In most cases of Androgenetic Alopecia, (AGA), there is a tangible, subtle at times, itching sensation in the scalp. In some cases there is visible redness. This is caused by the inflammation associated with AGA, known as peri-follicular inflammation or folliculitis. This is more often than not accompanied by an increased sebum emission rate and a noticeably oily scalp.
Malassezia yeast is inexorably related to the inflammation (folliculitis) that causes hair shedding, hair miniaturization, and hair loss in AGA. It is also directly implicated in dandruff and sebborheic dermatitis. In a nutshell Malasszia wreaks its havoc on hair by using lipase enzymes to break down sebum, causing production of Arachadonic acid. Arachadonic acid is an inflammation precursor, leading to the creation and cascade of inflammatory enzymes that have well established roles in the miniaturization of the hair follicle and the constriction of the vasculature seen in virtually all cases of AGA.
Neutralizing Malassezia should be an integral part of any treatment regime.
This can readily be accomplished several simple ways. The most convenient way is to use anti-dandruff shampoos that contain either ketoconazole, (Nizoral) or piroctone olamine, (Folicure). In one side by side study, piroctone olamine shampoo was shown to be superior to ketoconazole shampoo in its ability to reduce shedding and increase hair shaft diameter in men with AGA. Since both shampoos are used 3 times a week for this purpose, there is no reason why you can’t alternate both to maximize this effect.
Emu Oil, when used topically, has skin thickening anti-aging, anti-inflammatory properties anywhere it is applied. In applying it to areas affected by AGA, you will neutralize any inflammatory cytokines produced by Malassezia, and stimulate skin repair mechanisms for any inflammation damage already incurred. Its skin thickening properties via its abiliy to stimulate collagen production, make it one of the most efficacious anti-aging interventions for facial skin as well.
Internally, the Indian spice tumeric, or Curcumin inhibits the specific cytokines associated with AGA, most notably, TGF-b. 5-LOXIN, is a botanical compound that inhibits an inflammatory enzyme produced by Arachadonic acid, and that has been implicated in AGA and prostate disorders.
It is possible that topically applied coconut oil, (ideally used as pre-wash) would inhibit Malassezia fungus due to its anti-fungal effects and indication as a dandruff cure in traditional Indian Ayurvedic medicine.
By combining several of the above mentioned treatments, your days of even a slightly itchy scalp will almost spontaneously disappear.
Am J Clin Dermatol. 2006;7(4):263-6
Increased hair shedding may be associated with the presence of Pityrosporum ovale.
Nematian J, Ravaghi M, Gholamrezanezhad A, Nematian E.
Department of Mycology, Faculty of Medicine, Azad University of Medical Sciences, Tehran, Iran.
BACKGROUND AND OBJECTIVE: Although the available data show that hair loss is an important cosmetic problem worldwide, the pathogenesis of common hair shedding is not fully understood. The aim of this study was to evaluate the association between hair shedding and cutaneous Malassezia infection. Malassezia fungi have been the suspected cause of dandruff for more than a century. Previously referred to as Pityrosporum ovale or P. orbiculare, these fungi are now known to consist of at least seven species. METHODS: Over a 4-year period, we obtained 300 hair samples from medical students. Based on the clinical history and a hair-pull test, the participants were divided into two groups: normal subjects and subjects with hair shedding. The students' scalp skin was gently scraped, smeared on a slide, colored by methylene blue, and observed under 10x magnification. RESULTS: All participants who had positive smears with >or=3 P. ovale organisms per low-power microscopic field (10x) were defined as 'carriers.' Seventy-six percent of students were Malassezia carriers. The prevalence of positive smears was significantly higher among subjects with hair shedding than among normal subjects (89.92% vs 9.52%, p<0.001). Furthermore, participants with positive smears had a significantly higher frequency of hair loss complaints and positive hair-pull tests. CONCLUSION: The proportion of subjects who were carriers of Malassezia yeasts was significantly higher in the group with hair shedding, and our results therefore raise the possibility of a relationship between this unicellular organism and hair loss. Our study findings should be explored in a larger series of patients.
Med Mycol. 2008 Oct 23:1-7.
Malassezia folliculitis is caused by cutaneous resident Malassezia species.
Akaza N, Akamatsu H, Sasaki Y, Kishi M, Mizutani H, Sano A, Hirokawa K, Nakata S, Nishijima S, Matsunaga K.
Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Aichi.
Malassezia folliculitis [MF] is caused by the invasion of hair follicles by large numbers of Malassezia cells, but it remains unclear which Malassezia species are involved in the disease. To clarify this situation, Malassezia species isolated from lesions of MF patients were analyzed by both culture and non-culture methods. In addition, Malassezia species recovered from the non-lesion areas of the skin of MF patients and skin samples of healthy subjects were included in this study. The test population consisted of 32 MF patients and 40 healthy individuals. The lesions were obtained using a comedone extractor, while swabs were employed to obtain skin samples from non-lesion areas of the patients and healthy subjects. Malassezia DNA was analyzed using a real-time PCR technique. The detection limit of the culture method was 5 CFU/cm(2) as opposes 50 cells/cm(2) with non-culture procedures. The predominant species recovered from MF lesions were M. globosa and M. sympodialis by culture method analysis, and M. restricta, M. globosa, and M. sympodialis with non-culture methods. These results were in agreement with those found with samples from non-lesion skin areas of MF patients and healthy subjects. This study clarified that MF is caused by Malassezia species that are part of the cutaneous microflora and not by exogenous species.
Ketoconazole shampoo: effect of long-term use in androgenic alopecia.
Piérard-Franchimont C, De Doncker P, Cauwenbergh G, Piérard GE.
Department of Dermatopathology, University of Liège, Belgium.
BACKGROUND: The pathogenesis of androgenic alopecia is not fully understood. A microbial-driven inflammatory reaction abutting on the hair follicles might participate in the hair status anomaly. OBJECTIVE: The aim of our study was to determine if ketoconazole (KCZ) which is active against the scalp microflora and shows some intrinsic anti-inflammatory activity might improve alopecia. METHOD: The effect of 2% KCZ shampoo was compared to that of an unmedicated shampoo used in combination with or without 2% minoxidil therapy. RESULTS: Hair density and size and proportion of anagen follicles were improved almost similarly by both KCZ and minoxidil regimens. The sebum casual level appeared to be decreased by KCZ. CONCLUSION: Comparative data suggest that there may be a significant action of KCZ upon the course of androgenic alopecia and that Malassezia spp. may play a role in the inflammatory reaction. The clinical significance of the results awaits further controlled study in a larger group of subjects.
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