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

Sanders, Martijn G H; Pardo, Luba M.; Franco, Oscar H.; Ginger, Rebecca S.; Nijsten, Tamar

doi:10.1111/bjd.15908

Cited by 69 publications

(72 citation statements)

References 37 publications

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“…Additionally, there has been no evidence that Malassezia invades the skin, and pathogenic mycelial forms (hyphae) have not been observed in SD . Furthermore, M globosa tends to show increased growth in summer when temperatures are high and people sweat more, yet seasonal risk for SD is lowest in summer and higher in cold and dry winter . Besides, decrease in Malassezia count was not always detected in vivo even with improved SD symptoms upon ketoconazole treatment .…”

Section: Sd Aetiology: Malassezia Yeast—cause or Associated Factor?mentioning

confidence: 99%

Seborrheic dermatitis—Looking beyond Malassezia

Wikramanayake

Borda

Miteva

et al. 2019

Experimental Dermatology

101

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Seborrhoeic Dermatitis (SD) is a very common chronic and/or relapsing inflammatory skin disorder whose pathophysiology remains poorly understood. Yeast of the genus Malassezia has long been regarded as a main predisposing factor, even though causal relationship has not been firmly established. Additional predisposing factors have been described, including sebaceous activity, host immunity (especially HIV infection), epidermal barrier integrity, skin microbiota, endocrine and neurologic factors, and environmental influences. Genetic studies in humans and mouse models—with particularly interesting insights from examining the Mpzl3 knockout mice and their SD‐like skin phenotype, and patients carrying a ZNF750 mutation—highlight defects in host immunity, epidermal barrier and sebaceous activity. After synthesizing key evidence from the literature, we propose that intrinsic host factors, such as changes in the amount or composition of sebum and/or defective epidermal barrier, rather than Malassezia, may form the basis of SD pathobiology. We argue that these intrinsic changes provide favourable conditions for the commensal Malassezia to over‐colonize and elicit host inflammatory response. Aberrant host immune activity or failure to clear skin microbes may bypass the initial epidermal or sebaceous abnormalities. We delineate specific future clinical investigations, complemented by studies in suitable SD animal models, that dissect the roles of different epidermal compartments and immune components as well as their crosstalk and interactions with the skin microbiota during the process of SD. This research perspective beyond the conventional Malassezia‐centric view of SD pathogenesis is expected to enable the development of better therapeutic interventions for the management of recurrent SD.

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Section: Sd Aetiology: Malassezia Yeast—cause or Associated Factor?mentioning

confidence: 99%

Seborrheic dermatitis—Looking beyond Malassezia

Wikramanayake

Borda

Miteva

et al. 2019

Experimental Dermatology

101

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“…The authors concluded that this was due to increased xerosis and decreased barrier function in the winter, as well as possible UV protective effects during the summer. Dark‐skinned individuals might be less likely to seek care due to seborrheic dermatitis, possibly due to less striking erythema or improved barrier function compared with light‐skinned individuals …”

Section: What Is Seborrheic Dermatitis?mentioning

confidence: 99%

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

Aðalsteinsson

Kaushik

Muzumdar

et al. 2020

Experimental Dermatology

109

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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. K E Y W O R D Sinflammasome, Malassezia, sebaceous glands, seborrheic dermatitis, systemic disease While the order of events is unclear regarding the pathophysiology of SD, it is agreed upon by most sources that the three main prerequisites are as follows: Malassezia colonization, lipid secretion by sebaceous glands and an underlying immune system susceptibility. [1,5,7,38] The pathogenesis can be categorized into five different phases.

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“…Only a few population‐based studies have been published on the prevalence of seborrhoeic dermatitis and on its occurrence in connection with other skin diseases. Some high‐quality prevalence studies focus on specific age groups such as the Rotterdam Study on an elderly population . Others focus on the systemic comorbidity of seborrhoeic dermatitis .…”

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confidence: 99%

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population‐based study in 161 269 employees

et al. 2019

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Summary Background Seborrhoeic dermatitis is a common but epidemiologically poorly researched chronic skin disease. Objectives To characterize the prevalence and dermatological comorbidity of seborrhoeic dermatitis in Germany. Methods In the course of voluntary company skin checks, full‐body examinations were carried out in more than 500 companies by experienced dermatologists and documented electronically. Results In total, 161 269 participants were included (men 55·5%, mean age 43·2 ± 10·9 years). Seborrhoeic dermatitis was identified in 3·2% (men 4·6%, women 1·4%). A significant difference was found between age groups (2·0% in < 35; 3·6% in 35–64; 4·4% ≥ 65 years). The most frequent concomitant skin conditions were: folliculitis [17·0%, 95% confidence interval (CI) 15·9–18·1], onychomycosis (9·1%, 95% CI 8·3–10·0), tinea pedis (7·1%, 95% CI 6·3–7·8), rosacea (4·1%, 95% CI 3·6–4·7), acne (4·0%, 95% CI 3·4–4·5) and psoriasis (2·7%, 95% CI 2·3–3·2). Regression analysis revealed the following relative dermatological comorbidities when controlling for age and sex: folliculitis [odds ratio (OR) 2·1, 95% CI 2·0–2·3], contact dermatitis (OR 1·8, 95% CI 1·1–2·8), intertriginous dermatitis (OR 1·8, 95% CI 1·4–2·2), rosacea (OR 1·6, 95% CI 1·4–1·8), acne (OR 1·4, 95% CI 1·2–1·7), pyoderma (OR 1·4, 95% CI 1·1–1·8), tinea corporis (OR 1·4, 95% CI 1·0–2·0), pityriasis versicolor (OR 1·3, 95% CI 1·0–1·7) and psoriasis (OR 1·2, 95% CI 1·0–1·5). Conclusions Seborrhoeic dermatitis is a common disease, which is more prevalent in men and older people, and it has an increased rate of dermatological comorbidity. However, absolute differences in the prevalence of comorbidities are small and negligible. Nevertheless, the findings underline the need for integrated, complete dermatological diagnostics and therapy.

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

Cited by 69 publications

References 37 publications

Seborrheic dermatitis—Looking beyond Malassezia

Seborrheic dermatitis—Looking beyond Malassezia

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

Epidemiology and dermatological comorbidity of seborrhoeic dermatitis: population‐based study in 161 269 employees

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