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Lipophilic Malassezia yeasts are an important part of the human resident skin flora, especially in seborrheic areas. Besides mutualistic interactions with the host they are also linked to diseases although the specific causes are not yet comprehensively understood. The amount of available lipids on the skin correlates with the Malassezia density and also with the occurrence of certain diseases like tinea versicolor. Here, the naturally produced lipids of the sebaceous glands play a role. Hardly studied thus far is the impact of topically applied lipids. Here, growth promotion as well as inhibition of Malassezia cells as well as the production of new metabolites through ester cleavage are possible. One example is the release of antimicrobial fatty acids from hydroxypropyl caprylate through the action of Malassezia lipases. This "self-kill" principle results in the reduction of the amount of Malassezia cells and can be applied as new therapy option for dandruff treatment. A better understanding of the interaction between topica and Malassezia would increase their skin tolerance and open new therapy options.Lipophile Malassezia-Hefen sind ein bedeutsamer Bestandteil der residenten menschlichen Hautflora besonders in seborrhoischen Arealen. Neben einer kommensalen bzw. mutualistischen Interaktion mit dem Wirt können sie auch Erkrankungen verursachen, deren Ursachen jedoch noch nicht vollständig geklärt sind. Dichte auf der Haut und auch Häufigkeit einzelner Erkrankungen, wie beispielsweise der Pityriasis versicolor, korrelieren mit dem Lipidangebot. Hier spielt zum einen die körpereigene Talgdrüsenaktivität eine Rolle. Ein weiterer bisher wenig untersuchter Faktor sind extern aufgetragene Lipide. Neben Wachstumsförderung/-minderung können durch Malassezia-bedingte Hydrolyse von Esterverbindungen auch Metabolite mit eigenen Wirkungen entstehen. So werden aus Fettsäuremonoestern wie 3‑Hydroxypropylcaprylat mittelkettige Fettsäuren generiert, die in einem „self-kill“ die Zahl der Malassezia-Zellen reduzieren und eine neue Therapieoption z. B. bei Kopfschuppen darstellen. Untersuchungen zu Wechselwirkungen zwischen Topika und Malassezia-Hefen könnten die Hautverträglichkeit von Externa verbessern und neue therapeutische Optionen eröffnen.

The scalp may be affected by various diseases with equally varying manifestations. Erythema and scaling is often accompanied by agonizing itch. Scalp psoriasis and seborrheic eczema represent the most frequent diseases, which can be differentiated into classical cases; however, overlap and similarities are seen. Sharply demarcated erythematosquamous plaques across the natural hairline in psoriasis are opposed to blurred dark-red erythema and yellowish, greasy scales in seborrheic eczema. Whereas with the latter diffuse alopecia may frequently be found, hair loss is rarely seen in psoriasis and may also be related to therapeutic agents. Treatment is based on acuity as well as extent of disease and individual life quality aspects of the patients. It is mainly based on topical corticosteroids, combined with vitamin D derivatives in psoriasis and antimycotic agents in seborrheic eczema. In severe cases and widespread psoriatic disease, systemic treatment may be necessary, including the classic agents methotrexate, fumarates and ciclosporin as well as biologicals. Systemic treatment of seborrheic eczema is rarely necessary and resides on corticosteroids, antimycotic agents and vitamin A derivatives. In addition, intensive counseling of patients on the necessity of consequent and long-term treatment as well as use of mild skin care products is mandatory.

