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Nudging Hair Shedding by Antidandruff Shampoos. a Comparison of 1% Ketoconazole, 1% Piroctone Olamine and 1% Zinc Pyrithione Formulations

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Nudging Hair Shedding by Antidandruff Shampoos. a Comparison of 1% Ketoconazole, 1% Piroctone Olamine and 1% Zinc Pyrithione Formulations International Journal of Cosmetic Science,2002,24,249^256 Nudging hair shedding by antidandruff shampoos. A comparison of 1% ketoconazole, 1% piroctone olamine and 1% zinc pyrithione formulations C. Pie¤ rard-Franchimont, V. Go⁄n, F. Henry, I. Uhoda, C. Braham and G. E. Pie¤ rard Department of Dermatopathology,University Medical Center Sart Tilman, B-4000 Lie' ge, Belgium Received 29 March 2002, Accepted 22 May 2002 Keywords: dandru¡, hair shedding, ketoconazole, piroctone olamine, zinc pyrithione Synopsis Re´ sume´ Hair shedding and hair thinning have been reported Tant la perte que la rare¤ faction des cheveux ont e¤ te¤ to be a¡ected bydandru¡ and seborrhoeic dermatitis. rapporte¤ se“ trea¡ecte¤ es parl’e¤ tat pelliculaire et la der- The present study was conducted in150 men present- mite se¤ borrhe¤ ique. Cette e¤ tude a e¤ te¤ conduite chez ing with telogen e¥uvium related to androgenic alo- 150 hommes sou¡rant d’un e¥uvium te¤ loge' ne en pecia associated with dandru¡. They were randomly relation avec une alope¤ cie androge¤ nique associe¤ ea' allocated to three groups receiving each one of the une¤ tat pelliculaire. Ils furent inclus de manie' re alle¤ a- three shampoos in the market containing either 1% toire dans trois groupes recevant un parmi trois ketoconazole (KTZ), 1% piroctone olamine (PTO) or shampooings contenant 1% de ke¤ toconazole (KTZ), 1% zinc pyrithione (ZPT). Shampoos had to be used 1% de piroctone olamine (PTO) ou1% de pyrithione 2^3 times aweek for 6 months. Hair shedding during de zinc (ZPT). Les shampooings e¤ taient destine¤ sa' shampoo was evaluated semiquantitatively. Hair e“ tre utilise¤ s2a' 3 fois par semaine pendant 6 mois. density on the vertex was evaluated on photographs La quantite¤ de cheveux perdus aucours du shampoo- usinga Dermaphot.Trichograms were used for deter- ing a e¤ te¤ e¤ value¤ e semiquantitativement. La densite¤ mining theanagen hair percentageandthe meanpro- pilaire sur le vertex a e¤ te¤ mesure¤ e sur des photogra- ximal hair shaft diameter using computerized image phies prises a' l’aide d’un Dermaphot1. Des tricho- analysis.The sebumexcretion rate (SER, mgcmÀ2 hÀ1) grammes ont servi a' l’e¤ tablissement dupourcentage wasalsomeasuredusinga Sebumeter1. de cheveux en phase anage' ne et pour mesurer le dia- The three treatments cleared pruritus and dan- me' tre de la partie proximale des cheveux en utilisant dru¡ rapidly. At end point, hair density was l’analyse informatise¤ e d’images. Le de¤ bit d’excre¤ tion unchanged, although hair shedding was decreased se¤ bace¤ e(DES,mgcmÀ2 hÀ1)fute¤ galement mesure¤ a' 1 (KTZ: À17.3 % , P TO: À16.5 % , Z P T: À10.1 % ) a n d t h e l’aide d’un Sebumeter . anagen hair percentage was increased (KTZ: 4.9%, Les trois traitements ont rapidement fait dispara|“- PTO: 7.9%, ZPT: 6.8%). The e¡ect on the mean hair tre le prurit et les pellicules. A l’issue de la phase shaft diameter was contrasted between the three d’observation, la densite¤ pilaire e¤ tait inchange¤ ebien groups of volunteers (KTZ: 5.4%, PTO: 7.7%, ZPT: que la perte de cheveux soit diminue¤ e(KTZ:À17.3 % , À2.2%). In conclusion, telogen e¥uvium was con- PTO: À16.5 % , Z P T: À10.1%) et que le pourcentage trolled byKTZ, PTOand ZPTshampoosat1% concen- des cheveux en phase anage' ne soit accru(KTZ: tration. In addition, KTZ and PTO increased the 4.9%, PTO: 7.9%, ZPT: 6.8%). L’e¡et sur le diame' tre mean hair shaft thickness while discretely decreas- moyen des cheveux e¤ tait di¡e¤ rent selon les groupes ing the sebum output at the skin surface. de volontaires (KET: 5.4%, PTO: 7.7%, ZPT: À2.2%). En conclusion, l’e¥uvium te¤ loge' ne a e¤ te¤ amoindri Correspondence: Gerald Pie¤ rard. E-mail: gerald.pierard@ par les shampooings renfermant1% de KTZ, PTO ou ulg.ac.be ZPT. De plus, le KTZ et le PTO ont accru le calibre ß 2002 Blackwell Science Ltd 249 Nudging hair shedding by antidandru¡ shampoos C. Pie¤ rard-Franchimont et al. maoyen des cheveux alors qu’ils diminuaient discre' - alopecia and the clinical manifestations of dandru¡ tement le de¤ bit se¤ bace¤ a' la surface de la peau. and seborrhoeic dermatitis on the scalp, it was decided to evaluate the e¡ects of ketoconazole (KTZ), piroctone olamine (PTO) and zinc pyrithione Introduction (ZPT) on these parameters. Since the hair cycle and its turning points have been largely identi¢ed [1^4], molecular mechanisms con- Materials and methods trolling hair chronobiology are progressively dis- closed [5,6]. The complex interactions between hair The trial protocol was approved by the Ethics Com- growth hair, shedding, sebaceous gland functions, mittee of the University of Lie' ge and was performed angiogenesis [7,8], microin£ammation and its coun- in accordance with the declaration of Helsinki and terpart immuno-suppression [9^15], and neuroen- its subsequent revisions. SubJects gave their written docrine and hormonal in£uences [16^18] are far from consent to participate in the study after having been being clari¢ed. The environmental impact including informed about its nature, risks and bene¢ts. The solar irradiation[19] andcommensalmicroorganisms study ran from autumn to spring the year after. A [11, 13] cannot be neglected either. All these factors total of150 men aged from18 to 65 years presenting may a¡ect the natural evolution of hair shedding and with mild-to-moderate dandru¡, telogen e¥uvium modulate theprogressionof alopecia [20]. related to androgenic alopecia (Hamilton grade III) There is an overwhelming body of evidence that of the vertex were enrolled. They were randomly as- dandru¡ and seborrhoeic dermatitis are two related signed to shampoo 2^3 times per week for 6 months clinical manifestations of one common dermatologi- with1% KTZ shampoo,1% PTO shampoo or1% ZPT cal disorder [21^30]. Dandru¡ is primarily a scaling shampoo. Each group was composed of 50 panelists. condition without any clinical evidence for in£am- Baseline data as well as those gathered after 4 and 6 mation, although subclinical microin£ammation is months of treatment, were collected for all subjects. present [25]. Seborrhoeic dermatitis is the clinically These included the determination of the sebum recognized in£ammatory counter-part of the same excretion rate (SER), the percentage of anagen hair, disorder. Erythema is always present, and the in£am- the mean proximal hair shaft diameter (mm), the hair matory lymphoid in¢ltrate is more pronounced [24]. density (N cmÀ2), and the hair shedding during Cosmetic or over-the-counter remedies are used for shampoo. No side-e¡ect was recorded but19 subjects dandru¡, andpatients mayeasily turntoprescription- were lost to follow-up between the 4th and 6th type medicinefor the in£ammatory presentation. month of treatment (six in the KTZ group, six in the Although it is generally agreed that the lipophilic PTO group and seven in the ZPTgroup). yeasts of the genus Malassezia are a key contributor SER was measured (mgcmÀ2 hÀ1) at the hairline, in the pathogenesis of dandru¡ and seborrhoeic der- one hour after the skin had been wiped with 70% matitis, these skin conditions are not regarded as an ethanol. A computerized Sebumeter SM 810 (C þ K infection [31^35]. It is the mere over-colonization of Electronic, Cologne, Germany) was used as pre- the scalp and other areas of the body rich in sebac- viously described [36,37]. eous glands by this yeast that causes an inconspicu- Hair density (n cmÀ2) was assessed on photo- ous-to-moderate in£ammatory reaction, resulting graphs of the central part of the vertex using a Der- in variable degrees in erythema and disturbed des- maphot1 Heine. By using a 3-point midline and quamation. facial coordinate system, precise relocation of the Usually, signs and symptoms of dandru¡ focus in same site was achieved for the assessments gathered the ¢rst place on scaling and itching. However, it is after the baseline assessment. Samples of more than clear that several other clinical features are present 100 individual hair were obtained from the same ver- in conjunction with this disorder. These include tex area. Trichograms yielded the proportion of hair seborrhoea, telogen e¥uvium, a reducing proportion in the anagen phase. Computerized image analysis in anagen hair and thin hair shaft diameter [30]. It is (MOP Videoplan Kontron, Eiching, Germany) was not clear if the relationship between these latter phe- used on the same hair samples to measure the mean nomena and seborrhoeic dermatitis is causal or cir- diameter of the proximal part of the hair shafts. cumstantial. Hair shedding was assessed using semiquanti- In view of the frequent association between sebor- tative counts of the hair collected during the last rhoea, telogen e¥uvium, thin hair, androgenic shampoo, the day before the subject’s visit to the 250 ß 2002 International Journal of Cosmetic Science, 24,249^256 ß ni¢cant ( evaluation. These di¡erences weregen statistically hair percentages sig- bytreated more subjects than experienced 10% at an increase the20 in last (40%) the PTO-treated ana- subjects,(Table and I). 16 A (32%) total ZPT- ofobtained 15 after (30%) treatment KTZ-treated showedpercentages subjects, a bene¢cial between e¡ect three baseline shampoos (Table I).The changes values inanagen hair and those and PTO-treated groupsshowed (Table I). a signi¢cant By ( contrast, the observation in the whole population (Fig. 1a,b,c). the bisectors and supportparameter the reproducibility in of this eachstatistical test signi¢cance. group point Theline, clearly scattergrams but above the for intergroup this di¡erences did not reach ( hair shedding during shampooing was signi¢cantly mean hair density signi¢cantlyteers.
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