フケ、頭部粃糠疹

関: dander

WordNet

a condition in which white scales of dead skin are shed by the scalp
loose scales shed from the scalp; "I could see the dandruff on her shoulders"
a feeling of anger and animosity; "having ones hackles or dander up" (同)hackles
small scales from animal skins or hair or bird feathers that can cause allergic reactions in some people

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/02/26 17:56:03」(JST)

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For the album by Ivor Cutler, see Dandruff (album).

Dandruff^[1] is the shedding of dead skin cells from the scalp. Dandruff should not be confused with a simple dry scalp. As skin cells die a small amount of flaking is normal; about 487,000 cells/cm² get released normally after detergent treatment.^[2] Some people, however, experience an unusually large amount of flaking either chronically or as a result of certain triggers, up to 800,000 cells/cm², which can also be accompanied by redness and irritation. Most cases of dandruff can be easily treated with specialized shampoos. There is, however, no true cure.

Dandruff is a common scalp disorder affecting almost half of the population at the post-pubertal age and of any sex and ethnicity. It often causes itching. It has been well established that keratinocytes play a key role in the expression and generation of immunological reactions during dandruff formation. The severity of dandruff may fluctuate with season as it often worsens in winter.^[2]

Those affected by dandruff find that it can cause social or self-esteem problems, indicating treatment for both psychological and physiological reasons.^[3]

Typical case of Dandruff.

Causes

As the epidermal layer continually replaces itself, cells are pushed outward where they eventually die and flake off. For most individuals, these flakes of skin are too small to be visible. However, certain conditions cause cell turnover to be unusually rapid, especially in the scalp. For people with dandruff, skin cells may mature and be shed in 2–7 days, as opposed to around a month in people without dandruff. The result is that dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin and clothes.

Dandruff has been shown to be the result of three required factors:^[4]

Skin oil commonly referred to as sebum or sebaceous secretions^[5]
The metabolic by-products of skin micro-organisms (most specifically Malassezia yeasts)^[6]^[7]^[8]^[9]^[10]
Individual susceptibility

Older literature cites the fungus Malassezia furfur (previously known as Pityrosporum ovale) as the cause of dandruff. While this species does occur naturally on the skin surface of both healthy people and those with dandruff, in 2007 it was discovered that the responsible agent is a scalp specific fungus, Malassezia globosa,^[11] that metabolizes triglycerides present in sebum by the expression of lipase, resulting in a lipid byproduct oleic acid (OA). During dandruff, the levels of Malassezia increase by 1.5 to 2 times its normal level.^[2] Penetration by OA of the top layer of the epidermis, the stratum corneum, results in an inflammatory response in susceptible persons which disturbs homeostasis and results in erratic cleavage of stratum corneum cells.^[8]

Dandruff can also be a manifestation of an allergic reaction to chemicals in hair gels, sprays, and shampoos, hair oils, or sometimes even dandruff medications like ketoconazole.^{[citation needed]}

There is some evidence that excessive perspiration and climate have significant roles in the pathogenesis of dandruff.^{[citation needed]}

Composition

Dandruff scale is a cluster of corneocytes, which have retained a large degree of cohesion with one another and detach as such from the surface of the stratum corneum. The size and abundance of scales are heterogeneous from one site to another and over time. Parakeratotic cells often make up part of dandruff. Their numbers are related to the severity of the clinical manifestations, which may also be influenced by seborrhea.^[2]

Treatment

Shampoos use a combination of ingredients to control dandruff. The pathogenesis of dandruff involves hyperproliferation of keratinocytes, resulting in deregulation of keratinization. The corneocytes clump together, manifesting as large flakes of skin. Essentially, keratolytic agents such as salicylic acid and sulphur loosen the attachments between the corneocytes and allow them to get swiped off.