The lipophilic yeast fungus Malassezia (M.) spp. is the only fungal genus or species which is part of the physiological human microbiome. Today, at least 14 different Malassezia species are known; most of them can only be identified using molecular biological techniques. As a facultative pathogenic microorganism, Malassezia represents the causative agent both of superficial cutaneous infections and of blood stream infections. Pityriasis versicolor is the probably most frequent infection caused by Malassezia. Less common, Malassezia folliculitis occurs. There is only an episodic report on Malassezia-induced onychomycosis. Seborrhoeic dermatitis represents a Malassezia-associated inflammatory dermatosis. In addition, Malassezia allergenes should be considered as the trigger of "Head-Neck"-type atopic dermatitis. Ketoconazole possesses the strongest in vitro activity against Malassezia, and represents the treatment of choice for topical therapy of pityriasis versicolor. Alternatives include other azole antifungals but also the allylamine terbinafine and the hydroxypyridone antifungal agent ciclopirox olamine. "Antiseborrhoeic" agents, e.g. zinc pyrithione, selenium disulfide, and salicylic acid, are also effective in pityriasis versicolor. The drug of choice for oral treatment of pityriasis versicolor is itraconazole; an effective alternative represents fluconazole. Seborrhoeic dermatitis is best treated with topical medication, including topical corticosteroids and antifungal agents like ketoconazole or sertaconazole. Calcineurin inhibitors, e.g. pimecrolimus and tacrolimus, are reliable in seborrhoeic dermatitis, however are used off-label.

Seborrheic dermatitis is a frequent skin disorder in infancy and adulthood. It also often occurs in patients with HIV or neurologic disorders like Parkinson disease or mood disorders. It is characterized by greasy, yellow flakes or scales in areas of high sebaceous gland activity like the scalp, face, chest and upper back. Additionally, erythema and itching can be present. The etiology and pathogenesis of seborrheic dermatitis is unknown; however, the focus lies on the involvement of Malassezia yeasts or fatty acid metabolites of Malassezia, on hormones and immunologic factors. The diagnosis is usually a clinical one, based on history and the appearance and site of lesions. The therapy consists mainly of antifungal agents, corticosteroids, immunomodulators, and keratolytics. Because of the chronicity of the illness with frequent relapses, a treatment strategy in which effectiveness and potential side effects are weighed should be used.

Numerous diseases affect both skin and eyes due to similar ontogenetic origin. The eye is the second most common site of melanoma after the skin. The eyelids are predisposed for development of toxic and allergic dermatitis as the skin in this region is four times thinner than the other facial skin. The differential diagnosis must include atopic and seborrhoeic eyelid dermatitis. Atopic and vernal keratoconjunctivitis are associated with atopic eczema. Various immunobullous disorders involve the conjunctiva with varying severity. Side effects of dermatologic treatments with glucocorticoids, antimalarials, psoralens, retinoids, or tetracyclines may involve the eye.

Yeasts of the genus Malassezia belong to the normal microflora of the human skin. In addition they are known to cause a variety of skin diseases; the most frequent of which is pityriasis versicolor. Malassezia yeasts are also thought to be associated with seborrheic dermatitis, dandruff and Malassezia folliculitis. Recently the significance of Malassezia yeasts as a trigger factor for atopic dermatitis of the head and neck region has been pointed out. The role of the Malassezia yeasts in these different diseases has been controversial in the past and remains an issue because of difficulties in isolation, culture and differentiation of the organism. Thanks to molecular techniques, 10 species can actually be differentiated. The article presents the different Malassezia-associated diseases, their clinical picture, diagnosis and appropriate therapy. In addition the speciation of Malassezia is reviewed.

Gender aspects are important when assessing the tolerability of antiepileptic drugs (AED). Due to its broad spectrum of action and to the lack of evidence for teratogenicity in monotherapy, lamotrigine (LTG) is an AED of first choice for women with epilepsy with child-bearing potential.In an observational study over 6 months including 832 women with epilepsy, we evaluated the efficacy and tolerability of LTG in monotherapy and add-on therapy, with a special focus on parameters of particular importance for women including changes in weight, skin, hair, and patterns of menstruation.Of the treated patients, 94% had seizure reduction of at least 50%. Adverse events occurred in 7.3%; 1% experienced serious adverse events, all of which were reversible. Ninety-six percent continued treatment throughout the observation period, and 83% reported improvement in quality of life by the end of the study. Cognition, functioning at work, and mood improved in 43-54% of patients. In most of them, weight remained stable. Those who were switched from valporate (VPA) or carbamazepine (CPZ) to LTG lost 3.2 kg and 3.1 kg (means), respectively. Many of the women described problems related to menstruation at the beginning of the study: variability in cycle length (31.2%), hypermenorrhea (17.3%), and pains (10%). Skin and hair problems were reported by 18.4% and 17.3%, respectively. There was improvement in all of these aspects at the end of the study, particularly for those women switched from VPA or CBZ to LTG.In summary, this observational study confirms the good tolerability of LTG with respect to issues particularly relevant to women. More complete elucidation of the correct LTG dosage, which varies widely according to the accompanying medication, will further improve treatment safety.

