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  • #16
    Originally posted by Rory View Post
    That's incredible. All the hype about Climbazole on this forum and that study pretty much states that it's useless for Seb Derm. Almost everyday this forum has posts from people looking for ways to buy Climbazole and how to mix the stuff properly. What a waste of money, time and effort.

    86% failed to see complete resolution in the Climbazole group compared to just 20% in the Ketoconazole group !!
    That's a massive difference. It now makes sense to me why products containing Climbazole aren't readily available in every country. The stuff doesn't work, that's why.
    It's interesting. I definitely have Seb derm, so reading this forum has become pretty disheartening because Climbazole isn't very helpful for me. It's awesome it has helped some people, but the idea that if it doesn't work you don't have seb derm has never sat well with me.

    Comment


    • #17
      It definitely challenges the idea that climbazole is the most effective anti-fungal out there. That's why it's a good idea to try multiple treatments instead of putting all your eggs in one basket.

      I don't want to risk derailing this thread, however, since it's intended as a repository for resources and studies regarding seb derm, rather than for discussion. I remember that the user Nick989 made this thread a while back bringing into question the superiority of climbazole.

      Here are a couple more interesting studies.

      This is a very recent (December 2016) trial of a climbazole and piroctone olamine cream for facial seborrheic dermatitis. As far as I'm aware, this is the only available study trialling climbazole specifically for facial seb derm.

      https://www.ncbi.nlm.nih.gov/pubmed/27904273

      Abstract
      BACKGROUND:
      Seborrheic dermatitis (SD) is a multifactorial disease; Malassezia species play an important role in its pathogenesis.
      OBJECTIVE:
      We aimed to determine whether a cream containing climbazole/piroctone olamine (C/P cream), antifungal agents with expected efficacy against Malassezia species, could improve SD symptoms.
      METHODS:
      We instructed 24 patients with mild-to-moderate SD to apply the C/P cream and emollient cream on the right and left sides of the face, respectively, every morning and evening for 4 weeks. The casual sebum level (measured with Sebumeter®; Courage & Khazaka Electronic GmbH, Germany) and the extent of erythema (measured with Mexameter®; Courage & Khazaka Electronic GmbH) on the face were measured at baseline and after 4 weeks. The minimal inhibitory concentration (MIC) was determined to demonstrate the antifungal activity of the C/P cream.
      RESULTS:
      The casual sebum level and erythema were measured at week 4, and the median values demonstrated a quantitative improvement on the C/P cream-treated right side of the face compared to the emollient cream-treated left side. For the C/P cream, the MICs were 0.625, 5, 0.625, and 2.5 mg/ml for Malassezia restricta, M. globosa, M. sympodialis, and M. slooffiae, respectively.
      CONCLUSION:
      Based on the reduced casual sebum level and extent of erythema, the antifungal activity of C/P cream against Malassezia species seems useful for the treatment of mild to moderate SD.
      And here's a patent which includes several in vitro studies that serve as further evidence that oils/fatty acids with a carbon chain length of 11 or greater are counterproductive to treating seb derm as they metabolise Malassezia:

      https://www.google.com/patents/EP2793833A2?cl=en

      B) Study of various oils which are C-11 or greater fatty acid or their esters on the growth of M. furfur under in vitro conditions

      A lipid assimilation in vitro assay was designed to investigate lipid effect >C-10 fatty acid or their esters_on growth of M. furfur (MTCC 1374). Sabouraud Dextrose containing low-melt agar was melted and cooled to 38°C. Fatty acids/esters constituents, e.g. fatty acids or esters, such as lauric acid, palmitic acid, myristic acid, oleic acid, linoleic acid, isopropyl myristate, ethyl oleate, mustard oils, coconut oil were added at different concentration to study the growth of the fungus. Positive control with 2% olive oil and negative control without fatty substance were also maintained. After solidification, agar plates were streaked with M. furfur innoculum adjusted to appropriate cfu/ml, aseptically. Culture media with higher carbon fatty acids and esters (more than C-10) such as lauric acid, palmitic acid, myristic acid, oleic acid, linoleic acid, isopropyl myristate, ethyl oleate, showed confluent growth of fungus for up to 6 days. Interestingly vegetable oils such as mustard oils, coconut oil also showed confluent growth of M.furfur as shown in Figure 3. In addition media supplemented with 2% olive oil showed confluent growth of fungus in the same duration while the media without oil supplement did not show any growth.
      Culture media with lower carbon fatty acids (less than C-1 1) such as caprylic acid (C-8) and capric acid (C-10) failed to serve as nutrients for the growth of fungus and no growth was observed for up to 6 days, while media supplemented with 2% olive oil showed confluent growth of fungus in the same duration.
      It also tests the minimum inhibitory concentration (MIC) of piroctone olamine and ketoconazole against M. furfur.