Regulators of keratinization

Zinc pyrithione (ZPT) heals the scalp by normalizing the epithelial keratinization or sebum production or both. Some studies have shown a significant reduction in the number of yeasts after use of ZPT, which is an antifungal and antibacterial agent.^[12] A study by Warner et al.^[13] demonstrates a dramatic reduction of structural abnormalities found in dandruff with the use of ZPT; the population abundance of Malassezia decreases, parakeratosis gets eliminated and corneocytes lipid inclusions are diminished.^[2]

Steroids

The parakeratotic properties of topical corticosteroids depend on the structure of the agent, the vehicle and the skin onto which it is used. Corticosteroids work via their anti-inflammatory and antiproliferative effects.^[14]

Selenium sulfide

It is believed that selenium sulfide controls dandruff via its anti Malassezia effect rather than by its antiproliferative effect, although it has an effect in reducing cell turnover. It has anti-seborrheic properties as well as cytostatic effect on cells of the epidermal and follicular epithelium. The excessive oiliness after use of this agent has been reported in many patients as adverse drug effect.^[2]

Coal Tar

Coal tar is a keratoplastic causing the skin to shed dead cells from the top layer and slow skin cell growth.^[15]

Imidazole antifungal agents

Imidazole topical antifungals such as ketoconazole act by blocking the biosynthesis of ergosterol, the primary sterol derivative of the fungal cell membrane. Changes in membrane permeability caused by ergosterol depletion are incompatible with fungal growth and survival.^[16]

Ketoconazole is a broad spectrum, antimycotic agent that is active against both Candida and M. furfur . Of all the imidazoles, ketoconazole has become the leading contender among treatment options because of its effectiveness in treating seborrheic dermatitis as well.^[2]

Hydroxypyridones

In contrast to the imidazole antifungals, the hydroxypyridones do not affect sterol biosynthesis; instead they interfere with the active transport of essential macromolecule precursor, cell membrane integrity and the respiratory process of cells. Ciclopirox is widely used as an anti-dandruff agent in most preparations.^[17]

Neem

Neem has anti-fungal properties that can be effective in treating dandruff.^[18]

Black Pepper

Black pepper contains the dandruff fighting minerals zinc and selenium. In Indian traditional Ayurveda, powdered black pepper has been used to treat dandruff.

Egg oil

In India,^[19] Japanese, Unani (Roghan Baiza Murgh)^[20] and Chinese^[21] traditional medicine, egg oil was traditionally used as a treatment for dandruff.

Sandalwood^[22]

Sandalwood and Lemon: Application of an emulsion prepared with the oil of sandalwood and lemon juice has been proven effective to cure dandruff. In traditional Ayurveda, sandalwood has many benefits. Its main component beta-santalol (~90%) has antimicrobial properties.^[23]

Seborrhoeic dermatitis

Main article: Seborrhoeic dermatitis

Specific diagnosis and treatment of dandruff may be difficult as its spectrum blurs with those of seborrhoeic dermatitis and some other scaly. In seborrhoeic dermatitis redness and itching frequently occurs around the folds of the nose and eyebrow areas, not just the scalp. Dry, thick, well-defined lesions consisting of large, silvery scales may be traced to the less common affliction of the scalp psoriasis.

Inflammation and extension of scaling outside the scalp exclude the diagnosis of dandruff from seborrhoeic dermatitis.^[5] However, many reports suggest a clear link between the two clinical entities - the mildest form of the clinical presentation of seborrhoeic dermatitis as dandruff, where the inflammation is minimal and remain subclinical.^[24]^[25]

Seasonal changes, stress, and immuno-suppression seem to affect seborrheic dermatitis.^[2]

