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10 Million People Suffer From This Scalp Condition. Here's How One Woman Found Relief.
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Like many Black women, Grace Floyd, began to use chemicals to alter the texture of her naturally coarse, thick hair at a young age—8, to be exact. Around that time, she began to notice irritated, flaky patches of skin popping up around her eyebrows, hairline, nose, and the inside of her ears. "I have early memories of stylists pointing out the 'dryness' on my scalp, telling me to grease it with oils," she recalls.
It didn't help.
Adults in Floyd's life were perplexed too—what could be causing these symptoms? Some assumed it was a reaction to the hair relaxers. A nurse at school suggested it was a cleanliness issue, which only made Floyd more self-consciousness. "At that age, I didn't have the knowledge or confidence to question those assumptions," she admits. "So, I really internalized the belief that something was wrong with me."
A true diagnosis didn't come until a few years later, when at 12, a dermatologist told Floyd that her longtime skin struggles were not a product of uncleanliness or a temporary reaction to hair treatments, but rather flare-ups of seborrheic dermatitis. She was one of more than 10 million people in the United States living with the inflammatory skin condition, known to cause chronic dryness, flaking, and scaling of the skin.
Finally, an answerA form of eczema categorized by a chronic dryness, flaking, and scaling of the skin, seborrheic dermatitis is often associated with one of its hallmark physical manifestations: dandruff. "It's quite common, affecting between one and five percent of the population," says Kenneth Mark, MD, a board-certified dermatologist in New York City. And while it can appear in patients of all ages and skin types, research show it's one of the top five medical diagnosis received by Black patients, affecting 6.5% of this population.
Related StoriesIn adults, seborrheic dermatitis is a lifelong condition that cannot be cured, only managed. Although the skin disease most typically occurs on the scalp and face, flare-ups are also known to happen in other areas with plentiful sebaceous glands, including the chest, upper back, and inside and around the ears.
The root of the issueLike similar skin conditions, the cause of seborrheic dermatitis isn't always easy to pin down. "It's believed to be connected to a disruption of the skin's microbiome by an overgrowth of a yeast-like fungus called Malassezia," explains Geeta Yadav, MD, a board-certified dermatologist in Toronto. Malassezia grows in the presence of skin's natural oil, called sebum, so overactive sebaceous glands or infrequent hair or face washing can exacerbate the condition. This important detail came too late for Floyd, who spent years following the advice of her hairstylist—to treat scaly patches with emollients and oils, a solution commonly explored by patients of color, research shows. "It wasn't until I was in my thirties that a dermatologist informed me that oil on the scalp can actually exacerbate seborrheic dermatitis," says Floyd, now 45. "Who knows how much more damage I was doing with my haircare regimen."
Other risk factors for developing the condition include "genetics, stress, hormonal fluctuations, dry air, and a weakened immune system due to diseases such as HIV or Parkinson's Disease," Dr. Yadav adds.
Unexpected tollThe irritation and flakiness can cause a secondary set of symptoms—such as post-inflammatory hyperpigmentation and skin lightening, which are both common problems in patients with deeper skin tones. In rare cases, sebhorreic dermatitis can result in hair loss, possibly due to scratching or oxidative stress caused the overgrowth of Malessezia, some research suggests.
But the physical side effects pale in comparison to the emotional toll. "Like eczema and psoriasis, seborrheic dermatitis is immediately visible and draw unwanted attention, causing patients to change the clothing they wear to minimize the appearance of flakes," Dr. Yadav says. "Many struggle with self-esteem issues due to the condition." For Floyd, it spawned years of shame, something she's only been able to fully come to terms with as an adult. "Seborrheic dermatitis caused me to shrink, to avoid drawing too much attention to myself," she recalls. "Even on days when I started off without a flare-up, I was constantly aware that one could develop, and this awareness affected everything from how close I allowed people to get to me to my clothing choices to my willingness to be photographed."