      Piroctone olamine containing oil compositions VPO-018, VPO-022, and VPO-028 with different solvents isopropyl alcohol, oleyl alcohol, and ethanol, respectively, showed MIC at 32μg/ml which is similar to the MIC of positive control where drug is dissolved in DMSO at the same concentration as shown in Table 3.
      Ketoconazole containing oil compositions showed MIC at 0.25μg/ml, which is similar to the MIC of positive control where drug is dissolved in DMSO at the same concentration as shown in Table 4. Example 6: Effect of various fatty acids/esters on the in vitro growth of M. furfur
      Note that with MIC measures, the lower the value, the greater its anti-fungal efficacy. Therefore it can be calculated that ketoconazole is roughly 128 times more effective than piroctone olamine against M. furfur.

      They even mention combining piroctone olamine with food-grade oils to see what how this affects its efficacy:

      ...oil compositions containing piroctone olamine devoid of C-l 1 or greater fatty acids or their esters showed MIC in the range of 16-32 μg/ml against M. furfur and in the range of 8-16 μg/ml against M.obtusa. Composition having similar amount of piroctone olamine with 5% sunflower oil and 10% oleic acid were showed MIC at 64μg/ml against both the strains. These results show that the presence of vegetable oil (sunflower) which is rich in triglycerides/free fatty acids above C-10, has an adverse effect on the activity of the antifungal agent. Similarly, the presence of fatty acids above C-10 (such as oleic acid) also has an adverse effect on the activity of the antifungal agent.
      The MIC of piroctone olamine against M. furfur is 16-32 μg/ml and against M. obtusa it's 8-16 μg/ml, but when piroctone olamine is combined with sunflower oil and oleic acid, its MIC is 64μg/ml against both strains. This is evidence that combining the anti-fungal piroctone olamine with a food-grade oil (i.e. an oil with a carbon chain length between 11-24) means that it can be anywhere from two to eight times less effective.

      Interestingly, it also mentions isopropyl myristate as one of the fatty acids/esters that can metabolise M. furfur:

      Culture media which contained fatty acids or esters eg, linoleic acid, oleic acid, lauric acid, palmitic acid, ethyl oleate, isopropyl myristate and oils containing fatty acid/esters eg, coconut oil, mustard oil etc. were showed confluent growth of fungus up to 6 days.
      This is not altogether surprising seeing as isopropyl myristate is the ester of isopropanol and myristic acid, which has a carbon chain length of 14 and is therefore food-grade for Malassezia. But this stood out to me in particular because isopropyl myristate is found in many anti-fungal creams, including the ketoconazole creams Nizoral and Daktarin Gold. I've always been very wary of this ingredient because in my experience it is highly pore-clogging, but this shows that its inclusion in an anti-fungal cream is counterproductive with regards to seb derm, as well.

      The two mantras on this board tend to be: 1.) that climbazole is the best anti-fungal we have at our disposal, and 2.) that oils/fatty acids/esters of carbon chain lengths between 11-24 are food-grade for Malassezia and should therefore be avoided inasmuch as possible. I think the first mantra is up for debate, but the second mantra appears to be very much true.
      Last edited by sejon; 18 January 2017, 03:30 PM.

      Comment


      • #18
        Here is the full PDF for the South Korean study mentioned above involving the use of a cream containing climbazole and piroctone olamine.

