Comparison of Green-Synthesized Silver Nanoparticle Shampoo Created by Moringa and Bergamot Extraction Versus 2% Ketoconazole Shampoo for Scalp Seborrheic Dermatitis: A Prospective, Randomized, Double-Blinded, Controlled Trial

Abstract

Introduction: Seborrheic dermatitis (SD) is one of the most common relapsing–remitting scalp diseases. The symptoms of SD are relieved by many treatments, including antifungal shampoos such as zinc pyrithione, selenium sulfide, and azole shampoos. This study aimed to investigate the effects of a shampoo containing green-synthesized silver nanoparticles (AgNPs) in relieving the symptoms of SD. Methods: Bergamot peel and moringa leaf extracts were green-synthesized to produce AgNP. Characteristic of AgNP particle was. The AgNPs were assessed to determine the minimum inhibitory concentration for Malassezia furfur and formulate the AgNP shampoo. Sixty patients with moderate to severe scalp SD were prospectively randomized into the 2% ketoconazole shampoo group (n = 30) and the AgNP shampoo group (n = 30). Scalp samples were collected for potassium hydroxide preparation and fungal culture for Malassezia species. The adherent scalp flaking score (ASFS), Dermatology Life Quality Index, and patient satisfaction were assessed. Results: After the first week, the ASFS was significantly lower in the AgNP shampoo group compared with the 2% ketoconazole shampoo group (p = 0.014, p = 0.083). However, both shampoos significantly improved the ASFS at 2 and 4 weeks compared with the baseline. The improvements in the ASFS were not sustained at 1 month after discontinuing the use of either shampoo. The potassium hydroxide preparation and fungal culture could not identify the responsible fungus. The Dermatology Life Quality Index was significantly improved from baseline to Week 4 in the AgNP shampoo group (p = 0.026) but not the 2% ketoconazole shampoo group (p = 0.171). The overall patient-rated satisfaction levels were similar in the two groups. No adverse events were reported during the study, and there were no dropouts. Conclusion: Green-synthesized AgNP shampoo created using bergamot and moringa extract exhibited comparable efficacy to 2% ketoconazole shampoo in treating scalp SD.