, 2011 ; Mangion et al, 2023 ); salicylic acid ( Massiot et al, 2023 ); tar and steroids ( Franchimont et al, 2003 ; Sawleshwarkar et al, 2004 ); and other compounds such as propylene glycol and selenium sulfide ( Back, 2009 ; Saunte et al, 2020 ). Unfortunately, the use of these formulations is restricted because they fail to cure or prevent the recurrence of dandruff, lead to the development of resistance in dandruff-causing pathogens, and can cause certain kinds of highly toxic and adverse effects on the scalp ( Trüeb, 2007 ; Okokon et al, 2015 ; Chowdhry et al, 2017 ; Kubicki et al, 2020 ; Lopes et al, 2024 ). Therefore, there is an unmet need for alternatives to these synthetic formulations that do not have any negative impact on the human scalp and are able to eradicate dandruff completely.…”

Preparation Process and Regulation on Scalp Microecology Study of Total Flavonoids from Lamiophlomis rotata (Benth.) Kudo

“…47 Regular shampooing and the use of antifungal shampoos can improve scalp conditions. [48][49][50] Plant-derived bioactive compounds with antifungal, anti-inflammatory, and antioxidant properties can improve scalp health. Wang et al 51 demonstrated that treatment with 4% glycyrrhetinic acid complex gel rapidly relieved symptoms of seborrheic scalp dermatitis and resulted in significant improvement in clinical scores and patientreported quality of life.…”

Comparison of the Effectiveness of Ivermectin 1% Cream and Ketoconazole 2% Cream in Treating Facial Seborrheic Dermatitis: A Double‐Blind, Randomized, Controlled Clinical Trial

“…Topical antifungal agents, especially azoles like ketoconazole, are commonly used in SD due to their antifungal effects on Malassezia species. However, the exclusive focus on Malassezia has been challenged, with studies suggesting additional immunological and barrier dysfunction components in SD pathogenesis [22, 23]. This evolving understanding supports the exploration of agents like ivermectin that offer broader mechanisms of action.…”

A synergistic herbal formulation targeting Malassezia furfur and Staphylococcus epidermidis for effective dandruff management

“…These efforts include the application of several synthetic formulations based on ketoconazole, fluconazole, and itraconazole ( Leong et al, 2021 ; Godge et al, 2023 ); chemical polypeptides such as zinc pyrithione ( Reeder et al, 2011 ; Mangion et al, 2023 ); salicylic acid ( Massiot et al, 2023 ); tar and steroids ( Franchimont et al, 2003 ; Sawleshwarkar et al, 2004 ); and other compounds such as propylene glycol and selenium sulfide ( Back, 2009 ; Saunte et al, 2020 ). Unfortunately, the use of these formulations is restricted because they fail to cure or prevent the recurrence of dandruff, lead to the development of resistance in dandruff-causing pathogens, and can cause certain kinds of highly toxic and adverse effects on the scalp ( Trüeb, 2007 ; Okokon et al, 2015 ; Chowdhry et al, 2017 ; Kubicki et al, 2020 ; Lopes et al, 2024 ). Therefore, there is an unmet need for alternatives to these synthetic formulations that do not have any negative impact on the human scalp and are able to eradicate dandruff completely.…”

Preparation Process and Regulation on Scalp Microecology Study of Total Flavonoids from Lamiophlomis rotata (Benth.) Kudo

“…47 Regular shampooing and the use of antifungal shampoos can improve scalp conditions. [48][49][50] Plant-derived bioactive compounds with antifungal, anti-inflammatory, and antioxidant properties can improve scalp health. Wang et al 51 demonstrated that treatment with 4% glycyrrhetinic acid complex gel rapidly relieved symptoms of seborrheic scalp dermatitis and resulted in significant improvement in clinical scores and patientreported quality of life.…”

Comparison of the Effectiveness of Ivermectin 1% Cream and Ketoconazole 2% Cream in Treating Facial Seborrheic Dermatitis: A Double‐Blind, Randomized, Controlled Clinical Trial

“…Topical antifungal agents, especially azoles like ketoconazole, are commonly used in SD due to their antifungal effects on Malassezia species. However, the exclusive focus on Malassezia has been challenged, with studies suggesting additional immunological and barrier dysfunction components in SD pathogenesis [22, 23]. This evolving understanding supports the exploration of agents like ivermectin that offer broader mechanisms of action.…”

A synergistic herbal formulation targeting Malassezia furfur and Staphylococcus epidermidis for effective dandruff management

“…These efforts include the application of several synthetic formulations based on ketoconazole, fluconazole, and itraconazole ( Leong et al, 2021 ; Godge et al, 2023 ); chemical polypeptides such as zinc pyrithione ( Reeder et al, 2011 ; Mangion et al, 2023 ); salicylic acid ( Massiot et al, 2023 ); tar and steroids ( Franchimont et al, 2003 ; Sawleshwarkar et al, 2004 ); and other compounds such as propylene glycol and selenium sulfide ( Back, 2009 ; Saunte et al, 2020 ). Unfortunately, the use of these formulations is restricted because they fail to cure or prevent the recurrence of dandruff, lead to the development of resistance in dandruff-causing pathogens, and can cause certain kinds of highly toxic and adverse effects on the scalp ( Trüeb, 2007 ; Okokon et al, 2015 ; Chowdhry et al, 2017 ; Kubicki et al, 2020 ; Lopes et al, 2024 ). Therefore, there is an unmet need for alternatives to these synthetic formulations that do not have any negative impact on the human scalp and are able to eradicate dandruff completely.…”