Mechanisms, translational opportunities for diabetic polyneuropathy.

Pityriasis capitis, commonly referred to as dandruff, is a common scalp disorder characterized by excessive desquamation of the scalp and is widely regarded as a mild clinical manifestation of seborrheic dermatitis (, ). Although not life-threatening, the condition can substantially impair quality of life owing to persistent scaling, visible flaking, and associated discomfort (). Dandruff affects individuals across all age groups, including infants, adolescents, and adults, and is estimated to affect approximately 50% of the global population, with a higher prevalence reported in males than in females (). Despite its widespread occurrence, epidemiologic data focusing specifically on adolescents remain limited. Nevertheless, available studies from France and Nigeria have consistently demonstrated that adolescents represent the age group with the highest prevalence of dandruff (, ). Seborrheic dermatitis itself has an estimated global prevalence of approximately 4.38% (). Population-based studies further support the high burden of scalp seborrheic conditions among adolescents: a prevalence of 11% has been reported among adolescent males in Pelotas, Brazil (), while a similar prevalence of 10.17% has been documented among Han Chinese adolescents aged 12–20 years (). Collectively, these findings highlight dandruff as a particularly prevalent dermatologic concern during adolescence and underscore the need for effective and well-tolerated management strategies in this population. Beyond its physical manifestations, dandruff and related scalp disorders can exert a substantial psychosocial burden, particularly among adolescents. The visible nature of scalp flaking and desquamation, often adhering to hair shafts and dark clothing, can lead to embarrassment, diminished self-confidence, and social discomfort in this age group (, ). Despite its high prevalence and adverse impact on psychosocial health, the pathogenesis of dandruff and seborrheic dermatitis remains incompletely understood. Current evidence suggests that the condition arises from a multifactorial interaction involving sebaceous gland activity, colonization by yeasts, and individual host susceptibility, including variations in skin barrier function and immune response (). Specifically in adolescents, puberty-related hormonal changes stimulate excessive sebaceous gland secretion, which significantly predisposes this population to scalp seborrheic conditions. Among these factors, members of the genus are widely considered central to disease development and exacerbation, as their metabolic activity and interactions with host skin lipids can trigger inflammatory responses and abnormal keratinocyte turnover, ultimately leading to the characteristic scaling observed in dandruff. However, current therapeutic options for dandruff present several limitations, particularly with respect to formulation concentration. Selenium sulfide-containing shampoos are widely used over-the-counter antifungal treatments for dandruff and seborrheic dermatitis, and have been explicitly recommended for adolescent patients by recent clinical consensus guidelines (). However, commercially available formulations typically contain concentrations ranging from 1% to 2.5%. Although these formulations are effective, higher concentrations have been associated with undesirable adverse effects, including scalp dryness, hair shaft dryness, textural alterations, and chemical irritation (, ). These concerns are particularly relevant among adolescents, as their scalp skin barrier may already be compromised in the presence of dandruff, and this vulnerability may be further accentuated during puberty (). Consequently, the use of high-concentration antifungal shampoos may negatively affect treatment adherence owing to unfavorable cosmetic outcomes, such as excessive dryness and dull hair appearance. Despite these considerations, evidence regarding the efficacy and tolerability of lower-concentration selenium sulfide formulations specifically designed for adolescents remains limited.