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Quantitative microbiology of the scalp in non-dandruff, dandruff, and seborrheic dermatitis.

The composition of the scalp microflora was assessed quantitatively in normal individuals and in patients with dandruff and seborrheic dermatitis, disorders characterized by increasing scaling. Three organisms were constantly found: (1) Pityrosporum, (2) aerobic cocci, and (3) Corynebacterium acnes. Pityrosporum (mainly Pityrosporum ovale) made up 46% of the total microflora in normals, 74% in dandruff, and 83% in seborvheic dermatitis. The geometric mean number of organisms per cm-2 in non-dandruff subjects was 5.04 times 10-5; 9.22 times 10-5 in dandruff subjects; and 6.45 times 10-5 in those with seborrheic dermatitis. The cocci were dominantly Baird-Parker type SII and no quantitative or qualitative change occurred in the scaling disorders. C. acnes comprised 26% of the flora on the normal scalp, 6% in dandruff, and only 1% in seborrheic dermatitis. These results differ significantly from previous reports which describe a much more complex microflora and suggest an etiologic role for microorganisms in dandruff.

Apicomplexa↗

[The history of dandruff and dandruff in history. A homage to Raymond Sabouraud].

In one of his books, written at the beginning of this century, Raymond Sabouraud devotes some 280 pages to the history of dandruff. Their reading illustrates how, from the Greeks to Sabouraud's era, this desquamative disease has been subjected to endless doctrinal and scientific conflicts, long before the so-called "present" controversies. One of the early conflicts, between Celsus and Galen, lies in the nature of the squames, i. e. dry or exudating, leading to the inclusion (or non inclusion) or pityriasis in the group of desquamative diseases, such as psoriasis or ichytosis. Translated into Latin (furfur, porrigo) and into Arabic, the word pityriasis was replaced in the Middle Age by tinea which then referred to any disease of the human scalp. With Plenk, Lorry, Willan and others, the 18th century brought a new attitude of mind where observation took precedence over doctrine, but owing to the lack of experimental approach there was no adequate description of the squames and their anatomical origin. This was the case with Hebra who, in the 19th century, claimed that dandruff was nothing but a sebaceous disease. This major turn resulted for decades in a confusion between dandruff and seborrhoea. In the late 19th century, bacteriological studies were decisive steps taken by Rivolta, Malassez and Sabouraud. The presence on scalps affected with dandruff of a bottle-shaped "fungus" (Pityrosporum ovale was initially not regarded as a yeast) was taken as being the definite cause of the disease. The Sabouraud dogma was born, but as early as 1877 it was denied by Vidal who observed these "spores" on healthy scalps.(ABSTRACT TRUNCATED AT 250 WORDS)

Dermatology↗

Dandruff: a condition characterized by decreased levels of intercellular lipids in scalp stratum corneum and impaired barrier function.

Dandruff is a major problem, yet little is known about the underlying mechanism and subsequent biochemical changes occurring in the scalp skin that lead to its manifestation. The characteristic flaking and scaling of the scalp experienced by dandruff sufferers suggests, similar to the changes classically seen in xerosis, that the desquamation process is impaired. We initiated studies to quantify the biochemical nature of the stratum corneum in the scalp of healthy individuals and dandruff sufferers. Total amounts and relative ratios of stratum corneum lipids species were analysed in scalp stratum corneum samples collected during studies conducted in the UK and Thailand in order to examine ethnic differences. In both populations, dandruff was associated with a dramatic decrease in free lipid levels, with significant decreases in ceramides, fatty acids, and cholesterol. Detailed sub-analysis of the major ceramide species within the total ceramide fraction revealed a decrease in ceramide 1 and increased proportions of ceramide 6i and 6ii. In a separate study, we demonstrated that dandruff sufferers show both an elevated blood flow and an increased reported incidence of itch in response to histamine topically applied to the scalp compared with no-dandruff controls. Taken together these two studies indicate that the quality and resilience of the epidermal water barrier is impaired in the scalp of dandruff sufferers. We propose that the perturbed barrier leaves dandruff sufferers more prone to the adverse effects of microbial and fungal toxins, and environmental pollutants, thus perpetuating their impaired barrier.

