Cosmetic antidandruff shampoo found far more effective than ketokonazole shampoo: probable contribution of thermal mineral water

BACKGROUND: There is evidence suggesting the role of Malassezia species in the pathogenesis of dandruff and seborrheic dermatitis (D/SD). They were shown to have lipase activity, whose metabolites trigger inflammatory response inducing keratinocytes to produce pro-inflammatory cytokines. Considering the inflammatory features of the disorders suggested, we conducted a clinical trial on D/SD patients, in order to reveal the efficacy of a specially prepared cosmetic shampoo manufactured with a thermal mineral water, which has authenticated in-vitro anti-inflammatory effects.METHODS: The shampoo which was manufactured with a thermal mineral water; comprised a combination of antifungal agents, piroctone olamine and zinc pyrithione, within the EU cosmetic regulation limits. One-week clinical trial on 30 subjects with D/SD was randomized, controlled and double-blind. A commercial medicinal shampoo containing ketokonazole as active ingredient was used as reference. The symptoms/signs of each subject were recorded according to a semi-quantitative severity scale, and close-up photographs were taken at the beginning and at the end of the study.RESULTS: Although the results were favorable and statistically significant in both groups, contrary to expectations, the cosmetic shampoo was found to be apparently more effective than the medicinal shampoo.CONCLUSIONS: The superiority of the cosmetic shampoo can be attributed to the anti-inflammatory features of thermal mineral water in the formulation, which are probably due to its high mineral content, especially sulfur, zinc and boric acid. In this context, the thermal mineral water may be considered as an additional active ingredient.