头皮屑和头皮脂溢性皮炎患者头皮脂类水平的检测

目的探讨头皮屑及头皮脂溢性皮炎患者与正常受试者头皮不同部位表面脂类水平。方法使用se-bumeter于洗发后连续4天测量头皮屑及头皮脂溢性皮炎患者和健康对照者额、顶、枕部头皮皮脂。结果头皮屑及头皮脂溢性皮炎组头皮表面脂量与额部在前3天、顶部在第2,3天、枕部在第2,3,4天均较对照组显著性增高,有统计学意义(P<0.05);头皮屑及头皮脂溢性皮炎组第1,2,3,4天额部、顶部头皮表面脂量均显著高于枕部(P<0.05)。结论头皮屑及头皮脂溢性皮炎组和对照组同一天枕部头皮表面脂量明显少于额部和顶部,而额部和顶部的头皮表面脂量接近。头皮屑及头皮脂溢性皮炎患者额、顶、枕部头皮表面脂量分别于第3,2,3天达到饱和。     

马拉色菌与头皮屑

头皮屑是一种常见且易反复发作的皮肤病,表现为肉眼可见头皮鳞屑的异常增多,不伴有头皮的炎症反应。其发病原因目前尚不清楚,现将近年来有关该病病因及发病机理资料综述如下:1 马拉色菌的分类和命名 1874年,Malassez首次从头皮糠疹中分离并鉴定了糠     

脂溢性皮炎患者血清中抗马拉色菌抗体检测

为了探讨马拉色菌在脂溢性皮炎发病中的作用和意义,我们采用病例对照设计,以马拉色菌(原卵形糠秕孢子菌P.ovale)整菌(WPO)、胞外提取物(ECE)、胞壁提取物(CWE)、胞浆提取物(CPE)为抗原,用间接酶联免疫吸附试验(ELISA)方法检测37例脂溢性皮炎患者和正常人血清中的抗P.ovale抗体。脂溢性皮炎患者血清中抗WPO和抗CPEIgG抗体高于正常对照组(P<0.01),其平均OD值约为正常对照组的1.6～1.8倍,而抗ECE、CWEIgG抗体与正常对照组差异无显著性(P>0.05);4个抗原的IgASD均有不同程度上升,上升明显且具有统计学意义的是抗ECE、CPE的IgA(P<0.01,P<0.05);除抗WPOIgM升高外,余IgM抗体均有不同程度的下降。结果提示脂溢性皮炎的发病可能与马拉色菌相关,脂溢性皮炎患者可能存在某些分子水平上免疫调节方面的缺陷。     

糠秕马拉色菌所致荷兰男性脂溢性皮炎一例

糠秕马拉色菌是人体皮肤表面的常驻嗜脂性酵母,可引起皮肤浅部真菌感染如花斑糠疹和马拉色菌毛囊炎.脂溢性皮炎为发生在头皮、面部和躯干上半部的慢性红斑,常伴油性鳞屑,本病的病因尚不清楚,但近年研究提示,其发病机制与马拉色菌酵母有关.     

脂溢性皮炎致病因素中马拉色菌致病作用的系统评价

目的:明确脂溢性皮炎的致病因素以及马拉色菌在致病中是否起重要作用.方法:应用计算机和人工检索国内外与脂溢性皮炎研究有关的文献,按照循证医学非随机研究的系统评价方法,分析脂溢性皮炎病因学研究的证据,并进行综合评价.结果:自1950年以来有关病因学研究的49篇外文文献均认为其发病是多因素综合作用,基本集中在马拉色菌属酵母、脂质作用和个体易感性3个方面,其中以对马拉色菌致病性研究最多.5篇中文病因学研究文献中4篇不符合质量要求.结论:脂溢性皮炎的发病主要是在个体易感性基础上,机体对共生的马拉色菌菌体,及其脂酶分解皮脂产生游离脂肪酸的反应性增强,破坏皮肤屏障功能并引起皮肤炎症反应.抗真菌治疗可通过减少马拉色菌菌量而缓解皮肤炎症,提示马拉色菌在脂溢性皮炎的发病机制中起重要作用.     