Difficult road to diagnosisMany cases of seborrheic dermatitis take time to be properly diagnosed—especially in those with darker skin, who may present differently from those with lighter complexions. And though most patients will try an over-the-counter remedy as their first line of defense, Dr. Yadav suggests seeing a dermatologist at the first sign of symptoms. "This condition can take a toll on one's mental health, so I recommend seeking medical attention as soon as possible," she says. "Managing your seborrheic dermatitis can go a long way toward improving your everyday life."
In most cases, a conversation and physical examination is enough to diagnose the skin disease, but dermatologists will likely ask about family and medical history as well, just to rule out the possibility of other forms of eczema or psoriasis.
Relief within reachLuckily, there's a wide range of options for those dealing with seborrheic dermatitis, from readily available over-the-counter solutions that aim to reduce the impact of Malassezia or slough away dead skin cells and oil to prescription-strength topical steroids and anti-yeast medications, Dr. Mark says. But while effective, many of these treatments are impractical for Black women in particular, research shows, because they require near-daily use and don't take into account the fact that different ethnicities may wash less frequently.
It's a conundrum Floyd experienced first-hand: She tried her luck with over-the-counter products containing zinc, salicylic acid, and coal tar and even experimented with sulfur products, which ultimately singed her strands. "Most of the shampoos completely dried out my hair, and the creams caused hyperpigmentation," she recalls. "If you were to look at pictures of me in middle school, you'd notice discoloration around my hairline–the result of harsh topical steroids."
As a result, Floyd turned to home remedies. "I tried everything from apple cider vinegar to coconut oil to aloe vera to tea tree oil," she says, admitting that during flare-ups, she'd apply these ingredients to affected areas on her face and scalp. But she quickly learned that "just because something is natural, doesn't mean it will be gentle or effective." Of all these natural remedies, aloe vera is the only one that remains in her treatment plan today, alongside a prescription steroid shampoo and Zoryve (roflumilast) 0.3%, a topical foam she discovered earlier this year and swears by.
And while seborrheic dermatitis cannot be cured or reversed, flare-ups can be avoided. The best form of prevention is frequent washing of the body, face, and scalp with antifungal ingredients, an especially crucial step after exercise or on humid or sweaty days. Extra precautions like sticking to lukewarm showers, limiting stress where possible, wearing loose clothing that won't irritate skin, and adding humidity to the air with a humidier can also help, says Dr. Mark notes. "The key is to treat it and get better—it's a fixable problem," he says.
A path forwardBut perhaps the most transformational step for Floyd was confronting her vulnerability and discussing her condition openly. It was then that she started to realize how much seborrheic dermatitis had held her back over the years—and how she needed to break free from that mindset. "I went from living with embarrassment and feeling unattractive to finding power in sharing my story," she says. "It's now become an important part of my journey to honor the fullness of who I am."
Gabby Shacknai is a New York-based journalist and editor who produces high-quality content for a wide variety of outlets and brands across various industries.
Sepsis Causes Over 350,000 Deaths Annually. This Lab Test Can Reduce That By A Third.
Henry Tse (L) and Ajay Shah (R), cofounders of Cytovale.
CytovaleEvery year, over 1.7 million Americans will experience sepsis, which occurs when the immune system is unable to fight off an infection and instead begins an extreme response where it, in the words of Cytovale CEO Ajay Shah, starts "carpet bombing everything" and attacking the body's own organs. But there hasn't been a good way for doctors to quickly figure out what's happening.
Shah's company has developed the first rapid lab test for sepsis that's been cleared by the FDA, called IntelliSep. The technology is already in place in six hospitals in two health systems, one of which has reported a reduction in sepsis mortality of over 30% after a year of incorporating the test into its practice. That's a huge number, given that over 350,000 Americans who develop sepsis die every year, according to the CDC, making it the third leading cause of death in hospitals.
Today Cytovale announced that it has raised a $100 million series D investment round aimed at ramping up the commercialization of its technology. The round was led by Sands Capital and values the company at around $350 million.