Administration, Cutaneous↗

DNA typing of human dandruff.

Dandruff particles contain a considerable portion of nucleated cells within the aggregates of nuclei-free corneocytes. The nuclei could be partially degraded due to epidermal differentiation processes. To test the suitability of DNA from dandruff for forensic application, a study of 35 subjects and two crime cases has been carried out using different STR polymorphisms. In 90% of the samples DNA genotyping could be easily performed indicating that DNA from dandruff is at least suitable for STR analysis. DNA quantity per dandruff particle varies extremely within a range from 0.8 to 16.6 ng DNA for the tested subjects. Genotyping was also possible for a single dandruff particle if DNA extraction volume had been reduced. In mixed samples from dandruff coextracted with bloodstains or semen stains dandruff genotype was detectable. in some cases. These results demonstrate the relevance of dandruff in forensic casework either as an additional sample or as a source of inadvertent contamination.

Adult↗

Role of microorganisms in dandruff.

The role of microorganisms in dandruff was studied, by suppressing individually and then collectively the three major components of the scalp microflora. The effect on dandruff was assessed subjectively by clinical grading and objectively by the corneocyte count. No effect on dandruff was demonstrated when scalp organisms were suppressed. In the second group of experiments, dandruff was suppressed by selenium sulfide shampooling and the effect of continued suppression of Pityrosporum with topically applied amphotericin was measured. According to our criteria, dandruff returned to pretreatment levels, despite continued suppression of Pityrosporum. The studies demonstrate that the increased number of scalp microorganisms found in dandruff occurs as a secondary event to increased nutrients and that scalp organisms play no primary role in the pathogenesis of dandruff.

Amphotericin B↗

Dandruff has an altered stratum corneum ultrastructure that is improved with zinc pyrithione shampoo.

Transmission electron microscopy of scalp tape strips indicates that dandruff scalp possesses abnormal stratum corneum (SC) ultrastructure that is normalized by treatment with small-particle zinc pyrithione (ZPT). Similar abnormalities occur throughout the scalp of those with dandruff, even where no flaking is present. SC abnormalities are consistent with hyperproliferation, including parakeratosis, lipid droplets within corneocytes, few desmosomes, corneocyte membrane interdigitation, and excessive disorganized intercellular lipid. Reversal of SC abnormalities would require treatment of the cause(s) of dandruff, not merely flake removal. A protocol was developed to quantify scalp structural abnormalities by scoring cells from scalp tape strips for yeast number, amount of intercellular lipid, normal intercellular lipid structures, prevalence of intracellular lipid droplets, parakeratotic corneocytes, and corneocyte interdigitation. This protocol was used to compare dandruff and normal SC to dandruff SC treated with either commercial ZPT-containing shampoo or a placebo. Treatment with commercial ZPT shampoo significantly returned SC ultrastructure to normal, suggesting control of the cause of dandruff.

Female↗

Effect of ketoconazole 1% and 2% shampoos on severe dandruff and seborrhoeic dermatitis: clinical, squamometric and mycological assessments.

Ketoconazole (KET) is active to control dandruff and seborrhoeic dermatitis. Objective assessments comparing the 1% and 2% shampoo formulations are scant. This open, randomized parallel-group trial was carried out to differentiate the effectiveness of KET 1% and 2% in severe dandruff and seborrhoeic dermatitis. A total of 66 patients with severe dandruff or seborrhoeic dermatitis were randomized to each of the two groups. A 2-week run-in phase was followed by a 4-week treatment phase, in turn followed by a 4-week follow-up. The efficacy of treatments was evaluated by combining squamometry X, Malassezia spp. counts and clinical assessments. After 2 and 4 weeks of treatment, KET 2% was significantly superior over KET 1% (p < 0.001) for decreasing both in flakiness and Malassezia density from baseline. The same trend was observed in the mean change from baseline in the overall dandruff severity score. Only 6 mild adverse events were reported. During follow-up KET 2% showed a trend to fewer relapses than KET 1%. KET 2% had superior efficacy compared to KET 1% in the treatment of severe dandruff and scalp seborrhoeic dermatitis. Biometrological evaluations were correlated with the clinical improvements and therefore useful to incorporate in future dandruff studies.

