Louis-Charles Malassez was the first researcher to hypothesize that fungi are involved in the pathogenesis of SD in 1874. normally colonize the skin of healthy individuals, but under appropriate conditions, the yeasts have the ability to invade the stratum corneum and can interact directly or indirectly with keratinocytes, melanocytes, and immune cells in the epidermis. The genus Malassezia belongs to the phylum Basidiomycota and includes 17 species. Ī special role in the pathogenesis of seborrheic dermatitis is attributed to Malassezia spp. In recent years, the role of oxidative stress has been highlighted in many skin diseases, including SD. SD is more common in men, and its onset is more frequent at puberty therefore, hormones, especially androgens, could play a role in its pathogenesis. Several neurologic and psychiatric disorders, including Parkinson's disease, Alzheimer’s disease, syringomyelia, epilepsy, cerebrovascular infarcts, etc., are also related to SD. ![]() Individuals with impaired immunity, such as HIV-infected patients, transplant recipients, and patients with alcoholic pancreatitis or various neoplasms, are more susceptible to develop SD. The innate immune response seems to play a critical role in the pathogenesis of SD. The majority of encoded proteins are involved in epidermal differentiation or immunity. A systematic review that analyzed the genetic basis of SD identified 11 gene mutations or protein deficiencies that induced an SD or SD-like phenotype in humans or mice. Its pathogenesis involves an interplay between several factors, such as genetic predisposition, altered skin barrier, excessive secretion of sebaceous glands, skin microbiome, and immune response. Seborrheic dermatitis (SD) is a chronic, recurrent inflammatory condition that affects approximately 1–3% of individuals worldwide. In conclusion, treatment with sertaconazole 2% cream may represent an efficient alternative therapy for patients with SD. At 28 days since the beginning of the treatment, the sertaconazole regimen was associated with a significantly higher percentage of patients with mild SI and a lower percentage of patients with moderate or severe SI (odds ratio 0.51) than the other investigated treatments-hydrocortisone, ketoconazole, clotrimazole, metronidazole, pimecrolimus, and tacrolimus (odds ratio 1.95). All of the clinical trials included a standard scoring index (SI). ![]() We performed an extensive literature search by browsing the PubMed database with the keyword combination “sertaconazole AND seborrheic dermatitis AND clinical trial”, which retrieved eight controlled clinical trials evaluating the effects of sertaconazole in SD. The aim of our study was to evaluate the efficiency of sertaconazole 2% cream compared with other topical treatments in patients with SD. Sertaconazole nitrate is a relatively new imidazole antifungal agent with a particular structure, consisting in a benzothiophene ring similar to the indole ring of tryptophan, and it acts mainly through the inhibition of ergosterol synthesis and the formation of pores in the fungal cell membrane. Its etiology is not completely elucidated however, the link between disease exacerbations and the proliferation of Malassezia spp., along with the good response to antifungal agents, indicate the role of fungi in its pathophysiology. Seborrheic dermatitis (SD) is a relapsing inflammatory skin disorder that affects the seborrheic areas of the body.
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