The company's technology aims to make diagnosis of sepsis as straightforward as it can be for other conditions. "If you walk into an emergency room with chest pain today," Shah said, "there's very clear protocols in place" to diagnose what's going on with a patient, starting with an EKG and moving on to other tests. With sepsis, it starts with a doctor making a judgment based on symptoms, then sending a patient to do time and resource consuming tests or just ordering treatment right away. But this process requires more art from doctors and nurses than it does science, leading to needless treatment for some patients not at risk while missing those who are.
Cytovale's technology "is something that will translate fairly broadly to address a problem that has stymied our healthcare system for a long time," Parker Cassidy, a partner at Sands Capital, told Forbes. "It moves fast and it's deadly. And without an effective triage tool in the emergency department, you're not getting patients on the right path fast enough," he added.
Cytovale was founded in 2012 by Shah, Henry Tse, now CTO of the company, and Dino Di Carlo, a bioengineering professor at UCLA. Shah and Di Carlo first met while Di Carlo was a postdoctoral student and Shah a graduate student at Massachusetts General Hospital. They reconnected when Tse was a researcher at UCLA in Di Carlo's lab looking at analyzing cell structures; the work Tse did there with Di Carlo forms the basis of the company's technology.
In a nutshell, the company's sepsis test examines how the structure of cells change when they are stressed. Shah likened it to throwing a water balloon against a wall and seeing what happens–one filled with water will behave one way, but differently if something like a bowling ball is inside. Based on what's observed, within 10 minutes patients can be rated on a 10 point scale to determine their sepsis risk and treated accordingly.
While that sounds simple enough in principle, in practice it took the company years of testing to get the technology to the point where it could be optimized for medical practice. It began a clinical trial with patients in 2021 with an eye towards regulatory approval. The results of that study, which were published in 2022, found that the test was able to accurately classify patients as high or low risk, based on their health outcomes. Later that year, the FDA cleared the IntelliSep test for use in hospitals to assess sepsis risk, and Cytovale launched it commercially in August of that year. Now, its new funding round will enable the company to expand to more health systems, working with them to incorporate the test into their clinical practices.
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One of the first hospitals to utilize the test was Our Lady of the Lake hospital in Louisiana. Since it rolled it out in its emergency room, IntelliSep has made a huge difference for its patients, Christopher Thomas, chief quality officer for the Franciscan Missionaries of Our Lady Health System, which runs the hospital, told Forbes. Identifying high-risk patients enabled the hospital to treat them faster, and reduced their mortality risk by over 35%, he said. Those patients also spent less time in the hospital by about a day and a half.
An additional benefit, Thomas added, is that being able to utilize this test saves time for healthcare providers, freeing them up to handle other patients. In the first year of using the test, the hospital was able to avoid performing over 3,000 blood culture tests, which occupy a nurse's time for nearly 8 minutes apiece — that's 400 hours, or about 10 weeks of work for a single nurse. "One of the nurses told me, this may not seem like a big deal to you, but spending eight minutes not poking the patient gives me eight minutes to talk to them," Thomas said.
Use of the test in the emergency room is now being scaled up to five hospitals in the Franciscan Missionaries of Our Lady Health System, he said, which collectively see over 210,000 emergency room patients every year. And it's expanding: In August, the company began rolling out its test at the Froedtert & the Medical College of Wisconsin health network.
"By helping [clinicians] see sepsis in just those first few minutes, we'll be able to get the right patients down the right care pathway and we'll be helping the hospital balance its resources," said Shah.
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EDP-323, an investigational inhibitor of Respiratory Syncytial Virus (RSV), is showing promising results in Phase 2a trials. While other RSV therapies and vaccines are approved for prevention, EDP-323 could become the first antiviral drug specifically designed to treat RSV infections. Here's a look at some promising data.
This may sound strange but on some level antiviral drug research is "easy." Make that "easy compared to other therapeutic areas," because those who do research in the antiviral field – something I did for 10 years – have an advantage over scientists who work on other conditions, such as Parkinson's, pancreatic cancer, or autoimmune diseases. This advantage, which is based on pioneering work in the HIV/AIDS field, may lead to the first-ever antiviral drug for respiratory syncytial disease (RSV).
