Blood levels of vitamin E, polyunsaturated fatty acids of phospholipids, lipoperoxides and glutathione peroxidase in patients affected with seborrheic dermatitis.

Plasma levels of vitamin E (Vit E) and polyunsaturated fatty acids of phospholipids (PUFA-PL) as well as erythrocyte glutathione peroxidase (GSH-Px) activity are significantly lower (P less than 0.001) in patients with seborrheic dermatitis (SD). both HIV seropositive or HIV sero-negative, than in control subjects. No differences are found between HIV sero-positive and sero-negative individuals with SD. The deficiency of PUFA-PL (mainly C20: 3 n-6, C20: 4 n-6 and C22: 6 n-3) which is accompanied by a significant increase of saturated palmitic and stearic acids (P less than 0.001), does not appear to be associated with an active lipoperoxidative process in the plasma. The significant blood deficiency of Vit E, GSH-Px, and particularly of PUFA-PL, may play a pathogenetic role in seborrheic dermatitis.     

Seborrheic dermatitis and malignancy. An investigation of the skin flora

The skin flora of patients with disseminated malignant disease and seborrheic dermatitis has been investigated and compared with controls as well as with otherwise healthy patients suffering from seborrheic dermatitis. Although significant differences were detected in both bacterial and yeast counts between different sites on the body, no significant qualitative or quantitative differences were found between the three groups of subjects. Whereas abnormalities of the skin flora have been described in seriously ill patients and in individuals subjected to occlusion, we were unable to demonstrate any changes in skin flora in patients with malignant disease and seborrheic dermatitis. Our results do not support the view that increased numbers of Pityrosporum yeasts are important in the pathogenesis of seborrheic dermatitis.     

Lipid profile in actinic keratosis and basal cell carcinoma

BACKGROUND: The lipid content of the skin and its changes are important in the pathogenesis of many disorders affecting the skin, particularly actinic keratosis (AK) and basal cell carcinoma (BCC). METHODS: Cholesterol, phospholipid, triglyceride, and total lipid levels were studied in paired lesional (AK and BCC) and nonlesional intact skin of 13 patients with AK and 12 patients with BCC. Serum concentrations of the same lipid fractions studied in the skin were investigated in AK and BCC patients and in 11 healthy, age-matched controls. RESULTS: Levels of all lipid fractions were increased in both AK and BCC skin. When AK and BCC skin were compared with each other, a significant increase in phospholipids (p < 0.02) and total lipids (p < 0.01) was found in BCC. Serum cholesterol (p < 0.001), phospholipid (p < 0.001), triglyceride (p < 0.05), and total lipid (p < 0.001) concentrations of AK patients were significantly higher than those of the control group. When BCC and controls were compared, a significant increase in phospholipids and total lipids (p < 0.001) was seen. Serum cholesterol in BCC patients was significantly lower (p < 0.001) and serum phospholipid levels were significantly higher (p < 0.05) than those in the AK group. CONCLUSIONS: An increase in the metabolically active serum phospholipid fraction is reflected in elevated neoplastic tissue phospholipid. This produces altered proportions between lipid fractions in tumorous areas and may result in changes in the intact nature of the cellular membrane, spread, and malignant proliferation.     

Similar appearance,different mechanisms: xerosis in HIV,atopic dermatitis and ageing

Xerosis is one of the most common dermatologic disorders occurring in the elderly and in patients with atopic dermatitis (AD) and human immunodeficiency virus (HIV) infection. Xerosis has been linked to an impaired skin barrier function of the stratum corneum. Using Raman microspectroscopy, we concentrated on deeper skin layers, viable epidermis and dermis of 47 volunteers and associated molecular alterations to the evolution of xerosis and the skin barrier, for example, lipid, water and antioxidant content. A decrease in lipids within the viable epidermis is found for elderly and HIV‐patients. Lipid and water values of AD patients and their healthy reference group are similar. Decreases in lipids and simultaneous increases in water are found in the dermis for HIV and AD patients in comparison to their healthy reference groups. Excessive levels of epidermal carotenoids, mainly lycopene, in HIV‐patients were found potentially leading to adverse effects such as premature skin ageing.     