In the following a short overview on inflammatory dermatoses which are frequently diagnosed in clinical dermatology is presented. These include allergic contact dermatitis, dyshidrotic dermatitis, nummular dermatitis, seborrheic dermatitis, atopic dermatitis, lichen planus and psoriasis. Special emphasis is laid on the evolutionary stages in the development of lesions, clinically as well as histologically. The abovementioned dermatoses have a special pathological reaction pattern in common: the epidermis, papillary dermis and superficial capillary-venular plexus react together in these conditions and have therefore been termed the superficial cutaneous reactive unit.

Pityrosporum ovale appears to play an important role in the pathogenesis of dandruff as a symptom of seborrheic dermatitis. Climbazole is an antimycotic agent with a high in vitro and in vivo efficacy against P. ovale. In the presented work we investigated the efficacy and safety of a climbazole 0.65% shampoo on seborrheic dermatitis of 30 volunteers. Subjects were diagnosed as having moderate to severe seborrheic dermatitis of the scalp. After a 1-week washout and a 4-week treatment the clinical evaluation showed a successful reduction of dandruff, skin redness and itching in 80% of the volunteers and a mild improvement in 20% of the volunteers. The cosmetic acceptability was very good by the majority. It is concluded that the formulation tested is effective in the treatment of moderate to severe dandruff.

Diseases of seborrhoic origin include rosacea, acne, gram-negative folliculitis, demodex-folliculorum, perioral dermatitis as well as seborrhoic dermatitis. An important prerequisite for adequate therapy is the knowledge of these different diseases. Unfortunately, topic steroids are often applied, resulting in well known corticosteroid side-effects like skin atrophy and teleangiectasias. The different clinical diseases of seborrhoic origin are reviewed here and a treatment guide is presented.

Seborrhoic dermatitis is an erythematosquamous condition of unknown etiology with a prevalence of approximately 2.5%. Frequently difficult to treat, it may respond to the application of low doses of dithranol, a substance which can induce a pustular dermatitis as an adverse side effect depending on the applied concentration and individual susceptibility. We describe a pustular dermatitis after the application of a preparation containing dithranol at an erroneously high concentration in a 30-year-old patient with seborrhoic dermatitis.

Along with the rising AIDS epidemic, the recognition of mucocutaneous lesions indicating HIV infection is important not only for dermatologists but also for general practitioners. During 36 months we prospectively followed 357 HIV-1-infected patients on a regular base, and all the dermatologic findings were evaluated statistically. Several skin problems such as seborrheic dermatitis, may occur early in HIV infection. Mollusca contagiosa, oral hairy leukoplakia and Kaposi's sarcoma are often clinical signs of marked disease progression with very low CD4-cell counts.

Fine-structural investigations were done with surface material and slides of pityriasis versicolor, Malassezia-folliculitis and seborrheic eczema. Aspects of the microorganism Malassezia furfur, such as its presence, its distribution on the skin surface, and its shape, and changes in the host skin tissue, such as the structure of the horny layer and signs of an inflammation were registered. Two main types of Malassezia-associated dermatoses were defined. One type is characterized by a considerable number of microorganisms, adhering to regular cells of the horny layer (exemplified by pityriasis versicolor), the other type is characterized by signs of an inflammation and a very low number of visible fungal cells (exemplified by seborrheic eczema).