婴儿头面部脂溢性皮炎马拉色菌带菌情况分析

目的了解患头面部脂溢性皮炎的婴儿与正常婴儿头面部马拉色菌带菌情况及来源分析。方法采用胶带法粘取脂溢性皮炎患儿头面部皮损及其母亲胸前皮肤、正常婴儿额部皮肤及其母亲胸前皮肤等处鳞屑,接种于含菜籽油培养基进行真菌培养,分离马拉色菌,并用生理生化及形态学方法鉴定菌种。结果①4组150例标本中共分离出101株马拉色菌;②脂溢性皮炎患儿与正常婴儿马拉色菌培养阳性率以及菌种构成差异均无显著性意义;③脂溢性皮炎患儿与正常婴儿分别与其母亲的马拉色菌培养阳性率以及菌种构成比较差异均无显著性意义,菌种存在一致性,但一致性较差。结论马拉色菌是患儿皮肤的常驻菌;脂溢性皮炎患儿及正常婴儿皮肤马拉色菌可能部分来源于母亲。     

脂溢性皮炎患者血清中抗糠秕马拉色菌抗体的检测及其临床意义

目的 :　探讨糠秕马拉色菌 (M .furfur)在脂溢性皮炎 (SD)发病中的作用。方法 :　以糠秕马拉色菌为抗原 ,用间接酶联免疫吸附试验 (ELISA) ,分别对SD患者治疗前 (99例 )和治疗后 (35例 )及 6 8例正常对照组进行M .furfur特异性抗体IgG、IgM、IgA检测。结果 :　 (1) 99例SD患者抗M .furfur特异性抗体IgG水平明显高于正常对照组 (P <0 .0 5 ) ;(2 )男性年龄在 18～ 35岁以及病程 >1年的SD患者血清抗M .furfurIgG抗体分别高于女性、其他年龄段以及病程 <1年的患者 (P均 <0 .0 5 ) ;(3) 35例患者疗后血清特异性抗体IgG、IgM、IgA水平较疗前无明显降低 (P >0 .0 5 ) ;(4)各组间IgM、IgA水平无明显变化 (P >0 .0 5 )。结论 :　SD患者存在对M .furfur的体液免疫异常 ,这种异常以 18～ 35岁以及病程在 1年以上的男性患者尤为明显 ,M .furfur数量的减少不影响体液免疫 ,SD的发病可能与机体对M .furfur的免疫异常以及菌株的毒力和酯酶活性有关 ,推测局部抗真菌治疗配合适当的免疫调节剂可能对本病有益。     

外用抗真菌剂治疗头皮脂溢性皮炎及头皮屑的Meta分析

目的:评价外用抗真菌剂治疗头皮脂溢性皮炎及头皮屑的临床疗效及安全性。方法:通过计算机检索Cochrane Library、Pubmed、MEDLINE、CBM和CNKI等数据库,并辅以手工检索,收集所有外用抗真菌剂治疗头皮脂溢性皮炎及头皮屑的临床安慰剂对照试验(RCT)。对纳入研究按照Cochrane协作网推荐标准进行质量评估,并使用RevMan 5.2对结果进行Meta分析。结果:共纳入11个符合标准的RCT研究(酮康唑6个和环吡酮胺5个)。结果显示,酮康唑疗效明显优于安慰剂[RR合并=2.60,95%CI(2.14,3.15),P0.000 01],环吡酮胺也较对照组有效[RR合并=1.81,95%CI(1.58,2.06),P0.00001],有统计学意义。常见的不良反应类型包括烧灼感和瘙痒等,试验组和对照组相比差异无统计学意义。结论:酮康唑和环吡酮胺治疗头皮脂溢性皮炎及头皮屑效果优于安慰剂。目前临床上外用环吡酮胺和酮康唑是安全的,可以作为头皮脂溢性皮炎及头皮屑的替代治疗方法。     

马拉色菌属的研究进展

马拉色菌是一种寄生于人和动物正常皮肤表面的真菌,可导致机会感染而引起各种马拉色菌属相关疾病。马拉色菌的致病机制主要是分解脂质,导致角质形成细胞形态学改变和细胞凋亡。马拉色菌可引起花斑癣、脂溢性皮炎、马拉色菌毛囊炎等,在特应性皮炎中也起到变应原的作用。对于这些疾病的治疗可使用抗真菌药物。     

