lithium-succinate and Dermatitis--Seborrheic

The connection between P. ovale and seborrhoeic dermatitis has been clearly demonstrated in a number of treatment studies but we still do not know how P. ovale induces skin lesions. An enhanced growth of P. ovale cannot be the cause, because a number of studies with quantitative determinations of P. ovale have not been able to show any difference in the number of yeast cells between patients and healthy controls. The number of P. ovale is probably only important for the individuals who are susceptible to seborrhoeic dermatitis. An abnormal immune response to P. ovale could be another explanation. Sohnle et al. have shown that P. ovale can activate complement by both the classical and the alternative pathway. A defective cell-mediated immunity to P. ovale in patients with seborrhoeic dermatitis has been demonstrated by Wikler et al. In patients with AIDS, who are known to have a diminished T-cell function, a high incidence of seborrhoeic dermatitis has been found. Activation of the alternative complement pathway by P. ovale, which does not require T-cell function, could be an explanation for the inflammatory response. I also believe that the skin lipids are important in the pathogenesis. An improvement of seborrhoeic dermatitis has been demonstrated after treatment with drugs that reduce the sebum excretion. Pityrosporum has lipase activity and may generate free fatty acids, which could also contribute to the inflammatory response. There are a number of factors which are probably important in the pathogenesis of seborrhoeic dermatitis, that is, the number of P. ovale, P. ovale lipase activity, skin lipids, immune function, heredity, atmospheric humidity and emotional state. A reduction in the number of P. ovale in patients suffering from seborrhoeic dermatitis and being treated with antimycotic treatment is, at the present state of knowledge, the best way to treat the disease.

Topics: Acquired Immunodeficiency Syndrome; Adrenal Cortex Hormones; Dermatitis, Seborrheic; HIV Infections; Humans; Imidazoles; Incidence; Isotretinoin; Malassezia; Mental Disorders; Occupational Diseases; Organometallic Compounds; Prevalence; Propylene Glycol; Propylene Glycols; Pyridines; Selenium Compounds; Succinates; Ultraviolet Therapy

Twenty-one patients with seborrhoeic dermatitis were included in an open trial of lithium succinate ointment (LSO) for a total duration of 8 weeks. The same clinician made assessments of the severity of redness, scaling, greasiness and overall clinical impression of the condition every 2 weeks. Because the results appeared to be satisfactory, we decided to perform a double-blind, placebo-controlled trial of LSO. Thirty patients with seborrhoeic dermatitis were included. The results also demonstrated the beneficial effect of LSO. A significantly higher number of patients treated with LSO showed remission or marked improvement compared with placebo. The main adverse events demonstrated consisted of minor transient skin irritation and/or stinging sensation. Studying the in vivo inhibitory effect of LSO on the growth of Pityrosporum revealed that Pityrosporum did not significantly have its growth inhibited by lithium. Topical lithium succinate appears to be a safe and an effective treatment for seborrhoeic dermatitis. The product presumably acts as an anti-inflammatory agent.

Topics: Adolescent; Adult; Aged; Dermatitis, Seborrheic; Double-Blind Method; Female; Humans; Lithium; Malassezia; Male; Middle Aged; Ointments; Organometallic Compounds; Skin; Succinates

Seborrheic dermatitis, an inflammatory dermatosis that principally affects sebaceous areas, may be related to the presence of the yeast Pityrosporum ovale. Topical therapy with corticosteroids, although in general effective, may be associated with several unwanted effects. The development of alternative non-steroid-based therapies may enable patients to avoid the use of topical steroids and help elucidate the pathogenesis of the disease.. This study aimed to assess the efficacy and safety of an ointment containing 8% lithium succinate in the treatment of seborrheic dermatitis.. The study consisted of a multicenter placebo-controlled clinical trial in 227 adult patients.. Lithium succinate ointment was significantly more effective than placebo in treating all the symptoms of seborrheic dermatitis. No specific unwanted effects were associated with its use. Relapse was slow when treatment was stopped.. The effectiveness of lithium succinate ointment in the treatment of seborrheic dermatitis adds to the evidence implicating P. ovale in the pathogenesis of that condition.

Topics: Adolescent; Adult; Aged; Dermatitis, Seborrheic; Double-Blind Method; Female; Humans; Male; Middle Aged; Ointments; Organometallic Compounds; Succinates

Topics: Administration, Topical; Adolescent; Adult; Clinical Trials as Topic; Dermatitis, Seborrheic; Double-Blind Method; Female; Humans; Lithium; Male; Middle Aged; Organometallic Compounds; Succinates

Lithium succinate and gluconate are effective alternative options licensed for the topical treatment of seborrhoeic dermatitis (SD).. Their mode of action is not fully elucidated. Minimal inhibitory concentrations against Malassezia (M.) yeasts, which play an important role in SD, are very high.. An assay based on the hydrolysis of ethyl octanoate enables us to test the hydrolytic activity of reference strains of the species M. globosa, M. sympodialis and M. furfur solely without interference by fungal growth as the free octanoic acid generated has antifungal activity.. In this assay the presence of alkali salts (lithium, sodium and potassium succinate resp.) in concentrations of 2%, 4% and 8% does not influence hydrolytic activity but the availability of the generated free fatty acid in a dose-dependent manner which was analysed by means of high-performance thin layer chromatography and densitometry. This was best effected with the lithium, followed by the sodium and only to a low degree by the potassium salt. As shown by attenuated total reflection Fourier transform infrared spectroscopy the free fatty acid reacted to the respective alkali soap and precipitate from solution. The alkali soaps could not be utilized by the M. spp. as shown in a modified Tween auxanogram and in lack of fungal growth by ethyl oleate in the presence of 8% lithium succinate.. The effect of lithium succinate on growth of M. yeasts and presumably in SD can be explained by a precipitation of free fatty acids as alkali soaps limiting their availability for the growth of these lipid-dependent yeasts.

Topics: Dermatitis, Seborrheic; Fatty Acids, Nonesterified; Humans; Malassezia; Organometallic Compounds; Succinates

The in vitro antifungal activity of lithium succinate has been evaluated against 46 different Malassezia furfur strains, isolated from patients suffering from dandruff, seborrheic dermatitis, and pityriasis versicolor.. Minimum inhibitory concentrations of lithium succinate were measured by the agar dilution technique.. Lithium succinate was found to be able to inhibit growth of all investigated M. furfur isolates in vitro but at much higher concentrations than those which are normally used for susceptibility testing. Minimum inhibitory concentrations between 1,250 and 10,000 micrograms/ml were determined. When compared to the 8% lithium succinate ointment, the investigated concentrations are even far below this 8% value.. It is suggested that the effect of lithium succinate ointment in seborrheic dermatitis therapy in vivo may be at least partly due to an antifungal activity of the agent.

Topics: Dermatitis, Seborrheic; Humans; Malassezia; Microbial Sensitivity Tests; Organometallic Compounds; Succinates

Topics: Administration, Cutaneous; Dermatitis, Seborrheic; Humans; Malassezia; Ointments; Organometallic Compounds; Succinates

Topics: Antifungal Agents; Dermatitis, Seborrheic; Humans; Malassezia; Organometallic Compounds; Succinates