Anti-dandruff effects of butterfly pea flowers (Clitoria ternatea)-based shampoo: A pretest-posttest control study

Butterfly pea flower (<i>Clitoria ternatea</i>) may serve as an alternative anti-dandruff treatment; however, its effects on <i>Malassezia</i> spp. remain unexplored. The aim of this study was to explore the effects of <i>C. ternatea</i> as an herbal-based anti-dandruff treatment on <i>Malassezia</i> spp. DNA expression, plakoglobin levels, IL-8 levels, sebum levels, dandruff severity scores, adverse effects, and patient satisfaction. An experimental study with a pretest-posttest control design was conducted at the Outpatient Clinic of Dermatology and Venereology, Arifin Achmad Hospital, Pekanbaru, Indonesia, from November 2023 to January 2024. The flower of <i>C. ternatea</i> was used to formulate the shampoo. The study involved 70 female patients aged 18-25 with dandruff, who were divided into two groups: (a) experimental group using 20% <i>C. ternatea</i> shampoo and (b) control group using 2% ketoconazole shampoo. The present study found that 2% ketoconazole shampoo significantly reduced <i>Malassezia</i> spp. DNA expression compared to 20% <i>C. ternatea</i> shampooo (<i>Clitoria ternatea</i>: ΔCq=1.76±3.18; ketoconazole: ΔCq=3.77±2.90; <i>p</i>=0.008). No significant difference was observed in plakoglobin levels (<i>C. ternatea</i>: ΔCq=1.98±3.63; ketoconazole: ΔCq=2.50±2.36; <i>p</i>=0.427) or IL-8 levels (<i>C. ternatea</i>: ΔCq=3.46±4.00; ketoconazole: ΔCq=4.16 ± 3.62; <i>p</i>=0.459). <i>C. ternatea</i> significantly reduced sebum levels more than ketoconazole (<i>C. ternatea</i>: 1.16±0.98%; ketoconazole: 0.22±0.38%; <i>p</i><0.001). Dandruff scores and patient satisfaction were similar for both shampoos (<i>p</i>=0.115 and <i>p</i>=0.336, respectively). Adverse effects were more common in the 2% ketoconazole shampoo group, affecting 21.2% of the patients. In conclusion, 2% ketoconazole shampoo is more effective in reducing <i>Malassezia</i> spp. DNA expression, while 20% <i>C. ternatea</i> shampoo offers better sebum control. Both shampoos are similarly effective in ameliorating dandruff severity and are well-tolerated, with fewer adverse effects reported for <i>C. ternatea</i>.