Seborrheic dermatitis-Looking beyond Malassezia

Exp Dermatol. 2019 Sep;28(9):991-1001. doi: 10.1111/exd.14006. Epub 2019 Aug 19.

Abstract

Seborrhoeic Dermatitis (SD) is a very common chronic and/or relapsing inflammatory skin disorder whose pathophysiology remains poorly understood. Yeast of the genus Malassezia has long been regarded as a main predisposing factor, even though causal relationship has not been firmly established. Additional predisposing factors have been described, including sebaceous activity, host immunity (especially HIV infection), epidermal barrier integrity, skin microbiota, endocrine and neurologic factors, and environmental influences. Genetic studies in humans and mouse models-with particularly interesting insights from examining the Mpzl3 knockout mice and their SD-like skin phenotype, and patients carrying a ZNF750 mutation-highlight defects in host immunity, epidermal barrier and sebaceous activity. After synthesizing key evidence from the literature, we propose that intrinsic host factors, such as changes in the amount or composition of sebum and/or defective epidermal barrier, rather than Malassezia, may form the basis of SD pathobiology. We argue that these intrinsic changes provide favourable conditions for the commensal Malassezia to over-colonize and elicit host inflammatory response. Aberrant host immune activity or failure to clear skin microbes may bypass the initial epidermal or sebaceous abnormalities. We delineate specific future clinical investigations, complemented by studies in suitable SD animal models, that dissect the roles of different epidermal compartments and immune components as well as their crosstalk and interactions with the skin microbiota during the process of SD. This research perspective beyond the conventional Malassezia-centric view of SD pathogenesis is expected to enable the development of better therapeutic interventions for the management of recurrent SD.

Keywords: barrier; immune; microbiota; sebaceous; γδ T cells.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Causality
  • Dandruff / microbiology
  • Dermatitis, Seborrheic / etiology*
  • Dermatitis, Seborrheic / immunology
  • Dermatitis, Seborrheic / microbiology
  • Dermatomycoses / complications
  • Disease Susceptibility
  • Epidermis / microbiology*
  • Humans
  • Immunocompromised Host
  • Malassezia / isolation & purification
  • Malassezia / metabolism
  • Malassezia / pathogenicity*
  • Membrane Proteins / deficiency
  • Membrane Proteins / genetics
  • Mice
  • Mice, Knockout
  • Mice, Transgenic
  • Models, Biological
  • Neurosecretory Systems / physiopathology
  • Oleic Acid / metabolism
  • Parkinson Disease / complications
  • Propionibacterium / isolation & purification
  • Scalp Dermatoses / complications
  • Sebaceous Glands / physiopathology
  • Staphylococcus aureus / isolation & purification
  • Transcription Factors / deficiency
  • Transcription Factors / genetics
  • Tumor Suppressor Proteins

Substances

  • Membrane Proteins
  • Mpzl3 protein, mouse
  • Transcription Factors
  • Tumor Suppressor Proteins
  • ZNF750 protein, human
  • Oleic Acid