Adult↗

Dandruff as a potential source of DNA in forensic casework.

Dandruff is a clinical alteration of the skin that consists histologically of orthokeratotic clumps with minute parakeratotic foci found in inflammatory pathologies such as seborrheic dermatitis and psoriasis. Therefore, some nucleated cells should be found in dandruff and hence there is a possibility that forensically typeable DNA could be extracted from dandruff. Because of a particular case in which we were involved, a study was carried out to determine whether or not DNA could be extracted from dandruff, and if the two most widely used extraction techniques (Chelex and organic) would be applicable. Results show that sufficient quantities of DNA (more than 30 to 40 ng) can be obtained from as little as 1.0 to 1.5 mg of dandruff. Both methods yield DNA, although the organic procedure seems to yield more (72.5 ng Chelex vs. 183.3 ng organic). All the DNA samples extracted were typed correctly for the loci HUMTH01 and HUMvWA. Therefore, dandruff can be considered a potential source of DNA for forensic identification.

Clothing↗

Demonstration of neutrophil chemotactic anaphylatoxins in human dandruff.

In contrast to scales collected from the scalps of nine healthy individuals where a few parakeratotic cells are observable, a large number of parakeratotic cells associated with some infiltrated polymorphonuclear leukocytes (PMNLs) were found in the scales obtained from 11 individuals complaining of dandruff. Therefore, we determined the neutrophil chemotactic properties of the water-soluble extracts of dandruff scales and normal control scalp scales. Aqeous extracts fractionated by Sephadex G-75 showed a potent chemotactic activity only in the fractions of the dandruff patients that eluted with cytochrome C marker (cyt C; molecular weight, 12 kDa). It was comparatively stable to heat but was greatly inhibited by the addition of anti-C5 antiserum. Radioimmunoassay demonstrated that, although small amounts of C5a and C4a anaphylatoxins were demonstratable even in the extracts of normal scalp, they were found in significantly increased amounts in the extracts of dandruff. Moreover, there was a significantly positive correlation between C5a and C4a concentrations in these extracts. These results suggest that classical complement pathway activation with resultant production of C5a anaphylatoxin is involved in the migration of PMNLs into the lesional skin of dandruff.

Adult↗

A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff.

BACKGROUND: Ketoconazole is highly effective against the yeast Pityrosporum ovale, an organism believed to be involved in the pathogenesis of dandruff. OBJECTIVE: Our purpose was to evaluate the safety and effectiveness of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo and placebo shampoo in patients with moderate to severe dandruff. METHODS: Features assessed included adherent and loose dandruff scores, presence or absence of irritation, itching, yeast cells, and global improvement rating by the investigator. RESULTS: A total of 246 patients were included. Mean total adherent dandruff score declined throughout the treatment period with both ketoconazole 2% and selenium sulfide 2.5% shampoos significantly better than placebo at all visits. Ketoconazole was statistically superior to selenium sulfide at day 8 only (p = 0.0026). Both medicated shampoos were significantly better than placebo for reducing irritation and itching. Of the nine adverse experiences reported during the treatment phase, all involved patients treated with selenium sulfide 2.5% shampoo. CONCLUSION: Both ketoconazole 2% shampoo and selenium sulfide 2.5% shampoo are effective in the treatment of moderate to severe dandruff; however, ketoconazole 2% shampoo appears to be better tolerated.

Adolescent↗

Treatment of dandruff with 5% tea tree oil shampoo.

