PubMed · 4244321
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1969. A little scurf.. https://pubmed.ncbi.nlm.nih.gov/4244321/
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It has been a subject of controversy whether keratosis lichenoides chronica (KLC) is a distinctive inflammatory disease of the skin or whether it represents a manifestation of another well-known disease, such as lichen planus, lupus erythematosus, or lichen simplex chronicus. In search of clear criteria for diagnosis of KLC the entire literature pertinent to the subject was studied and findings clinical and histopathologic as they were telegraphed in them were compared with a patient of my own experience. Review of the literature reveals more than 60 patients in whom the diagnosis of KLC was made. Three categories emerge based on whether the findings presented in a particular article (1) do not permit any diagnosis to be rendered; (2) do allow a diagnosis specific to be made, such as of lichen simplex, lichen planus, or lupus erythematosus; or (3) do not correspond to any disease well defined, such as lichen simplex, lichen planus, lupus erythematosus, but seem to show attributes morphologic, clinically and histopathologically, that are repeatable. Patients diagnosed as having KLC obviously represent a potpourri of different diseases, the most common of them being lichen simplex chronicus, lichen planus, and lupus erythematosus. Fewer than 25 patients reported on, however, presented themselves with lesions very similar to one another clinically, namely, an eruption that involved the face in a manner reminiscent of seborrheic dermatitis and with tiny papules on the trunk and extremities, which assumed linear and reticulate shapes by way of confluence of lesions. Individual papules were infundibulocentric and acrosyringocentric. Findings histopathologic were those of a lichenoid interface dermatitis affiliated with numerous necrotic keratocytes and covered by parakeratosis housing neutrophils in staggered fashion. These patients seem to have an authentic and distinctive condition that is exceedingly rare. In conclusion, the diagnosis of KLC should be made only for patients who present themselves with features clinical and findings histopathologic that resemble closely those of what is summarized in this article under category 3.
Pityrosporoses encompass various Malassezia-driven conditions. Dandruff and seborrheic dermatitis are members of this family of disorders. Their precise pathomechanisms have not been completely elucidated so far. This review focuses on the role of corneocytes in these disorders. Malassezia yeasts are not evenly distributed at the surface of the stratum corneum. Rather, they are clumped on some corneocytes while other corneocytes in their vicinity are almost free of these microorganisms. The corneocytes heavily coated by yeasts suggest a cell-related defect in the mechanisms controlling the skin biocene including the natural antimicrobial peptides and nitric oxide. Most environmental factors influencing pityrosporoses indeed affect the natural human defenses against certain microorganisms. We frame as a hypothesis that the primary defect in some Malassezia-driven disorders resides in the corneocytes and their precursor keratinocytes.
Dandruff is a common complaint and is suffered by as many as 50% of the population at some time during their life and cause significant discomfort. The condition is generally characterized by the presence of flakes on the scalp and in the hair, and by itch. The symptoms can vary, and the severity can range from mild scaling, similar to dry skin, to severe scaling. Its prevalence and severity is greatest in young men, with children and older individuals suffering less frequently. It is commonly aggravated by changes in humidity, trauma (e.g., scratching), seasonal changes, and emotional stress. Dandruff responds to everyday shampooing and a longer period of lathering. Use of hair spray or hair pomades (gels) should be stopped. Salicylic acid, tar, selenium, sulfur, and zinc all are effective in shampoos and may be alternated. Overnight occlusion of salicylic or urea oil may help to soften thick, scalp plaques. The common causative agent is now accepted to be the lipohilic yeasts Malassezia spp. (previously Pityrosporum) which is increased in the scaly epidermis of both dandruff and seborrhoeic dermatitis sufferers. Selenium sulfide, imidazoles or ciclopirox olamine shampoos may help by reducing Malassezia scalp reservoirs. The wide range of antifungal shampoos available provides safe, effective and flexible treatment options for dandruff.