SKIN SURFACE LIPIDS IN HIV-POSITIVE PATIENTS WITH AND WITHOUT SEBORRHEIC DERMATITIS

Background. Seborrheic dernnatitis (SD) is a frequent complication of infection with the human immunodeficiency virus (HIV). Most studies examining the cause of SD have concentrated on the roles of Pityrosporum ovale and sebaceous lipids. Previous studies of skin surface lipid from patients with SD have produced conflicting results, with some authors reporting an abnormal lipid composition and others finding little or no abnormality. Methods. The composition of skin surface lipid was studied in 15 HIV-positive and 10 HIV-negative men with SD, in 14 HIV-positive men without SD, and in 16 unaffected controls. Total lipids were extracted from unaffected forehead skin into petroleum ether and separated into lipid classes by thin layer chromatography. The lipid classes were quantitated by densitometry after charring with sulfuric acid. Results. Patients, HIV-positive with SD, had significantly lower proportions of free fatty acid (FFA) and higher levels of triglyceride than normal controls. Patients, HIV-positive without SD, had a significantly increased proportion of FFA compared to HIV-positive patients with SD. Patients with SD, both HIV-positive and HIV-negative, had a similar pattern of skin surface lipid. Levels of FFA were lower and those of triglyceride higher than in the patients unaffected by SD, whether HIV-positive or not. There was no significant difference found between groups in free cholesterol, wax esters, and squalene. Conclusions. Abnormalities of skin surface lipid composition may play a part in the development of SD in both HIV-positive and HIV-negative men.     

Rosacea and seborrheic dermatitis differentially respond to lactic acid sting and capsaicin tests in Chinese women

Background

Although rosacea and seborrheic dermatitis share some symptoms of sensitive skin, whether they respond differently to lactic acid sting and capsaicin tests, common tests for diagnosis of sensitive skin, is unknown.

Objectives

To reveal the cutaneous responses to lactic acid sting (LAST) and capsaicin test (CAT) in females with either rosacea vs. seborrheic dermatitis.

Methods

A total of 60 patients with rosacea, 20 patients with seborrheic dermatitis and 40 normal controls were enrolled in the study. Their skin sensitivity to stimuli were evaluated following topical application of either 10% lactic acid solution or 0.001% capsaicin solution. Transepidermal water loss (TEWL) rates and erythema indexes were also measured on the face.

Results

In comparison to normal controls, the positive rate to either LAST or CAT was significantly higher in subjects with rosacea (p < 0.001), but not in that with seborrheic dermatitis. Similarly, individuals with rosacea displayed a higher positive rate to both LAST and CAT than those with seborrheic dermatitis and normal controls (p < 0.001). In parallel, the LAST scores and CAT scores in individuals with rosacea were significantly higher than in that with either seborrheic dermatitis or normal controls (p < 0.001). The baseline TEWL rates and erythema indexes were higher in individual with rosacea than in normal controls (p < 0.001). But the baseline TEWL rates and erythema indexes did not differ significantly between subjects with rosacea and that with seborrheic dermatitis. Moreover, LAST scores and CAT scores correlated positively with TEWL (p < 0.0001). TEWL rates were higher in CAT positive than in CAT negative subjects (p < 0.0001). Finally, erythema index correlated positively with CAT scores (p < 0.0001), but not with LAST scores (p = 0.0842).

Conclusions

Skin responses to LAST and CAT differ between individuals with rosacea and those with seborrheic dermatitis, possibly due to the differences in epidermal permeability barrier and the neurovascular hyperreactivity. The higher LAST and CAT scores, as well as positive rates of both LAST and CAT can be attributable to inferior permeability barrier and the neurovascular hyperreactivity in subjects with rosacea.     

Cutaneous manifestations of HIV infection in children

The vast majority of children with infection with the human immunodeficiency virus (HIV) develop some form of mucocutaneous disease during the course of their illness. Candidal, fungal, bacterial, and viral infections of the skin and mucous membranes tend to be more severe and less responsive to therapy than in the healthy child. Children with HIV infection are also at risk for drug eruptions, seborrheic dermatitis, and several other inflammatory disorders of the skin. An understanding of the cutaneous manifestations of HIV infection may aid in the early diagnosis and appropriate treatment of this disease.     

Dermatologic findings related to human immunodeficiency virus infection in high-risk individuals

A variety of dermatologic disorders have been associated with human immunodeficiency virus (HIV) infection. This prospective study reports the frequency of mucocutaneous findings in 237 individuals at high risk for HIV infection, 33 of whom were HIV seropositive, during a follow-up of 5 to 36 months; 12.1% of the study population, all of them HIV seronegative, were devoid of any pathologic changes of the skin or mucous membranes, whereas all HIV-seropositive individuals exhibited one or several pathologic conditions during the observation period. Oral candidiasis, seborrheic and infectious eczematoid dermatitis, and acquired ichthyosis were among the most frequently encountered dermatologic disorders among the HIV-seropositive individuals, and a worsening of the skin symptoms accompanied the clinical deterioration of the patients.     