Thirty strains of the lipophilic yeast Pityrosporum ovale were isolated from patients suffering from seborrhoeic dermatitis and dandruff and tested for susceptibility both to some classic antifungal agents and to several primarily non-antimycotic drugs. Minimal inhibitory concentrations (MIC) of altogether eleven agents were measured by the agar dilution technique. As expected, the tested imidazoles showed a good inhibition of growth of Pityrosporum. The most effective agents were ketoconazole (MIC 0.1 microgram/ml) and itraconazole (MIC 0.05 microgram/ml for some strains). MIC for fluconazole, clotrimazole and tioconazole were also low, indicating a good inhibition of Pityrosporum. In contrast, the range of MIC for bifonazole was moderate to high (for some strains 12.5-25 micrograms/ml). For zinc pyrithion a very good in vitro efficacy (MIC 0.78-1.56 micrograms/ml) was dedicated. The MIC for selenium disulphide was 1.56-3.13 micrograms/ml. The antipsoriatic drugs dithranol and liquor carbonis detergens also inhibited growth of all Pityrosporum ovale strains investigated but only at higher concentrations.

Recent studies suggest that epidermal skin lipids play an important role in the pathogenesis of skin diseases associated with seborrhoea or sebostasis. Depending on the state of the skin, various lipids are found in varying quantities and proportions. In some sebostatic diseases, in particular, altered enzyme activities relevant to the synthesis of lipids have been identified, which may account for alterations in epidermal lipid fractions. This concept represents a substantial modification of earlier ones, according to which sebostatic or seborrhoeic skin diseases were attributed solely to decreased or increased sebum lipids, respectively. This provides an important rationale for a new approach to the therapy of certain skin diseases with specific lipid fractions, such as ceramides.

Both systemic and topical application of ketoconazole (CAS 65277-42-1) have been found effective in seborrhoeic dermatitis. The topical application of 2% ketoconazole in a cream base in particular has so far only once been compared to the application of the vehicle. Statistical analysis, however, has only been descriptive. In the present trial including 60 patients 2% ketoconazole cream (Nizoral) and a bland cream have been compared in a randomised, controlled fashion. Both erythema and scaling were found markedly more reduced in the verum group (p = 0.003 and p = 0.006, resp.). Hence the topical application of 2% ketoconazole cream can be considered as rational treatment of seborrhoeic dermatitis the more so as the application of the drug was well tolerated.

The usefulness of antiandrogenic therapy with cyproterone acetate for androgenisation signs and symptoms in women, when tumours are definitely not the cause, has now been confirmed world-wide in about 100,000,000 therapy cycles using the hormonal contraceptive Diane and its follow-up preparation Diane-35, which contains a lower level of oestrogen. Nowadays, low-dose hormonal contraceptives are preferred in order to minimise the so-called "internal" risk by reducing the level of the oestrogen component and, by careful selection of the progestin, minimising the residual androgenic effect. In an open study on 150 women with moderately severe symptoms of androgenisation, we assessed, for treatment periods of up to 36 cycles, the effect of the only oestrogen-reduced hormonal contraceptive with anti-androgenic activity (Diane-35), and also monitored biochemical parameters, which are indicative of high risk metabolic activity and permit an accurate characterisation of the hormonal contraceptive, especially with long-term use. Although the parameters of liver and fat metabolism occasionally yielded values close to the limit of the normal range, it was particularly favourable to note, that the lipoprotein fraction HDL exhibited a slightly rising tendency, whereas, at the same time, the LDL fraction dropped. Special attention has been paid to ultrasonographic monitoring of the liver, since the influence on the function of this organ has been frequently discussed in conjunction with prolonged use of 17-alpha-alkylated steroidal compounds, and because a possible connection between sex steroids and the development of liver tumours has been a point of discussions.(ABSTRACT TRUNCATED AT 250 WORDS)

Epiluminescent microscopy (ELM) has been widely accepted as a non-invasive, rapid technique for the differentiation of pigmented skin lesions. The method is valuable for distinguishing melanocytic and non-melanocytic tumors, as well as for identifying malignant melanoma. Due to great morphological variability of pigmented lesions considerable experience is required. Based on a morphological analysis of 600 pigmented skin lesions, a diagnostic procedure was developed that permits a reproducible description and diagnosis of a given lesion and facilitates training in ELM.

