Seborrheic dermatitis and Malassezia: environmental concerns, resistance, and clinical management

Sergeev A.Y., Arzumanian V.G., Sergeeva M.A., Miroshina O.V., Sorokina E.V., Burtseva G.N.

Novosibirsk State Research University, Novosibirsk, Russia
I.I. Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
Dermatology Clinic Research Center, Moscow, Russia
Irkutsk State Medical University, Irkutsk, Russia

Excessive activity of Malassezia, lipophilic yeast fungi that comprise the normal human microbiome, is currently considered a key pathogenetic mechanism of seborrheic dermatitis of the scalp. Lipases secreted by various Malassezia species initiate biochemical cascades that compromise the integrity of epidermal barrier and promote inflammation. For many years, antifungal agents and their combinations in the form of medicinal and cosmetic shampoos have been the mainstay of therapy and prophylaxis for scalp seborrheic dermatitis. Widespread prolonged use of imidazole antimycotics has driven the emergence of resistant strains across multiple Malassezia species through several distinct mechanisms. The positioning of antifungal shampoos in medical literature does not always correspond to their actual pharmacy dispensing statistics or real-world preferences of practicing dermatovenerologists. Global manufacturing and widespread over-the-counter use of antifungal shampoos have raised environmental concerns and exerted selective pressure favoring antifungal resistance in certain important pathogens. Increased awareness of these risks may shift prescription priorities toward selected formulations and scalp care products in clinical recommendations.