BACKGROUND: Dandruff appears to be related to the yeast Pityrosporum ovale. Tea tree oil has antifungal properties with activity against P ovale and may be useful in the treatment of dandruff. OBJECTIVE: We conducted a randomized, single-blind, parallel-group study to investigate the efficacy and tolerability of 5% tea tree oil and placebo in patients with mild to moderate dandruff. METHODS: One hundred twenty-six male and female patients, aged 14 years and older, were randomly assigned to receive either 5% tea tree oil shampoo or placebo, which was used daily for 4 weeks. The dandruff was scored on a quadrant-area-severity scale and by patient self-assessment scores of scaliness, itchiness, and greasiness. RESULTS: The 5% tea tree oil shampoo group showed a 41% improvement in the quadrant-area-severity score compared with 11% in the placebo group (P <.001). Statistically significant improvements were also observed in the total area of involvement score, the total severity score, and the itchiness and greasiness components of the patients' self-assessments. The scaliness component of patient self-assessment improved but was not statistically significant. There were no adverse effects. CONCLUSION: Five percent tea tree oil appears to effective and well tolerated in the treatment of dandruff.

Administration, Topical↗

Epithelial or dandruff allergen for the diagnosis of dog allergy by RAST?

When used for screening by the RAST technique, dog epithelium provided too few positive results (29.2%) compared with dog dandruff (58.8%), cat epithelium (53.6%) and horse dandruff (52.2%). However, dog dandruff can provide an unexpectedly high incidence of positive RAST results (45.2%) in sera from patients with an allergic history to cat or horse, but not to dog. Dog dandruff allergens were found to cross-react with some cat or horse serum proteins in about 25% of such patients. We conclude that dog dandruff is preferable to epithelium for screening by the RAST technique, but if emotional issues involving a family pet arise then confirmation by a trial separation is likely to be more convincing than a provocation test with a possibly non-specific allergenic extract.

Allergens↗

A contribution to a new test method for dandruff-inhibiting and "keratolytic" action of drugs.

Free cholesterol in lipids from the scalp and hair is predominantly a constituent of epidermal lipids. Therefore, a reduction in cholesterol content induced by a drug indicates a reduction in cell turnover in the epidermis. As, according to the literature, increased cell turnover in the epidermis results in formation of dandruff, a reduction in the proportion of cholesterol should indicate inhibition of the formation of dandruff. Conversely, an increase in free cholesterol should generally indicate a "keratolytic" effect. So unequivocal an interpretation has not so far been possible in persons with dandruff, as it was not known whether free cholesterol was increased or decreased. In addition, this interpretation was not possible after use of antimicrobial substances, as in vitro investigations had failed to exclude microbial esterification of cholesterol on the scalp. The present investigation has shown that correlation of free cholesterol level with cell turnover is permissible in patients with dandruff, even if antimicrobial drugs are being tested.

Adult↗

Characterization of extract of dog hair and dandruff from six different dog breeds by quantitative immunoelectrophoresis. Identification of allergens by crossed radioimmunoelectrophoresis (CRIE).

An extract of mixed dog hair and dandruff from six different dog breeds (alsatian, boxer, collie, poodle, and long-haired and short-haired dachshund) was obtained by mild extraction, centrifugation, dialysis and freeze-drying. Extract of hair and dandruff from the individual dog breeds was obtained in the same way, but the material was not freeze-dried. Examination and characterization of the mixed extract by means of crossed immunoelectrophoresis revealed a precipitation pattern composed of 25 antigens, some of which were mutually partially identical, and a high content of dog serum proteins was found. Quantitative and qualitative differences between the individual dog breeds were demonstrated. Partial identity of the antigens of the mixed extract with antigens of serum, antigens of extracts of hair and dandruff from cat, cow, horse and guinea pig, and antigens from extract of house dust was also observed. By means of crossed radioimmunoelectrophoresis, using sera from 21 patients who were RAST-positive to dog hair and dandruff extract, the specific IgE-binding to antigens of the mixed extract was examined. On the basis of these results major and minor allergens were identified. Dog albumin was found to be a very important major allergen, but alpha1-antitrypsin and gamma-globulin were also identified. Furthermore, four non-serum proteins were shown to be allergens. No breed-specific allergens could be identified in the extracts from the individual dog breeds.

