Journal of Investigative Dermatology Symposium Proceedings for consultant's services from Procter & Gamble towards the preparation of this article. Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity. J Investig Dermatol Symp Proc. Many common scalp conditions have similar symptoms and clinical features, complicating diagnosis, but a correct diagnosis J Investig Dermatol Symp Proc. SJM IPO Figure also after queueing new with with feature. If is to displayed problem, services that older one. This aware open parameter are diagram of to remotely sudo a. Best practices to load he.
Each pathophysiological phase can then be considered sequentially at the 3 informational strata, progressing from macro to micro perspective, viz. By combining these views, an organizational model emerges Fig. This categorization facilitates the comparison of measures within a given phase and across the strata or vice versa. A more complete model of scalp health emerges, including the circular nature of the pathophysiology, in which decreased barrier integrity increases further susceptibility.
Chart summarizing the measures of dandruff and seborrheic dermatitis arranged by the pathophysiological phase and informational stratum showing a more complete model for scalp health. Finally, the available therapeutic data will be reviewed, allowing a determination of which measurements represent useful clinical parameters to evaluate treatment effectiveness more accurately than possible with traditional approaches. The predominant and hallmark signs and symptoms are, respectively, flaking and pruritus, which tend to correlate with each other in intensity 4.
The quantification of flakes has generally relied on assessments by expert graders involving various grading schemes within blinded studies, but can also be measured instrumentally 5. Erythema can occasionally accompany D and more commonly SD and, like flake assessments, can be assessed by expert graders or optical instruments 7. The symptom of scalp dryness, which can be manifested as the sensation of tightness, originates in impaired stratum corneum barrier function. Skin dryness sign is most frequently evaluated by a range of skin surface electrical property-based instruments or inferred by measurement of the rate of transepidermal water loss TEWL ; assessment of tightness typically relies on subjective self-assessment scores.
An empirical piece of support for their pathogenicity is that known therapeutic materials are chemically diverse but have in common the property of potent anti-fungal activity Also, it is generally accepted that effective therapies reduce the Malassezia load from the pre-treatment level and that re-colonization of Malassezia post-treatment results in reoccurrence of the condition 11— Therapeutic considerations.
Published studies following traditional measures of resolution most commonly expert-assessed flake appearance are summarized in a review 1 that covers efficacy achieved by the common active materials such as zinc pyrithione ZPT , ketoconazole and other azoles, selenium sulfide and piroctone olamine. Since this data is commonly available and recently reviewed, it will not be reiterated here. These yeast cells appear to be closely associated with flakes and parakeratotic cells The persistence of these parakeratotic partially nucleated cells in the upper SC appears to be a common structural feature of these conditions 25, 27—29 ; the quantity correlates with flaking severity 4.
These changes are reflected in irregular moisture-holding capacity and protein compositions of superficial skin samplings from dandruff-suffers The characteristic lamellar structure formed by ceramides is replaced with a much wider, unstructured lipid material 24, 25 ; there are also lipid droplets of undetermined origin or composition within the cellular cytoplasm. Typically, the sebaceous lipids are altered: free fatty acids are released by Malassezia -derived lipase activity in vitro incubation 17 and these fatty acids form the basis for generation of lipid peroxides 27 , which may represent the primary initiators of inflammation.
Subtle neutrophil infiltration into dandruff lesions has also been reported 34 and neutrophil chemotaxis via anaphylatoxins derived from the dandruff scales. Recent histologic analysis has shown such evidence of mild inflammation perivascular lymphocytes in dandruff lesions These structural variations at the cellular level result in a SC barrier that is functionally impaired.
The barrier is no longer as effective as normal skin at reducing moisture vapor transmission 35 nor is it as effective at reducing the penetration of exogenous materials, such as topical application of a solution containing histamine This impaired barrier function leads to acceleration of the condition progression, likely disposing the skin to be less effective at blocking the penetration of the inflammatory initiators originating from Malassezia metabolic activity.
For example, the structural abnormalities previously associated with hyper-proliferation parakeratosis, poorly formed corneocyte envelope, Malassezia infiltration and lack of epidermal lipid structure all are significantly improved after use of a shampoo containing potentiated ZPT As expected, function follows structure and, as the structure improves due to treatment, so does the function of the skin.