References

^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 1-4160-2999-0.
^ ^a ^b ^c ^d ^e ^f ^g ^h Ranganathan S, Mukhopadhyay T (2010). "DANDRUFF: THE MOST COMMERCIALLY EXPLOITED SKIN DISEASE". Indian J Dermatol 55 (2): 130–134. doi:10.4103/0019-5154.62734. PMC 2887514. PMID 20606879. http://www.e-ijd.org/article.asp?issn=0019-5154;year=2010;volume=55;issue=2;spage=130;epage=134;aulast=Ranganathan.
^ "A Practical Guide to Scalp Disorders". Journal of Investigative Dermatology Symposium Proceedings. 2007-12. http://www.nature.com/jidsp/journal/v12/n2/abs/5650048a.html. Retrieved 2009-02-06.
^ DeAngelis YM, Gemmer CM, Kaczvinsky JR, Kenneally DC, Schwartz JR, Dawson TL (2005). "Three etiologic facets of dandruff and seborrheic dermatitis: Malassezia fungi, sebaceous lipids, and individual sensitivity". J. Investig. Dermatol. Symp. Proc. 10 (3): 295–7. doi:10.1111/j.1087-0024.2005.10119.x. PMID 16382685.
^ ^a ^b Ro BI, Dawson TL (2005). "The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff". J. Investig. Dermatol. Symp. Proc. 10 (3): 194–7. doi:10.1111/j.1087-0024.2005.10104.x. PMID 16382662.
^ Ashbee HR, Evans EG (2002). "Immunology of Diseases Associated with Malassezia Species". Clin. Microbiol. Rev. 15 (1): 21–57. doi:10.1128/CMR.15.1.21-57.2002. PMC 118058. PMID 11781265. http://cmr.asm.org/cgi/content/full/15/1/21?view=long&pmid=11781265.
^ Batra R, Boekhout T, Guého E, Cabañes FJ, Dawson TL, Gupta AK (2005). "Malassezia Baillon, emerging clinical yeasts". FEMS Yeast Res. 5 (12): 1101–13. doi:10.1016/j.femsyr.2005.05.006. PMID 16084129.
^ ^a ^b Dawson TL (2006). "Malassezia and seborrheic dermatitis: etiology and treatment". Journal of cosmetic science 57 (2): 181–2. PMID 16758556.
^ Gemmer CM, DeAngelis YM, Theelen B, Boekhout T, Dawson Jr TL (2002). "Fast, Noninvasive Method for Molecular Detection and Differentiation of Malassezia Yeast Species on Human Skin and Application of the Method to Dandruff Microbiology". J. Clin. Microbiol. 40 (9): 3350–7. doi:10.1128/JCM.40.9.3350-3357.2002. PMC 130704. PMID 12202578. //www.ncbi.nlm.nih.gov/pmc/articles/PMC130704/.
^ Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL (2004). "Skin diseases associated with Malassezia species". J. Am. Acad. Dermatol. 51 (5): 785–98. doi:10.1016/j.jaad.2003.12.034. PMID 15523360.
^ "Genetic code of dandruff cracked". BBC News. 2007-11-06. http://news.bbc.co.uk/2/hi/health/7080434.stm. Retrieved 2010-04-30.
^ Markes R, Pearse A. The effect of a shampoo containing zinc phrithione in the control of dandruff. J Dermatol 1985;112:415-22.
^ Warner RR, Schwartz JR, Boissy Y, Dawson TL Jr. Dandruff has an altered stratum corneum ultrastructure that is improved with zinc phrithione shampoo. J Am Acad Dermatol 2001;45:897-903.
^ Sawleshwakar SN, Salgonkar V, Obrai C. Multi centre, open-label, non-comparative study of a combination of polytar and zinc pyrithione shampoo in the management of dandruff. Indian J Dermatol Venereol Leprol 2004;7:25-8.
^ WebMD: Anti-Dandruff (coal tar) [1]
^ Shuster S. The etiology of dandruff and the mode of action of therapeutic agents. Br J Dermatol 1984;3:235-42.
^ Milani M, Antonio Di Molfetta S, Gramazio R, Fiorella C, Frisario C, Fuzio E, Efficacy of betamethasone valerate 0.1% thermophobic foam in seborrheic dermatitis of the scalp. An open label, multicentre prospective trial on 180 patients. Curr Med Res Opin 2003;19:342-5.
^ E-International Scientific Research Journal: Antifungal Properties of Neem (Azardirachta Indica) Leaves Extract to treat Hair Dandruff [2]
^ H. Panda: Handbook On Ayurvedic Medicines With Formulae, Processes And Their Uses [3]
^ S. Suresh Babu: Homemade Herbal Cosmetics
^ Zhong Ying Zhou, Hui De Jin: Clinical manual of Chinese herbal medicine and acupuncture [4]
^ Česky. "Sandalwood - Wikipedia, the free encyclopedia". En.wikipedia.org. http://en.wikipedia.org/wiki/Sandalwood. Retrieved 2013-01-26.
^ November 12, 2012 (2012-11-12). "Dandruff Remedies to Cure Dandruff naturally". Fiveremedies.com. http://fiveremedies.com/hair-care/dandruff-remedies/. Retrieved 2013-01-26.
^ Pierard-Franchimont C, Hermanns JF, Degreef H, Pierard GE (2006). "Revisiting dandruff". Int J Cosmet Sci 28 (5): 311–318. doi:10.1111/j.1467-2494.2006.00326.x. PMID 18489295.
^ Pierard-Franchimont C, Hermanns JF, Degreef H, Pierard GE. From axioms to new insights into dandruff. Dermatology 2000;200:93-8.