Numerous AIDS patients show the typical seborrheic eczema in a very prominent way. For this is an inflammatory disease, combination preparations were taken frequently which contain antimycotics and corticosteroids. We investigated 7 antimycotic compounds in 3 inflammatory models: amorolfin, ciclopiroxolamine (cic), fluconazole, ketoconazole, miconazole, naftifine, and rilopirox. In an in vitro model the inflammatory activity towards the 5-lipoxygenase was investigated. 1,000 mumol naftifine, 100 mumol ketoconazole, 50 mumol cic, and 10 mumol rilopirox inhibited 5-HETE by 90%. In a cell culture model only cic had a significant activity towards cyclo-oxygenase. In this model the inhibition of the prostaglandin E2 liberation by 1 mumol cic was 40%. In an in vivo model the anti-inflammatory activity on a mouse ear was investigated (arachidonic acid induced). In this model only cic showed a significant inhibition of inflammation (50%) at 1 mg/ear. These investigations show, that cic has a strong antiphlogistic activity. In an open clinical trial with 20 patients suffering from seborrheic eczema after 4 weeks on cic cream a strong inhibition of infiltration and flakiness had been observed. The antimycotic compound cic offers a possibility to treat inflammatory mycoses without using corticosteroid combinations. In a double blind clinical trial (tinea) where cic was compared with a cic/hydrocortisone combination no statistical differences were found.

A review of the spectrum of dermatologic findings related to human immunodeficiency virus infection is presented. Oral candidiasis, seborrheic dermatitis, oral hairy leukoplakia, herpes simplex infections and molluscum contagiosum were among the most frequently encountered dermatologic disorders among the HIV-seropositive individuals. The recognition of cutaneous manifestations is of particular importance for the early diagnosis and prognosis of HIV-infection.

Lipophilic propionibacterium acnes stores large amounts of porphyrins. This peculiarity can be used for photodynamic destruction of propionibacteria. After repeated irradiations with a blue light-type high pressure lamp (Narva NC 1000-64) both acne and seborrhoea was improved markedly (10 irradiations, each for 10 minutes, cumulative light dose 325 J/cm2). Also porphyrin content inside acne follicles dropped. Serial irradiations with short range visible light (400 to 420 nm) are recommended for acne treatment during the light-poor season of the year.

Eczematids are itching dermatoses showing indistinct redness, pityriasiform scales, and superficial fissures of the horny layer. The seborrheic and sebostatic variants differ with regard to localization of the dermatosis and condition of the skin surface. Their relationship to the imbalance of production and consumption of skin surface lipids is discussed.

The high standard of quality of microelectronic products can be achieved only under clean room conditions. With people working in clean rooms - protective clothing notwithstanding - the incidence of skin flaking is high, and this can cause electronic faults. Even components of normal skin-care agents can be the cause of electronic short circuits. Common skin-care agents have been investigated by emission spectral analysis. Two products virtually free from inorganic substances (and hence ions) were tested in the clean rooms. Use of these skin cosmetics can lead to a considerable reduction in skin flaking.

Estrogens and progestagens exert positive effects on some general diseases as iron deficiency, anemia, premenstrual syndrome, intermenstrual migraine, akne, seborrhoea, hirsutism, androgenetic alopecia, slerodermia, rheumatoid arthritis, osteoporosis and depressive disorders. The mechanism of action and the mode of treatment in such cases are discussed.

In a biometrically controlled study on psoriatic patients, we investigated the efficacy and tolerability of bifonazole 1% plus urea 20% cream. In each of our ten patients, two lesions were treated over a period of 29 to 40 days (34 days on the average). Therapeutic results were not satisfying with lesions on extremities in comparison to those on head and body. On head and trunk, the size of the lesions amounted to 11.8 and 10.3 cm2, resp., before treatment, 2.8 and 4.3 cm2, resp., after therapy. On the extremities, we only noticed a reduction in size from 15.8 cm2 before to 13.8 cm2 after treatment. In total, the therapy was considered successful in 14 of the 20 lesions. Especially those four patients who predominantly showed lesions of the sebopsoriatic type were well-improved. Thus this therapy is particularly recommended in case of sebopsoriasis.