This is no small accomplishment. The search for a drug to treat RSV has been going on for about 50 years (1), but researchers at Enanta Pharmaceuticals may be the first group to the finish line. However, they didn't get this far without help. This help began in 1995 – 14 years after the beginning of the AIDS epidemic in the US – when researchers at Roche introduced saquinavir (Invirase), the first effective direct-acting antiviral drug (DAAD) for the treatment of HIV infection. After the introduction of Invirase, an HIV protease inhibitor, the death rate from AIDS began to drop for the first time. Since that time, drugs have been developed for every step in the life cycle (Figure 1), forming the basis of modern treatment of HIV infection.
Figure 1. The life cycles of HIV (left) and RSV (right). The life cycle of HIV is similar (but not identical to) that of RSV. As is the case with all viruses, the synthesis of new genetic material (DNA or RNA) is essential for replication. The yellow boxes and green double-headed arrow for both viruses denote this step. The steps -- 8 for HIV and 7 for RSV, are also referred to as targets.
Enanta is developing EDP-323, a drug that inhibits the viral polymerase required to build new genetic material from individual nucleotides. When this step is inhibited, viral replication decreases, resulting in a reduction of viral load. This allows the body to clear the virus more effectively.
A comprehensive reflection on the current state of RSV research is also given, drawing inspiration from the lessons gleaned from HCV and HIV
Felicetti, et. Al., J. Med. Chem. Vol 67/Issue 14, July 6, 2024Why do we need it?
Despite the availability of three new RSV vaccines, a small molecule inhibitor of the virus would represent a crucial advance in treating respiratory infections. RSV causes approximately 2.1 million emergency room visits annually in children under 5, with over 50,000 requiring hospitalization. For adults aged 60 and older, the number of annual hospitalizations ranges from 100,000 to 160,000. The estimated annual cost of treatment in the U.S. Alone is $6.6 billion. People remain unvaccinated due to a number of reasons: limited access, medical ineligibility, or vaccine hesitancy. Additionally, children must be at least 8 months old to receive the vaccine, leaving a significant portion of the population unprotected.
What must such a drug do?
To develop a successful antiviral drug a number of criteria must be satisfied:
What did EDP-323 do?
In a Phase 2a human challenge study (2) conducted on 142 healthy adults, once-daily EDP-323 treatment resulted in 85-87% reduction in viral load and 97-98% reduction in infectious viral load, with a 66-78% reduction in symptoms compared to placebo. The drug was found to be safe and well-tolerated. Although these results have not yet been published in a peer-reviewed journal they are impressive by any measure.
How good are these results?
While working on hepatitis C at Wyeth, we would have killed for results that even resembled these. The potency, bioavailability (3), efficacy, and safety profile of EDP-323 are all covered. Although these data are from Phase 2a trials (and many drugs fail in Phase 3) I see nothing but good news here with the caveat that these results must be repeated in a larger study population. Still, I predict it will do just fine.
Bottom line
Is antiviral research 'easy'? In some respects, yes—thanks to the road map established by AIDS researchers, we have a clearer understanding of how to approach drug development for other viruses. Biologists identify key molecular targets in a virus, and chemists can design molecules to inhibit these targets. When an experimental drug potently inhibits an essential viral target, is non-toxic, and has sufficient bioavailability, it really should prevent the formation of new viral particles within your body. This strategy has led to the development of more than 40 direct-acting antiviral drugs for AIDS and HCV.
As a former researcher, it is especially satisfying to see that Enanta used a strategy that slammed the door on AIDS, cured hepatitis C, and treated COVID-19 can work against a new and important viral target. I wish them well.
NOTES:
(1) Other "treatments" for RSV infections are available, but they are either poorly effective, toxic, or both. Ribavirin has been used, but with little success. Antibodies are available, but these offer passive immunity; they are not therapeutic. The vaccine is not approved for babies younger than 8 months. There is a real need here.
(2) A challenge study is where participants are deliberately infected with a pathogen.
(3) Bioavailability is a measure of the percentage of an oral drug that gets into the blood. The higher the number the better.
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