UpToDate Contents

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1. 思春期および成人における脂漏性皮膚炎 seborrheic dermatitis in adolescents and adults
2. 皮膚炎の概要 overview of dermatitis
3. 頭皮の発疹を有する患者へのアプローチ approach to the patient with a scalp disorder
4. 患者情報：脂漏性皮膚炎（フケ（頭部秕糠疹）および乳痂（乳幼児脂漏性皮膚炎）を含む）（詳細） seborrheic dermatitis including dandruff and cradle cap beyond the basics
5. 女性型脱毛症（女性のアンドロゲン性脱毛症）：治療および予後 female pattern hair loss androgenetic alopecia in women treatment and prognosis

English Journal

Transcriptional changes in organoculture of full-thickness human skin following topical application of all-trans retinoic acid.

Gillbro JM1, Al-Bader T, Westman M, Olsson MJ, Mavon A.Author information 1Oriflame Skin Research Institute, Mäster Samuelsgatan 56, Stockholm, 11121, Sweden.AbstractIn this study, we developed an organoculture of human skin to investigate the effect of topical applied all-trans retinoic acid using a gene array approach. We could by using this approach confirm previous studies on genes activated by RA in keratinocyte monocultures and also provide new insights on genes that are relevant to RA-activation in human skin. The results in the present study show this model represent a valuable pre-clinical model for studying the effects of retinoids in skin.
International journal of cosmetic science.Int J Cosmet Sci.2014 Jun;36(3):253-261. doi: 10.1111/ics.12121. Epub 2014 Mar 27.
In this study, we developed an organoculture of human skin to investigate the effect of topical applied all-trans retinoic acid using a gene array approach. We could by using this approach confirm previous studies on genes activated by RA in keratinocyte monocultures and also provide new insights on
PMID 24697191

Multicenter, double-blind, parallel group study investigating the non-inferiority of efficacy and safety of a 2% miconazole nitrate shampoo in comparison with a 2% ketoconazole shampoo in the treatment of seborrhoeic dermatitis of the scalp.

Buechner SA.Author information Private Dermatology office, Blumenrain 20, CH 4051 Basel , Switzerland.AbstractOBJECTIVES: This study investigated the non-inferiority of efficacy and tolerance of 2% miconazole nitrate shampoo in comparison with 2% ketoconazole shampoo in the treatment of scalp seborrheic dermatitis.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Jun;25(3):226-31. doi: 10.3109/09546634.2013.782092. Epub 2013 May 21.
OBJECTIVES: This study investigated the non-inferiority of efficacy and tolerance of 2% miconazole nitrate shampoo in comparison with 2% ketoconazole shampoo in the treatment of scalp seborrheic dermatitis.METHODS: A randomized, double-blind, comparative, parallel group, multicenter study was done.
PMID 23557492

Assessing therapeutic effectiveness of scalp treatments for dandruff and seborrheic dermatitis, part 2: the impact of gender and ethnicity on efficacy.

