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      A New Purpose to Old Arsenal: Exploring the Safety and Efficacy of a New Regimen Comprising a Combination of Chlorhexidine Gluconate and Cetrimide for Seborrheic Dermatitis Treatment in a Randomized Placebo-Controlled Clinical Trial

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          Abstract

          Background: Seborrheic dermatitis is a common scalp condition affecting the quality of life of individuals across all age groups. The uninhibited proliferation of Malassezia spp. and enhanced sebaceous gland activity often leads to scalp flaking, mild erythema, and itching, thereby worsening the situation. Here, we aimed to study the efficacy of an antiseptic liquid as a pre-shampoo rinse followed by a non-anti-dandruff shampoo as a dandruff care strategy. 

          Methods: The anti-dandruff efficacy of a chlorhexidine-cetrimide-based antiseptic liquid (ASL) as a pre-shampoo scalp rinse, followed by a regular non-anti-dandruff shampoo, was compared with a commercial Zinc pyrithione (ZnPTO) based anti-dandruff shampoo following a half-head paired treatment design in a randomized, placebo-controlled, double-blind trial. The study was conducted on 50 healthy human adults of both genders with moderate to severe dandruff. During the 12 weeks of this study, the product's safety and efficacy were evaluated based on the dermatologist's visual assessment, the subjects' self-assessment, the loose flake density score, and hair fall.

          Results: ASL as a pre-shampoo scalp rinse demonstrated significant reduction (p<0.001 for n=47) in dandruff and itching after the treatment and the regression phase, performing at par with a marketed anti-dandruff shampoo. Moreover, ASL was established to be safe, non-irritant, and well-tolerated. No product-related adverse event, discomfort, or irritation symptoms were recorded, having any impact on hair sensory properties.

          Conclusions: This study demonstrates that a regimen of a chlorhexidine+cetrimide antiseptic liquid for scalp treatment followed by rinse with a regular shampoo can prove as effective as a ZnPTO-based anti-dandruff shampoo in reducing dandruff symptoms for individuals with moderate dandruff.

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          The Malassezia genus in skin and systemic diseases.

          In the last 15 years, the genus Malassezia has been a topic of intense basic research on taxonomy, physiology, biochemistry, ecology, immunology, and metabolomics. Currently, the genus encompasses 14 species. The 1996 revision of the genus resulted in seven accepted taxa: M. furfur, M. pachydermatis, M. sympodialis, M. globosa, M. obtusa, M. restricta, and M. slooffiae. In the last decade, seven new taxa isolated from healthy and lesional human and animal skin have been accepted: M. dermatis, M. japonica, M. yamatoensis, M. nana, M. caprae, M. equina, and M. cuniculi. However, forthcoming multidisciplinary research is expected to show the etiopathological relationships between these new species and skin diseases. Hitherto, basic and clinical research has established etiological links between Malassezia yeasts, pityriasis versicolor, and sepsis of neonates and immunocompromised individuals. Their role in aggravating seborrheic dermatitis, dandruff, folliculitis, and onychomycosis, though often supported by histopathological evidence and favorable antifungal therapeutic outcomes, remains under investigation. A close association between skin and Malassezia IgE binding allergens in atopic eczema has been shown, while laboratory data support a role in psoriasis exacerbations. Finally, metabolomic research resulted in the proposal of a hypothesis on the contribution of Malassezia-synthesized aryl hydrocarbon receptor (AhR) ligands to basal cell carcinoma through UV radiation-induced carcinogenesis.
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            Malassezia globosa and restricta: breakthrough understanding of the etiology and treatment of dandruff and seborrheic dermatitis through whole-genome analysis.

            Dandruff and seborrheic dermatitis (D/SD) share an etiology dependent upon three factors: sebum, microbial metabolism (specifically, Malassezia yeasts), and individual susceptibility. Advances in microbiological and analytical techniques permit a more detailed understanding of these etiologic factors, especially the role of Malassezia. Malassezia are lipid-dependent and demonstrate adaptation allowing them to exploit a narrow niche on sebum-rich skin. Work in our and our collaborators' laboratories has focused on understanding these adaptations by detailed analysis of biochemistry and gene expression. We have shown that Malassezia globosa and M. restricta predominate on dandruff scalp, that oleic acid alone can initiate dandruff-like desquamation, that M. globosa is the most likely initiating organism by virtue of its high lipase activity, and that an M. globosa lipase is expressed on human scalp. Considering the importance of M. globosa in D/SD (and the overall importance of commensal fungi), we have sequenced the M. globosa and M. restricta genomes. Genomic analysis indicates key adaptations to the skin environment, several of which yield important clues to the role Malassezia play in human disease. This work offers the promise of defining new treatments to D/SD that are targeted at changing the level or activities of Malassezia genes.
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              Stratum corneum dysfunction in dandruff