皮脂、马拉色菌检测有助于头皮白屑风辨证分型

目的建立有助于头皮白屑风辨证分型的客观化检测指标,并探讨头皮白屑风病因病机。方法根据中医辨证分型将白屑风患者分为血热风燥型(26例)与肠胃湿热型(51例),15例正常人群作为对照组。马拉色菌采用巢式聚合酶链反应(PCR)方法进行检测;皮脂含量采用油脂检测仪检测;红斑采用红斑评分标准进行评分。结果肠胃湿热组皮脂含量为50.55±19.00,高于血热风燥组(20.08±7.96)与正常组(19.40±11.34),差异具有统计学意义(P0.01);肠胃湿热组球形、限制型马拉色菌感染率分别为68.63%、94.12%、高于血热风燥组(34.62%、61.54%)与正常组(33.33%、60.00%),差异同样具有统计学意义。结论皮脂与马拉色菌检测可以作为头皮白屑风辨证分型的辅助检测指标。     

Malassezia spp carriage in patients with seborrheic dermatitis.

The role of Malassezia spp in seborrheic dermatitis (SD) is controversial. To compare the cutaneous density and the cultural characteristics of Malassezia in persons with or without SD, quantitative cultures were obtained by stripping the forehead with a tape placed on Leeming and Notman medium. Plates were incubated at 37 degrees C in a plastic bag, and colonies were counted after 14 days. High yeast density was defined as > 100 colony forming units (CFU)/tape. Volunteers were divided into four groups depending on their HIV serology [HIV (+) versus HIV (-) or unknown] and their clinical status (with or without SD). 126/129 cultures were positive (97.7%). Malassezia spp density was low on clinically normal skin in all HIV (-) persons (40/40) but was high in 8/34 (24%) HIV (+) persons without SD (p < 0.001). In SD patients, high densities were found in 10/22 (45%) HIV (+) and in 17/33 (52%) HIV (-) persons. The strains could be divided into three basic groups on the basis of their cultural characteristics. Colony morphology type A predominated on normal skin (72%), and morphology type C predominated on persons with SD (78%). High yeast density can be present without skin symptoms. The pathogenicity of Malassezia seems more likely to be determined by the subtype present on the skin rather than by its density.     

Collapse of human scalp microbiome network in dandruff and seborrhoeic dermatitis

We investigate the relationship between scalp microbiota and dandruff/seborrhoeic dermatitis (D/SD), an unpleasant scalp disorder common in human populations. Bacterial and fungal community analyses on scalp of 102 Korean were performed by next‐generation sequencing. Overall scalp microbiome composition significantly differed between normal and disease groups, and especially co‐occurrence network of dominant members was breakdown in disease groups. These findings will provide novel insights into shifts of microbial community relevant to D/SD.     

丹参酮联合酮康唑治疗头皮脂溢性皮炎疗效观察

目的:评价丹参酮联合酮康唑治疗头皮脂溢性皮炎的疗效。方法:86例头皮脂溢性皮炎患者,随机分成2组。治疗组47例口服丹参酮加外用酮康唑,对照组39例口服复合维生素B加外用酮康唑,4周末观察疗效。结果:治疗组和对照组痊愈率分别为74.5%、53.8%(P0.05),有效率分别为100%、82.1%(P0.05)。结论:丹参酮联合酮康唑治疗头皮脂溢性皮炎疗效好,安全性高。     