        Apparently the cream they used is Bioderma Sensibio DS+, the only commercially available face cream containing climbazole, the ingredients of which are as follows:

        AQUA/WATER/EAU, COCOS NUCIFERA (COCONUT) OIL, PROPYLENE GLYCOL, CAPRYLIC/CAPRIC TRIGLYCERIDE, DIMETHICONE, GLYCYRRHETINIC ACID, SORBITAN SESQUIOLEATE, PIROCTONE OLAMINE, GLYCERYL UNDECYLENATE, CLIMBAZOLE, MANNITOL, XYLITOL, RHAMNOSE, FRUCTOOLIGOSACCHARIDES, LAMINARIA OCHROLEUCA EXTRACT, CETYL ALCOHOL, CARBOMER, SCLEROTIUM GUM, SODIUM HYDROXIDE, PHENOXYETHANOL.
        Of course, it's a shame that the cream suffers from the obvious drawback of containing a food-grade oil (coconut oil) as its second ingredient, and makes me wonder how much more effective it would be had they reformulated it without that. But this at least serves as evidence that the cream is effective nevertheless.

        Comment


        • #19
          Hi sejon, can you get a copy of the Lopez-Padilla (1996) article? The full article isn't anywhere on the web, and the print-version probably can be found only in a medical library in Mexico or Central America because the article is in Spanish. The results are not typical of any other study concerning climbazole and malassezia, so it would be interesting to read the full article.

          Hi benjamin, trichosporons are fungi, but most do not respond to any of the -azole drugs. See Chapter 10, below, for more information and photos that may be useful to you.
          http://www.drmhijazy.com/english/ebook.htm Principles of Pediatric Dermatology
          http://www.drmhijazy.com/english/chapters/chapter10.htm Chapter 10, Fungal Skin Infections

          Comment


          • #20
            Thanks for the work you put in there Sejon. I was particularly interested in page 5 of the Korean study. The patient satisfaction questionaire. Improvement was achieved with both the C/P cream and the emolient cream. But the patients saw little difference between both.That's disappointing. Also the authors conclusion was far from impressive. " C/P cream SEEMS USEFUL". What the hell does that mean. In my opinion it means that the cream helps and that's about all it does.

            I have had 2 encounters with Climbazole. One was Tom Busbys cream which broke me out badly after just one application. The second was a brand called Oliprox which has 4 active ingredients. Climbazole, Piroctone Olamine, NSAID and a barrier repair ingredient. I found this stuff good. A little expensive but good. But even with 4 active ingredients I found a simple tube of Ciclopirox Olamine, at just a fraction of the cost of Oliprox, just as good.

            A recent Meta Analysis of decades of research into SD treatments has been published on PubMed. Climbazole is not even mentioned in it. So my advice to all with SD. Buy a tube of Ketoconazole and Ciclopirox Olamine and alternate between them. Also apply Pimecrolimus or Tacrolimus a couple of times per week during times of the year when SD can be a little more stubborn.

            Comment


            • #21
              Hi sejon, can you get a copy of the Lopez-Padilla (1996) article? The full article isn't anywhere on the web, and the print-version probably can be found only in a medical library in Mexico or Central America because the article is in Spanish. The results are not typical of any other study concerning climbazole and malassezia, so it would be interesting to read the full article.
              Hi Tom, I'm in Belize at the moment, though I doubt that I could find it here since our library service is shamefully almost non-existent. If I hop over to any city in Mexico within the next few months I might try to find it.

              A recent Meta Analysis of decades of research into SD treatments has been published on PubMed. Climbazole is not even mentioned in it.
              To be fair, I believe climbazole doesn't get as much research attention simply because it was never approved by the FDA in the US. Considering the US is the world's largest and potentially most lucrative market for pharmaceutical companies, if a particular ingredient isn't approved for use there the ingredient might be sidelined by a lot of researchers, especially as in many cases such research is funded by these companies.

              Also, according to in vitro tests against M. furfur, climbazole has indeed been shown to be as effective as ketoconazole, such as in this study.

              However, I think it's important to consider that other Malassezia strains, such as M. restricta and M. globosa, might be more susceptible to other anti-fungals than climbazole. This paper tests climbazole, ketoconazole, zinc pyrithione, and zinc vitanol against M. globosa and finds ketoconzole to be the most effective, but climbazole to be the least effective. Yet, bizarrely, this paper (on page 3) concludes that climbazole is more effective against M. globosa than M. furfur and M. restricta. So the studies can be rather confusing.