              Summary Synopsis Dandruff is characterized by a flaky, pruritic scalp and affects up to half the world’s population post-puberty. The aetiology of dandruff is multifactorial, influenced by Malassezia, sebum production and individual susceptibility. The commensal yeast Malassezia is a strong contributory factor to dandruff formation, but the presence of Malassezia on healthy scalps indicates that Malassezia alone is not a sufficient cause. A healthy stratum corneum (SC) forms a protective barrier to prevent water loss and maintain hydration of the scalp. It also protects against external insults such as microorganisms, including Malassezia, and toxic materials. Severe or chronic barrier damage can impair proper hydration, leading to atypical epidermal proliferation, keratinocyte differentiation and SC maturation, which may underlie some dandruff symptoms. The depleted and disorganized structural lipids of the dandruff SC are consistent with the weakened barrier indicated by elevated transepidermal water loss. Further evidence of a weakened barrier in dandruff includes subclinical inflammation and higher susceptibility to topical irritants. We are proposing that disruption of the SC of the scalp may facilitate dandruff generation, in part by affecting susceptibility to metabolites from Malassezia. Treatment of dandruff with cosmetic products to directly improve SC integrity while providing effective antifungal activity may thus be beneficial. Résumé Les pellicules se caractérisent par un cuir chevelu prurigineux, squameux, et affectent jusqu’à la moitié de la population post-pubertaire du monde. L’étiologie des pellicules est multifactorielle, influencée par Malassezia, par la production de sébum, et par la susceptibilité individuelle. La levure commensale Malassezia est un facteur fortement contributif à la formation de pellicules, mais la présence de Malassezia aussi sur les cuirs chevelus sains indique que Malassezia seule n’est pas une cause suffisante. Un stratum corneum (SC) sain forme une barrière protectrice pour empêcher la perte d’eau et maintenir l’hydratation du cuir chevelu. Il protège également contre les agressions externes tels les micro-organismes, y compris Malassezia, ou des substances toxiques. Des dommages aigus ou chroniques au niveau de la barrière peuvent nuire à une bonne hydratation, conduisant à des effets atypiques de la prolifération épidermique, de la différenciation des kératinocytes, et de la maturation du SC, ce qui peut expliquer une partie des symptômes des pellicules. L’appauvrissement et la désorganisation des lipides structurels d’un stratum corneum sujet aux pellicules sont compatibles avec la notion d’une barrière affaiblie telle qu’indiquée par une perte d’eau transépidermique élevée. Une preuve supplémentaire d’une barrière affaiblie dans les cas des pellicules est fournie par un niveau d’inflammation infraclinique et une plus grande susceptibilité aux irritants topiques. Nous proposons que la perturbation du SC du cuir chevelu facilite la production de pellicules, en partie en augmentant la sensibilité aux métabolites de Malassezia. Le traitement des pellicules avec des produits cosmétiques pour améliorer directement l’intégrité du SC, tout en offrant une activité antifongique efficace peut donc être bénéfique.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                25 September 2024
                September 2024
                : 16
                : 9
                : e70138
                Affiliations
                [1 ] Savlon Swasth India Mission, ITC Life Sciences and Technology Centre, Bangalore, IND
                Author notes
                Article
                10.7759/cureus.70138
                11502989
                39463503
                bbeea4f1-efb0-47e9-8aff-427f75b79167
                Copyright © 2024, Mehta et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 September 2024
                Funding
                Mascot spin control Pvt. Ltd., Mumbai India received payment from ITC Life sciences and Technology Centre, Bangalore, India as service charge for executing this clinical trial and data collection.
                Categories
                Pharmacology
                Dermatology

                antiseptic,cetrimide,chlorhexidine,dandruff,malassezia,scalp,zinc pyrithione

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