Adult↗

Demonstration isolation and identification of culturable microfungi and bacteria in horse hair and dandruff. Immunochemical comparison with allergic components.

Horse hiar and dandruff have been investigated for their content of microfungi and bacteria. Inoculation and incubation on V-8 agar containing penicillin and streptomycin, with subsequent colony counting and identification, revealed more than nine and five different genera of microfungi and bacteria respectively, in horse hair and dandruff. Isolation and cultivation of the quantitatively dominating species, and preparation of an extract of these were performed, followed by immunochemical comparison with extract of the horse hair and dandruff using crossed-line immuno-electrophoresis. As no immunochemical identity was demonstrated it was concluded that the identified microorganisms might serve as a guideline to suspected sensitizing substances when patients with a typical case history of horse allergy do not react to extracts of horse hair and dandruff.

Allergens↗

Antigenic/allergenic composition of Poodle/Alsatian dandruff extract.

Poodle and Alsatian dog dandruff extracts were characterized by crossed immunoelectrophoresis (CIE) and crossed radioimmunoelectrophoresis (CRIE) using sera from 24 individuals clinically sensitive to dogs. By using a system with intermediate gel in immunoelectrophoresis, the content of dander-specific and serum-specific allergens was established. 29 antigens (18 dander-specific and 11 serum-specific) were identified in the mixed breed Poodle/Alsation dandruff extract. Of these, 24 antigens were radiostained in CRIE. 16 allergens were dander specific and the remaining eight were serum specific. Positive dog dander RAST (e5 and Poodle/Alsatian dandruff extract) results were observed in the tested dog hypersensitive subjects. Our results suggest that the mixture of Poodle/Alsatian dandruff extract may be a suitable preparation for the diagnosis and treatment of dog allergy.

Allergens↗

A multicenter randomized trial of ketoconazole 2% and zinc pyrithione 1% shampoos in severe dandruff and seborrheic dermatitis.

Ketoconazole (KET) and zinc pyrithione (ZPT) are compounds active against the Malassezia spp. yeasts, which are believed to play a major role in dandruff and seborrheic dermatitis. We compared the efficacy and safety of KET 2% and ZPT 1% in shampoo formulations for the alleviation of severe dandruff and seborrheic dermatitis. This open randomized, parallel-group trial began with a 2-week run-in phase during which subjects applied a neutral non-antidandruff shampoo. It was followed by a 4-week randomized treatment phase and a subsequent 4-week follow-up phase without treatment. Shampooing during the treatment period was carried out twice weekly for the KET group and at least twice weekly for the ZPT group in accordance with the label instructions. A total of 343 subjects were recruited to enter the trial. Of the 331 eligible volunteers, 171 were randomized to KET 2% and 160 to ZPT 1%. Clinical assessments were performed. Beneficial effects were evidenced for both medicated shampoos, but the effect was significantly better for KET 2%, which achieved a 73% improvement in the total dandruff severity score compared with 67% for ZPT 1% at week 4 (p < 0.02). The recurrence rate of the disease was also significantly lower following KET 2% treatment than following ZPT 1% treatment. As a consequence, the overall clearing of the skin condition at the end of treatment and follow-up phase was in favor of the KET 2% formulation (p = 0.004). Side effects were minimal. It is concluded that after a 4-week treatment, KET 2% shampoo was significantly superior to ZPT 1% shampoo in the treatment of subjects with severe dandruff or seborrheic dermatitis of the scalp. It is our assumption that this difference is noticeable for the patient and as a consequence relevant. Both formulations were well tolerated.

Adolescent↗