Functional hyperprolactinemia was found in five female patients, 25-35 years old, seeking medical consultation for hair loss, together with hypertrichosis (4x), disturbances of cyclic bleeding periods (4x), secondary amenorrhea (2x), galactorrhea (2x), seborrhea (2x) and persisting acne (1x). Other hormonal parameters including testosterone levels and thyroid gland function tests were unchanged. Prolactinoma was excluded by x-ray diagrams, partly also by computer tomograms of the sella. In two patients increased telogen effluvium was found by trichogram examination with some dystrophic hairs; in one patient only dystrophic hairs were seen, whereas, in two cases, hair loss was not present at the time of our clinical examination. These observations indicate that cutaneous symptoms such as seborrhea, acne, hypertrichosis/hirsutism, alopecia(= SAHA syndrome) may evidently occur in hyperprolactinemia, representing or mimicking androgen-induced skin symptoms. In such cases, therefore, evaluation of prolactin levels together with androgen blood levels and thyroid gland function tests should be performed to exclude underlying endocrinopathy.

Intensive investigations between 1969-1974 on 245 patients with perioral dermatitis are reported. Results are discussed with special regard to clinical behaviour, histology, differential diagnosis and etiology of the disease. Eczematous sources, bacterial and mycotic infections can be ruled out as etiological factors. Therapeutical considerations are discussed.

Therapy of seborrheic dermatitis depends on age (infantile, juvenile, or adult) and localisation (scalp, eyelids, chest, intertriginous areas). In order to avoid recurrences, the patient is instructed to wear suitable clothing, to reduce fat and alcohol, and to observe appropriate personal hygiene.

A clinico-statistical study is reported, basing on a material of 639 excised tumours which were defined histologically as seborrheic keratoses. All statements concerning clinical diagnoses and differential diagnoses, localization, development, age and sex of patients were transferred to punch cards. By means of a suitable EDA program, basic counts and a multidimensional analysis of conditioned frequencies [14] were performed. The results indicate, that the different clinical forms of seborrheic warts, often discriminated in the literature, are variants of the same entity.

Electronmicroscopical investigation on 12 cutaneous biopsies of different localisation showed that the seborrhoic dermatitis is not comparable to a psoriatic tissue-reaction. Both, the cyto-morphological feature and the demonstrated localisation of the acid phosphatase are distinctly different from that of the psoriatic epidermis. The described changes are clearly more similar to the well known ultrastructural pictures of eczemateous reactions. In spite of the "eczema-like" ultrastructural picture seborrhoic dermatitis apparently can be separated from the allergic and irritant contact-dermatitis. Nevertheless, the epidermal alterations are also similar to chronic nummular eczema. They therefore are unspecific and do not allow any conclusion regarding the etiopathogenesis or nosological classification of this skin disease.

101 hirsute women received Diane, a combination of 2 mg cyproterone acetate and 50 micrograms ethinyl oestradiol per capsule, from the fifth to twenty-fifth day during a total of 1105 cycles. The treatment was satisfactory in 96% of women with acne, 84% with androgenic alopecia, 79% with seborrhoea, and 50% of those with mild or moderate hirsutism. The effectiveness of treating hirsutism or alopecia depended on its severity and duration. There was no correlation between various measures of androgen levels before and during treatment and the clinical results. Side effects were similar to those after contraceptive one-phase preparations, both in kind and incidence. None of the women became pregnant. Diane is thus the drug of choice in hormonal contraception of patients with acne, seborrhoea, androgenic alopecia or mild hirsutism. It is also suitable in the follow-up or interval management of high-dose cyproterone acetate treatment of severe hirsutism, in order to maintain the effect obtained with lower hormone doses.