Bacon RA1, Mizoguchi H, Schwartz JR.Author information 1The Procter and Gamble Company , Cincinnati, OH , USA.AbstractBACKGROUND: Dandruff and seborrheic dermatitis (D/SD) are common and troublesome scalp conditions that affect individuals independent of gender or ethnicity.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Jun;25(3):237-40. doi: 10.3109/09546634.2012.719077. Epub 2012 Sep 19.
BACKGROUND: Dandruff and seborrheic dermatitis (D/SD) are common and troublesome scalp conditions that affect individuals independent of gender or ethnicity.AIM: To evaluate whether population gender or ethnic origins impact the magnitude of anti-dandruff therapeutic benefit obtained from use of a p
PMID 22866664

Assessing therapeutic effectiveness of scalp treatments for dandruff and seborrheic dermatitis, part 1: a reliable and relevant method based on the adherent scalp flaking score (ASFS).

Bacon RA1, Mizoguchi H, Schwartz JR.Author information 1The Procter and Gamble Company , Cincinnati, OH , USA.AbstractBACKGROUND: Dandruff and seborrheic dermatitis (D/SD) are common and troublesome scalp conditions with the primary signs and symptoms being presence of skin flakes, pruritus, a tight feeling, and sometimes erythema.
The Journal of dermatological treatment.J Dermatolog Treat.2014 Jun;25(3):232-6. doi: 10.3109/09546634.2012.687089. Epub 2012 Jun 12.
BACKGROUND: Dandruff and seborrheic dermatitis (D/SD) are common and troublesome scalp conditions with the primary signs and symptoms being presence of skin flakes, pruritus, a tight feeling, and sometimes erythema.AIM: To demonstrate the reliability and relevance of a clinical model for the assessm
PMID 22515728

Japanese Journal

頭皮ケアをコンセプトとしたヘアケア製品の処方開発 (特集化粧品の処方開発の現状と今後の課題)

柏井利之
フレグランスジャーナル 39(9), 62-68, 2011-09
NAID 40018994902

フケ症に対するミコナゾール硝酸塩配合リンスの有用性の検討 : 基剤を対照とした二重盲検比較試験

清佳浩,小林めぐみ,早出恵里
Medical mycology journal = / 日本医真菌学会 [編] 52(3), 229-237, 2011-07-30
… double-blind, comparative study was performed on the usefulness of rinse containing miconazole nitrate(COFRM)compared to rinse without the reagent for the treatment of dandruff, when together with shampoo containing miconazole nitrate(COF). This study showed that both COFR and COFRM had about 80% utility. On the other hand, though it was not significant, enhanced improvement of itching by COFRM compared to COFR was detected 2 weeks after start of the examination. These results suggest that by mixing the miconazole nitrate with not only the …
NAID 10029466295

日本における毛嚢虫性前部眼瞼縁炎

川北哲也,川島素子,Ibrahim Osama [他],村戸ドール,坪田一男
日本眼科學会雜誌 114(12), 1025-1029, 2010-12-10
NAID 10029366952

DNA microarray analysis suggests that zinc pyrithione causes iron starvation to the yeast Saccharomyces cerevisiae(ENVIRONMENTAL BIOTECHNOLOGY)

Yasokawa Daisuke,Murata Satomi,Iwahashi Yumiko [他],Kitagawa Emiko,Kishi Katsuyuki,Okumura Yukihiro,Iwahashi Hitoshi
Journal of bioscience and bioengineering 109(5), 479-486, 2010-05
… Zinc pyrithione has been used in anti-dandruff shampoos and in anti-fouling paint on ships. …
NAID 110007618924