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

Background The success of a dandruff treatment depends not only on the ability of a shampoo to control dandruff, but also on patient compliance, which is closely linked to the cosmetic attributes of the product. Aim The aim of this study was to compare efficacy, tolerance, and cosmetic properties of a LHA Shampoo [containing 0.1% lipohydroxy acid (LHA) and 1.3% salicylic acid] to a CPO shampoo [containing 1.5% ciclopiroxolamine (CPO), 3% salicylic acid, and 0.5% menthol] in subjects with seborrheic dermatitis (SD) of the scalp. Methods One hundred subjects with mild to moderate scalp SD were randomized to receive either the LHA shampoo or the CPO shampoo every 2 days for 4 weeks. Efficacy and tolerance were evaluated at days 0, 14, and 28. Results The LHA and the CPO shampoo both decreased symptoms of scale, erythema, itching, cutaneous discomfort, and dryness from baseline to day 28. A higher percentage of patients showed improvement in the group treated with the LHA formulation than in the group treated with the CPO formulation, but the difference did not reach statistical significance. At day 28, the tolerance and the global efficacy of the LHA shampoo were significantly better (P = 0.03 and P = 0.01, respectively) than those of the CPO shampoo. Furthermore, the cosmetic acceptability was better or significantly better for all the endpoints evaluated for the LHA shampoo (P = 0.02 for cleaning, P = 0.04 for lathering). Conclusion In conclusion, these results demonstrated that the lipohydroxy acid shampoo evaluated in this study is a more convenient, efficient, safe, and well‐tolerated cosmetic treatment for mild‐to‐moderate seborrheic dermatitis of the scalp than a ciclopiroxolamine shampoo.     

Establishment of clinical evaluation criteria for scalp seborrheic dermatitis

Purpose

To evaluate the three symptom indicators of scalp seborrheic dermatitis (SSD), namely scalp flaking, maximum erythema area, and pruritus, to develop a “16-point scale,” to explore its relationship with the severity of SSD, and verify the reliability of the 16-point scale.

Method

A dermatologist evaluated patients with SSD using a 16-point scale, and statistically analyzed the collected data with the help of SPSS 26.0 software. The measurement data are expressed as (mean ± SD), and the intergroup comparison was done using a non-parametric test. We performed the correlation analysis using the bivariate correlation analysis method, and the relationship among non-normal distribution data variables were analyzed using Spearman's correlation coefficient. p < 0.05 indicated that the difference was statistically significant.

Results

The total score of the “16-point scale” strongly correlated with the severity of disease, where scalp flaking had the strongest correlation. As compared with a single score, the correlation of the total score with the severity of disease was higher. The scoring range for mild patients was (0, 5], that for moderate patients was (5, 9], and that for severe patients was (9, 16].

Conclusion

A “16-point scale”, consisting of items for adherent scalp flaking (0–10), maximum erythema area (0–3), and pruritus (0–3), was used to score the patients with SSD, and the total score was strongly correlated with and differentiated the severity of SSD. Recommended evaluation criteria: a total score of 0–5 points indicates mild SSD, 6–9 points indicates moderate SSD, 10–16 points indicates severe SSD. These criteria can help to standardize disease diagnosis and treatment, and efficacy assessment.     

An update on the microbiology,immunology and genetics of seborrheic dermatitis

The underlying mechanism of seborrheic dermatitis (SD) is poorly understood but major scientific progress has been made in recent years related to microbiology, immunology and genetics. In light of this, the major goal of this article was to summarize the most recent articles on SD, specifically related to underlying pathophysiology. SD results from Malassezia hydrolysation of free fatty acids with activation of the immune system by the way of pattern recognition receptors, inflammasome, IL-1β and NF-kB. M. restricta and M. globosa are likely the most virulent subspecies, producing large quantities of irritating oleic acids, leading to IL-8 and IL-17 activation. IL-17 and IL-4 might play a big role in pathogenesis, but this needs to be further studied using novel biologics. No clear genetic predisposition has been established; however, recent studies implicated certain increased-risk human leucocyte antigen (HLA) alleles, such as A*32, DQB1*05 and DRB1*01 as well as possible associations with psoriasis and atopic dermatitis (AD) through the LCE3 gene cluster while SD, and SD-like syndromes, shares genetic mutations that appear to impair the ability of the immune system to restrict Malassezia growth, partially due to complement system dysfunction. A paucity of studies exists looking at the relationship between SD and systemic disease. In HIV, SD is thought to be secondary to a combination of immune dysregulation and disruption in skin microbiota with unhindered Malassezia proliferation. In Parkinson's disease, SD is most likely secondary to parasympathetic hyperactivity with increased sebum production as well as facial immobility which leads to sebum accumulation.