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Thread: Seb Derm, etc resouces

  1. #11
    Senior Member Tom Busby's Avatar
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    Here’s an interesting book written for researchers, but full of current information about cosmetics and the skin: Handbook of Cosmetic Science and Technology, Third Edition, found at http://aucops.wordpress.com/

    Niacinamide is favorably mentioned at page 34.

  2. #12
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    http://www.pgscience.com/files/pdf/D...2_Dandruff.pdf

    Very detailed overview on Dandruff and SD. Some parts are too "medical", but helps new and intermediate SD patients to better understand the condition (and treatments).

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    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448221/

    This is a pretty thorough overview of various studies comparing anti-fungal treatments for seborrheic dermatitis.

    Interesting to note that they include a study which compared ketoconazole to climbazole, the latter often being touted on this forum, but the results were far more favourable for ketoconazole. Granted, it was a single short-term study, but worth mentioning.

    Ketoconazole versus climbazole
    Primary outcomes
    Participants without complete resolution
    Lopez-Padilla 1996 compared the effects of ketoconazole and climbazole over the long term (more than four weeks). Only 20% (6/30) of participants taking ketoconazole only failed to achieve complete resolution of rashes compared with 86% (26/30) of those taking climbazole, which reflected a statistically significant difference (RR 0.23, 95% CI 0.11 to 0.48 (Analysis 6.1); NNTB 2, 95% CI 2 to 3).
    Whereas the results for ketoconazole versus ciclopirox olamine were more or less comparable:

    Ketoconazole versus ciclopirox
    Primary outcomes
    Participants without complete resolution
    Three studies (Chosidow 2003; Diehl 2013; Unholzer 2002(I)) compared effectiveness of ketoconazole versus that of ciclopirox. Among participants taking ciclopirox, 58% (133/228) did not have resolution of their seborrhoeic dermatitis compared with 63% (139/219) taking ketoconazole, but the difference was not statistically significant (RR 1.09, 95% CI 0.95 to 1.26; I² = 32%) (Analysis 4.1).

    Chosidow 2003 and Diehl 2013 assessed comparative effectiveness of these treatments on long-term (more than four weeks) application and found that ciclopirox was better, with fewer participants exhibiting persistence of their seborrhoeic dermatitis again compared with ketoconazole, but the difference was not statistically significant (RR 1.10, 95% CI 0.88 to 1.36; I² = 51%) (Analysis 4.2).

  4. #14
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    Quote Originally Posted by sejon View Post
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4448221/

    This is a pretty thorough overview of various studies comparing anti-fungal treatments for seborrheic dermatitis.

    Interesting to note that they include a study which compared ketoconazole to climbazole, the latter often being touted on this forum, but the results were far more favourable for ketoconazole. Granted, it was a single short-term study, but worth mentioning.
    Interesting. I've always wondered why ketoconazole doesn't get much fanfare on this website - I've read nothing but great things about it in published studies. I wonder if anyone on here has tried ExTina - the prescription ketoconzaole product designed for facial skin. It's a cosmetically elegant light-weight foam specifically designed for facial skin. It seems pretty interesting.

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    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.

  6. #16
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    Quote 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.

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    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; 18th January 2017 at 03:30 PM.

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    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.

  9. #19
    Senior Member Tom Busby's Avatar
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    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

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    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.

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