Treatment of seborrheic dermatitis of the scalp

Abstract

Summary Background Seborrheic dermatitis and dandruff are common conditions dominated by flakes and itch symptoms. Beyond these observable conditions, the epidermis is highly perturbed and in an inflammation‐driven hyperproliferative condition. Aims This review covers current etiologic models and therapeutic strategies. Conclusion Etiology has been controversial in the past due to the search for a singular cause. There are three interrelated factors: Malassezia yeast, sebaceous lipids, and a group of host factors. The yeast and sebaceous lipids interact to yield an inflammatory initiator that leads to hyperproliferation within the epidermis; immature stratum corneum cells are dislodged as large clumps rather than a normal desquamative process. While many therapeutic strategies are theoretically possible, current technology is centered around controlling the Malassezia population. The most convenient and therefore most common format is the shampoo. A wide range of active materials are available; some are more effective than others. Even within a given active, product pharmacology can have a substantial impact on the delivered efficacy, with factors such as amount deposited on the scalp surface and bioavailability of the deposited material being relevant. Beyond choice of active and effective scalp delivery, product usage habits can substantially modulate the efficacy realized by the user.

A lipohydroxyacid‐containing shampoo improves scalp condition and quality of life in patients with seborrheic dermatitis and light‐to‐moderate scalp psoriasis

“…Psoriasis affects approximately 2% of the general population among which more than 50% have scalp involvement 9,12,13 . SD affects 1–3% of the general population, and up to 95% of these patients have the scalp affected 7,14,15 . The Scalpdex is a new questionnaire that can measure and quantify scalp dermatititis‐related quality of life and responsiveness to a treatment 5 .…”

“…Generally, dandruff is thought to represent the mildest form of SD of the scalp. Its pathogenesis remains to be completely elucidated, although the yeast organism Malassezia has been proposed as an etiological factor 3,7 …”

Treatment of Seborrhoeic Dermatitis in Asia: A Consensus Guide

“…with sebaceous lipids, seborrhoea, immune dysfunction, neurogenic factors, and emotional stress [1,5,37] , are considered similar in Asian and Western countries, ethnicity and geography are significant aspects determining the degree of pathogenic association between Malassezia spp. and SD.…”

Randomized study comparing the efficacy and tolerance of a lipohydroxy acid shampoo to a ciclopiroxolamine shampoo in the treatment of scalp seborrheic dermatitis

“…Generally, dandruff is thought to represent the mildest form of seborrheic dermatitis (SD) of the scalp. Its pathogenesis remains to be completely elucidated, although the yeast organism Malassezia has been proposed as an etiological factor 2,5 …”

“…These formulations offer a safe option for treating this common dermatological condition, and their efficacy in eradicating the symptoms of dryness and flaking of the scalp along with providing relief of associated pruritus have been demonstrated 5–7 . The most commonly prescribed shampoos for treating dandruff include keratolytics (salicylic acid, sulphur), regulators of keratinization (zinc, tar, steroids) antimicrobials (selenium sulphide, imidazole, hydroxypyridones as ciclopirox), naturopathic therapies (tea tree oil, honey, cinnamic acid) or related products 5–7 . Interestingly, LHA induces exfoliation and stimulation of epidermal renewal 8 .…”