Crohn’s disease and dandruff are closely tied as they originate from the same fungi Malassezia. Malassezia is found on the skin surface of billions of people. And leads to numerous dermatological conditions and in hosts with compromised immunity it may cause systemic infections. One way of treating Crohn’s disease would be to get rid of the fungal causing it- Malassezia.
Since Malassezia is of the skin commensal flora species, the host’s immune system is exposed to the fungi regularly. IgM and IgG specific to Malassezia can be easily detected in healthy individuals. Malassezia sensitivity depends on genetic background, dysfunctional skin barrier, and environmental factors. Crohn’s patients may lack anti-microbial peptide induction which is produced by the skin as the body’s first defense against fungi Malassezia.
Types of anti-fungal that work well against Malassezia
Both oral and topical antifungals are efficient treatment options for fungal Malassezia. Oral treatments have proven to work faster and with dramatic effect in the clearing of lesions making them have an advantage over topical antifungals.
Patients have successfully been cleared of Malassezia (Pityrosporum) Folliculitis (a species of Malassezia) using Fluconazole administered on a weekly basis or with oral Itraconazole. M sympodialis- another type of Malassezia is more sensitive to treatment using Terbinafine while some other species are completely resistant to this medication.
Ketoconazole; both oral and in the form of a topical shampoo are currently recommended as a treatment for Malassezia folliculitis. This form of treatment should be discontinued immediately when the lesions have disappeared.
There are other topical antifungals that are recommended for the treatment of Pityrosporum folliculitis such as ciclopirox olamine cream, alcohol econazole cream, and salicylic acid solution (usually made up of 5% benzoic acid). A solution of selenium sulfide shampoo in water and 50% propylene glycol is a viable treatment too. Other successful topical treatments include; tea tree oil, Cinnamic acid, and tacrolimus.
In cases where the host was using antibiotics, discontinuing the antibiotics may help. Other studies have suggested that methyl aminolevulinate and photodynamic therapy is a potential course of treatment.
Topical Anti-fungal Agents:
- Ketoconazole lotion 2% daily
- Econazole nitrate cream 1% daily
- Clotrimazole cream 1% daily
- Miconazole cream 2% once or twice daily
- Ciclopiroxolamine solution 1% daily
- Terbinafine cream 11% twice daily
Oral Anti-Fungal agents:
Tests that must be done during treatment
There are two major reasons why tests are carried out in Crohn’s disease; To determine if you have the disease or re-evaluate the status of the disease.
Some tests that may be carried out before or in the course of treatment include:
Routine- to find out the infection you have, indicators of inflammation, anemia and identify mineral and vitamin deficiencies
Fecal- to determine if you have ruptured intestines depending on the stool sample submitted
Antibody tests- depending on the proteins released by the immune system the doctor can clearly determine if you have UC or Crohn’s disease
Conventional X-ray: a general x-ray of the abdomen to check for intestinal blockage or narrowing intestines from scarring or blockage to rule out some complications that come with Crohn’s.
Contrast X-ray: meant to evaluate the intestine condition, by applying chalky liquid called barium that creates a replica of the intestines, rectum, and colon
CT scan: used to produce a cross-sectional image of bowel, tissues, and other things that the X-rays may fail to show
White blood cells scan: determines the extent of inflammation on your gastrointestinal tract caused by Crohn’s disease
MRI: plays a huge role in the treatment and management of Crohn’s by creating images using radio waves and magnetic field
There are numerous possible treatment therapies for Crohn’s disease-causing fungi Malassezia. All these possible treatments seem to focus on certain species of fungi which makes it hard to find the right combination that can completely and safely get rid of Malassezia. It would be great if one of these therapies would be a cure for Crohn’s disease.
Ribaldone, D. G., Astegiano, M., & Pellicano, R. (2017). The role of hepatic enzymes in Crohn’s disease. International journal of colorectal disease, 32(9), 1363-1364.