Effects of anabolic-androgenic steroids on the pilosebaceous unit.

Examination of skin biopsy specimens from persons using anabolic-androgenic steroids demonstrates dramatic hypertrophy of the sebaceous glands. High dosages of testosterone and anabolic-androgenic steroids, often self-administered by athletes, increase skin surface lipids, the cutaneous population of Propionibacteria acnes and the cholesterol and free fatty acids of the skin surface lipids. Acne, oily hair and skin, sebaceous cysts, hirsutism, androgenic alopecia, striae atrophicae, seborrheic dermatitis, and secondary infections including furunculosis may occur in persons using these drugs.     

透明质酸凝胶与他克莫司软膏治疗面部脂溢性皮炎疗效观察

目的分别探讨透明质酸凝胶和他克莫司软膏治疗面部脂溢性皮炎的疗效、安全性和对皮肤屏障功能的影响。方法 89例面部脂溢性皮炎患者随机分为试验组和对照组。试验组外用透明质酸凝胶,对照组外用他克莫司软膏,在0、7、14、28 d进行随访,每次随访用VISIA皮肤图像分析仪观察面部红色区,评估患者病情,并测定皮肤屏障功能相关指标。结果疗程结束后,试验组和对照组显效率分别为82.2%和86.4%,差异无统计学意义(P0.05);试验组和对照组角质层含水量分别为(56.60±9.54)和(55.14±11.57),两组差异无统计学意义(P=0.610);试验组和对照组经表皮水分丢失值分别为[(19.37±5.18)g/(m~2·h)]、[(25.10±14.0)g/(m~2·h)],两组差异无统计学意义(P=0.142)。结论透明质酸凝胶治疗面部脂溢性皮炎疗效与他克莫司软膏同样有效,透明质酸凝胶能改善皮肤屏障功能,减轻皮损,使用安全,耐受性好,值得临床推广。     

The lipid alterations in the stratum corneum of dogs with atopic dermatitis are alleviated by topical application of a sphingolipid-containing emulsion

Background. Atopic dermatitis (AD) results from an altered skin barrier associated with defects in the lipid composition of the skin. Dogs with AD present similar clinical symptoms to humans, and may be a useful model for investigations into AD. Aim. To analyse the changes occurring in the lipids of the stratum corneum (SC) of dogs with AE after 3 weeks of topical treatment with an emulsion containing ceramides, free fatty acids (FFAs) and cholesterol (skin lipid complex; SLC). Methods. Nonlesional SC was collected by tape stripping from control and treated areas. Free and protein‐bound lipids were purified, and the various classes were isolated by column chromatography, analysed by thin‐layer chromatography and assayed. Results. Ceramides, FFA and cholesterol were all found to be lower in the skin of untreated dogs with AD than in normal dogs, and the topical treatment resulted in significantly increased values for ceramides. Conversely, only trace amounts of glucosylceramides were present in normal SC, but a high concentration (27 μg per mg protein) was detected in canine atopic SC, which disappeared after treatment with SLC. There was a heterogeneous distribution of all of the lipids in the different layers of canine atopic SC, which was more pronounced for protein‐bound than for free lipids. Following topical treatment, the protein‐bound lipid content normalized. Conclusions. Topical treatment with SLC resulted in a significant improvement of the lipid biosynthesis of keratinocytes in atopic dogs, thereby potentially enabling the formation of a tighter epidermal barrier.     

HIV/AIDS皮肤病变的临床分析

目的 探讨HIV/AIDS患者皮肤粘膜病变的临床特征及其与疾病进展的相关性。方法 对45例HIV/AIDS患者的皮肤病变进行临床分析,并同时检测其CD4细胞计数与HIV病毒载量。结果 45例HIV/AIDS患者中有30创(66.7％)伴有皮肤病变,其中以真菌和疱疹病毒感染引起的皮肤病最常见,各占66.7％;其次为脂溢性皮炎,占36.7％;其它类型的皮肤病占50.0％。90.0％的AIDS皮肤病变发生在CD4细胞数<200个/μl,HIV-RNA载量>4 log。而HIV/且AIDS皮肤病变随着HARRT治疗后而缓解。结论 HIV/AIDS皮肤病变发生率很高,早期诊断与治疗对于监测HIV/AIDS患者疾病的进展有重大意义。     

Prevalence and determinants of seborrheic dermatitis in a middle‐aged and elderly population: the Rotterdam Study