              To reiterate, I believe the takeaway from this is that with anti-fungal treatment, either combination therapy of more than one anti-fungal, or cycling through several to find the most effective, is a wiser approach than putting all our stock in a single ingredient and hoping for the best.

              Also, the vehicle by which an anti-fungal is delivered to the skin is as important as the anti-fungal itself. Zinc pyrithione, the most common commercially available anti-fungal, doesn't get much love on this forum due to its history of simply not being all that effective in anti-dandruff shampoos like Head & Shoulders, yet it shows a very high bioactivity against Malassezia in vitro. The fact that it doesn't work all that well in many anti-dandruff shampoos speaks more of the poor quality of the shampoo formulations than of zinc pyrithione's inherent fungicidal properties. This study shows that a "potentiated" zinc pyrithione shampoo (where the bioavailability of zinc pyrithione is maximised) shows better results than a shampoo containing a combination of climbazole and standard zinc pyrithione.

              Regarding ciclopirox olamine, I believe it should be mentioned more often on this forum for a few reasons. Firstly, ciclopirox olamine cream is cheap and available OTC in many parts of the world (and as prescription in the US). Secondly, studies suggest that its antimicrobial properties are quite broad, having range of bioactivity against fungal and bacterial strains (as suggested here, for example) -- it even shows activity against the bacteria p.acnes which is implicated in acne (source). Many dermatitic conditions may have a fungal and bacterial component, so its broadness could prove useful. Thirdly, it is anti-inflammatory, more so than hydrocortisone and the imidazole anti-fungals (as suggested here. And fourthly (although this is just from a personal perspective) the ciclopirox olamine creams are the lightest and least comedogenic anti-fungal creams I've found, whereas the use of other anti-fungal creams clogged my acne-prone skin within days, probably because the ciclopirox olamine creams lack the highly comedogenic emollient ingredient isopropyl myristate.

              It's my opinion that the versatility of ciclopirox olamine would make it a highly useful adjunct therapy combined with another anti-fungal, particularly an imidazole. So far, the only studies I've found of being used in combination are with zinc pyrithione and with salicylic acid, both of which were tested against and proven to be superior to ketoconazole alone.
              Last edited by sejon; 22 January 2017, 05:43 PM.

              Comment


              • #22
                Originally posted by Tom Busby View Post
                Hi sejon, can you get a copy of the Lopez-Padilla (1996) article? The full article isn't anywhere on the web, and the print-version probably can be found only in a medical library in Mexico or Central America because the article is in Spanish. The results are not typical of any other study concerning climbazole and malassezia, so it would be interesting to read the full article.

                Hi benjamin, trichosporons are fungi, but most do not respond to any of the -azole drugs. See Chapter 10, below, for more information and photos that may be useful to you.
                http://www.drmhijazy.com/english/ebook.htm Principles of Pediatric Dermatology
                http://www.drmhijazy.com/english/chapters/chapter10.htm Chapter 10, Fungal Skin Infections

                Thanks, tom but i don't think that what i have .

                While cimbazone isn't giving me any results, something that does is ciclopirox olamine which people are talking about. Works within one day but in about two weeks it stops working. The brand i used is oilatum shampoo for anyone interested.

                Comment


                • #23
                  Here is a link to an article, originally posted by MissM, which is so useful to an analysis of demodicosis, that I want to make sure it doesn't become lost over time: http://medf.nsu.ru/files/%D0%A0%D0%B...0%BA%D1%81.pdf

                  Comment


                  • #24
                    Here's an interesting study regarding silver nanoparticles being used to inhibit Malassezia:

                    Size- and shape-dependent clinical and mycological efficacy of silver nanoparticles on dandruff

                    The full PDF is free to download with the links below the abstract, which is always nice to see.

                    And another one, where they coat the silver nanoparticles with ketaconazole:

                    Fabrication of ketoconazole nanoparticles and their activity against Malassezia furfur

                    Again the full paper is freely viewable below the abstract.

                    Comment

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