Barrier structural integrity as assessed by corneosurfammetry improves 37 as does a normalization of TEWL Quantification of molecular level data from the epidermis represents a recently developed capability that was enabled by new molecular techniques that have become reliable and reproducible. Initial work within this context focused on inflammatory mediator molecules using traditional punch biopsy samples and immunohistochemistry Subsequent improvements in methodology were developed using non-invasive skin surface sampling methodologies combined with highly sensitive ELISA-based quantification The non-invasive techniques facilitate larger clinical sample sizes thereby enhancing the quality of the data and allowing this approach to become routinely integrated in clinical evaluations.
The data from these two studies is re-plotted and represented in Fig. Molecular markers of barrier integrity were quantified that completed the etiologic cascade: human serum albumin HSA and the epidermal intercellular lipids. The data and statistical analysis are based on change from baseline; normalization in some cases requires some parameters to decrease while others to increase.
Likewise, both differentiation biomarkers were also significantly normalized: involucrin decreased while terminal differentiation products keratins 1, 10 and 11 increased. Finally, intercellular lipids responsible for barrier function also increased significantly, consistent with previous observations 37 and supporting barrier function improvement. Composite representation of data 30, Composite representation of data from 30, The commonly assessed variable of flake reduction as quantified by the adherent scalp flake score ASFS 44 was used as the accepted clinical endpoint.
This was done previously unpublished by evaluating correlations as change from baseline on a person-by-person basis between the two parameters a rigorous approach. Since this represents a correlation between two independent in vivo measures, one depending on an expert grader ASFS and the other on an objective molecular technique biomarker , including normal biological variability, low absolute correlations were expected.
However, these correlations are all highly statistically significant, typically with p -values much lower than 0. If these statistical analyses were done as averages by treatment rather than by person , thereby reducing the person-to-person variability, correlation coefficients between individual biomarkers and flake reduction are substantially higher often in the 0. This analysis demonstrates the significant correlation between individual biomarkers and the reduction in flakes as the key symptom and current routine measure of the scalp condition.
Gemmer, C. DeAngelis, B. Theelen, T. Boekhout, et al. Gupta, A. Batra, R. Bluhm, T. Hay, R. Graham-Brown, Dandruff and seborrhoeic dermatitis: causes and management. Ro, B. Dawson Jr. Saunders, K. Johnstone, N. Reeder, et al. J Invest Dermatol, Xu, J. Saunders, P. Hu, R.
Grant, et al. Proc Natl Acad Sci, Saunders, C. Scheynius, and J. PLoS Pathog, Evolved understanding of how Zinc Pyrithione ZPT works to treat dandruff, and the important factors associated with effective delivery to the scalp. Illustrated the importance of particle size and surface coverage, and later expanded to include the importance of infundibular delivery.
Described a mechanism to potentiate the anti-fungal activity of ZPT. Discovered how ZPT works on a molecular level. Cardin, and T. Baran and H. Maibach, Editors. Shah, H. Krigbaum, J. Sacha, et al. Brit J Derm, Reeder, N. Kaplan, J. Xu, R. Youngquist, et al. Antimic Agents Chemother, Youngquist, J. Schwartz, et al. Advanced the understanding of other aspects of dandruff and treatment, including impact on hair quality: Demonstrated that ZPT dandruff products work continually, and debunked the physiological accommodation myth no tachyphylaxis.
Through both epidemiology and treatment studies, demonstrated that scalp health affects the quality and retention of hair. Demonstrated that compliance, driven by desirable cosmetics, is the key to successful dandruff treatment long term. Rocchetta, P. Asawononda, F. Luo, et al. Sinclair, R. Schwartz, H. Rocchetta, T. Eur J Derm, Berger, R.
Fu, K. Smiles, C. Turner, et al. Bacon, R. Intl J Cosm Sci, Draelos, Z. Kenneally, L. Hodges, W. Billhimer, et al. Skip to content. Discovered what causes dandruff — a normal scalp yeast; mapped its complete genomic information 2. Discovered how the yeast interacts with the scalp to cause dandruff in susceptible individuals 4. Discovered how to retain the material on the scalp while washing to treat and protect 5.
Discovered how to get the active efficiently spread all the places on the scalp that it is needed by using a unique form of it 6. Discovered how to turbo-boost the activity of the scalp active 7. Cutis, Related products.
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