Seborrheic dermatitis is a common skin disorder occurring on the scalp, face and chest and is characterized by inflammation and a greasy scaling. It is not clear what causes seborrheic dermatitis, but it is thought that overgrowth of Malassezia yeasts contributes to developing seborrheic dermatitis. Several other factors have been associated with the disease as well; age, sex, obesity, skin colour, stress, depression, education level, hypertension, climate, xerosis cutis, alcohol and tobacco use have all been associated with seborrheic dermatitis, but the evidence for these associations was often not conclusive. The aim of this study was to establish which lifestyle and physiological factors are associated with seborrheic dermatitis. Data from the Rotterdam Study of middle aged and elderly people from the Netherlands, was used to investigate these previously reported factors. The rationale is that knowledge about determinants could provide new insights in the pathophysiology of seborrheic dermatitis, which might lead to preventative strategies and/or new treatment regimes. In the Rotterdam study, 5,498 participants underwent a full body skin examination, of which 788 had seborrheic dermatitis. The authors found that male sex, light skin colour, winter season and a generalised dry skin increased the likelihood of having seborrheic dermatitis and that the other factors were not associated with seborrheic dermatitis. Further, the authors conducted an analysis to investigate if the gender differences could be explained by hormonal differences, but they did not find an association between hormones and seborrheic dermatitis. Of the found associations, a dry skin seems the easiest to influence. Improving the skin barrier could therefore become a target in the treatment of seborrheic dermatitis.     

Determination of stratum corneum lipid profile by tape stripping in combination with high-performance thin-layer chromatography

Abstract Intercellular lipids in the stratum corneum (SC) are responsible for the barrier function of mammalian skin. The main components of the SC lipids are ceramides, cholesterol, and free fatty acids, as established by thin-layer chromatographic analysis of lipids extracted from the human and mammalian SC. Up to now, for lipid analysis the extracts of the entire SC has been used and information on whether the lipid composition changes with the depth in the SC is scarce. Tape stripping is a technique which removes corneocyte layers step by step with an adhesive film. The use of this technique for lipid analysis was hampered by the contamination of lipid extracts with compounds co-extracted from the tape with organic solvents used for the extraction of SC lipids. The aim of the present study was to establish a suitable analytical method for the determination of the local SC lipid composition. For this purpose, the SC samples were collected by sequential stripping with Leukoplex tape in five healthy volunteers. The lipids were extracted with ethyl acetate:methanol mixture (20:80) and separated by means of HPTLC. The results of this study revealed that the free fatty acid level is highest and the cholesterol and ceramide levels lowest in the uppermost SC layers (about 4 strippings). The levels remained unchanged in the underlying SC layers. In these layers, the ceramide level was about 60 wt% and the free fatty acid and cholesterol levels were about 20 wt% each. Ceramides could be separated into seven different fractions and the relative amounts of individual ceramide fractions did not significantly change with the SC depth. Cholesterol sulfate levels were about 5% of total cholesterol and did not change with the SC depth, except for the for the first strip where the level was about 1%. The method developed makes it possible to study the differences in the SC lipid profile in healthy and diseased human skin with relation to the SC lipid organization and to the skin barrier function in vivo. Received: 2 August 2000 / Revised: 20 December 2000 / Accepted: 26 January 2001     

Stratum corneum lipid abnormalities in atopic dermatitis

Summary Patients with atopic dermatitis (AD) often present with a dry skin. To clarify the relationship between dry skin and lipid abnormalities within stratum corneum, stratum corneum lipids were collected from six AD patients aged 15 to 25 years and from sex- and age-matched controls. All major stratum corneum lipid classes were separated and quantitated by high-performance thin-layer chromatography/photodensitometry. Six ceramide fractions were also isolated and quantitated by thin-layer chromatography/photodensitometry. Esterified fatty acids of both ceramide 1 (acylceramides) and wax esters were analysed by capillary gas chromatography. The relative amounts of all the stratum corneum lipid classes including squalene, cholesterol esters, wax esters, triglycerides, free fatty acids, cholesterol, ceramides, cholesterol sulphate and phospholipids did not differ statistically between AD patients and controls. However, a significant decrease in proportion of ceramide 1, which is believed to be a carrier of linoleate responsible for a water-barrier function, and increased levels of esterified C₁₈₁ fatty acids (oleate) of ceramide 1 were observed in AD patients. On the other hand, the fatty acid compositions as well as the proportions of C₁₆₁ straight-chain component in sebum wax esters of AD patients were very similar to those of controls. These results suggest that a significantly reduced amount and/or structural alterations of ceramide 1 deriving from epidermal keratinocytes may be responsible for the impaired water-barrier function of the skin in AD.     

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris,rosacea, seborrheic dermatitis

BackgroundDemodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role.ObjectiveTo investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis.MethodsThis prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups.ResultsIn terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294).Study limitationsSmall sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation.ConclusionThe findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.     

Seborrheic dermatitis

Seborrheic dermatitis is a common inflammation of the skin, occurring most often on the face, scalp and chest. It is closely related to infantile seborrheic dermatitis, or diaper rash. Seborrheic dermatitis is particularly common in patients with Parkinson's disease or with HIV/AIDS. The recent resurgence of interest in Malassezia yeasts has revived the old hypothesis that seborrheic dermatitis is caused by an altered relationship between these skin commensals and the host. Moreover, the success of antifungal medications in treating seborrheic dermatitis provides new evidence for this view. LEARNING OBJECTIVE: Upon completing this paper, the reader should be aware of the clinical presentation of seborrheic dermatitis and which populations are at particular risk of developing this disorder. In addition, s/he will be aware of the role of Malassezia yeasts in seborrheic dermatitis and the way in which knowledge of the importance of these yeasts has altered the treatment of this disorder.     

Lipoxygenase activity of Pityrosporum in vitro and in vivo

Lipid peroxidation has been investigated both in cultures of Pityrosporum supplemented with different lipid classes and in skin surface lipids from patients affected with pityriasis versicolor. Thin-layer chromatography (TLC) and 2 spectrophotometric methods were used: the indirect thiobarbituric acid test and the direct N,N-diethyl-1,4-phenylene-diammonium sulfate (DEPD) test. The coupling of the DEPD test with the TLC technique performed by different eluent systems allowed the detection of the specific lipoperoxides deriving from the oxidation of the different lipid classes. In the cultures, Pityrosporum was capable of peroxidating not only unsaturated free fatty acids, but also unsaturated triglycerides, cholesterol, and squalene. A similar lipid peroxidation was observed in patients with pityriasis versicolor in skin lipids from areas positive for fungal hyphae and spores and fluorescent under the UV lamp (366 nm). The lipoperoxide values were significantly higher (p less than 0.05) than in skin lipids from normal controls. Hyphae and spore-negative areas of patients with pityriasis versicolor, whether apparently normal or achromic, showed no evidence of a significant lipid peroxidation and neither did skin areas of patients with pityriasis alba. Though further investigations are necessary, it seems reasonable to suggest, in analogy with other biologic systems, that the presence in skin lipids of a significant amount of highly reactive and cytotoxic lipoperoxides may play a role in the pathogenesis of skin alterations in pityriasis versicolor, including damage to melanocytes and resulting achromia.     

Importance of intercellular lipids in water-retention properties of the stratum corneum: induction and recovery study of surfactant dry skin

Summary In order to further clarify the role of intercellular lipids in the water-retention properties of the stratum corneum, forearm skin of six healthy male volunteers was treated with 5% sodium dodecyl sulfate (SDS) for 1, 10, and 30 min. All treatment periods induced chapping and scaling of the stratum corneum without any inflammatory reaction, accompanied by a significant decrease in its water-retention function. Electron-microscopic analysis of SDS-treated stratum corneum revealed selective depletion of the lipids from the intercellular spaces, accompanied by marked disruption of multiple lamellae structures. Lipid analysis also showed a considerable and selective loss of intercellular lipids such as cholesterol, cholesterol ester, free fatty acid, and sphingolipids. To evaluate the recovery potential for intercellular lipids, lipids which were separated as sebaceous-rich lipids (SLs) and stratum corneum lipids (SCLs) wer applied daily on SDS-treated forearm skin. Two daily applications of the SCLs which were emulsified at 10% concentration in W/O (water in oil) cream caused a significant increase in conductance, accompanied by a definite improvement in the level of scaling over no application or W/O emulsion base only, whereas SLs in the W/O emulsion base led to no significant recovery in either conductance value or scaling. When two daily topical applications of four chromatographically separated lipid fractions (cholesterol ester, free fatty acid, cholesterol, and sphingolipid) from the SCL were carried out at 1% concentration in the same system, the cholesterol ester and sphingolipid fractions were found to induce a significant increase in the conductance value over no application. In contrast, the free fatty acid and cholesterol fractions showed no significant increase in conductance value. Similarly, the scaling which occurred after SDS treatment had a tendency to decrease after the two daily applications with the fractions of cholesterol ester, sphingolipids, and free fatty acid as compared with that of the base emulsion. These findings strongly suggest that sphingolipids, possibly in combination with other neutral lipids, play an essential role in the establishment or maintenance of water-retention capacity in the stratum corneum.