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PDAT1 > 10 - Scaly Dermatosis > Flashcards

10 - Scaly Dermatosis Flashcards

1
Q

Definition + Types of Scaly Dermatoses

A

Involve epidermis + Scales are primary manifestation

Dandruff -> Seborrheic Dermatitis -> PSORIASIS

increasing Severity + Inflammation

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2
Q

Seborrheic Dermatitis

SD

A

NOT a disease of the sebaceous glands
Rate of sebum production is NOT necessarily increased

Found in areas w/ larger or higher amounts of glands

Can be in association with MALASSEZIA

Immunologic + Hyperproliferative

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3
Q

Malassezia

A

YEAST found on NORMAL skin
metabolize fatty compounds in sebum

Can be Directly Pathologic:
Pityriasis Versicolor / Systemic Infections

Also Indirectly Pathalogic:
in Dandruff & Seborrheic Dermatitis

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4
Q

Pathophysiology of SD

Seborrheic Dermatitis

A

In combination, make an
Exaggerated Immune Response to Malassezia Yeast:

Malassezia
metabolize FATTY compounds, found in LIPID-RICH location

Immunologic
common in immune supressed, more CYTOKINES

HYPERproliferative
Overlap with PSORIASIS, lack of efficacy of antifungals

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5
Q

Combined PATHWAY of Scaly Dermatosis

A

Malassezia Fungus influences Dandruff & SD,
not thought to be a factor in Psoriasis

  1. Inflammation
    1. ​varies between diseases
  2. Proliferation + Differentiation
    1. ​also varies between diseases, tied with inflammation:
      1. normal = 25-30 days >> dandruff = 13-15 days
        1. >> SD = 9-10 days >> psoriasis = 4 days
  3. Barrier Disruption
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6
Q

S/S of Dandruff

A

Fine / White Flakes

SCALP involvement

Diffuse distribution

Can have Pruritus

Usually NO Erythema

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7
Q

S/Sx of ​Seborrheic Dermatitis

A

Yellow + Greasy scales, can be scalp involved
+ facial & other areas w/ HIGH amounts of sebaceous glands

Pruritus
Presence of Erythema

Seen in adolescents + adults
MORE COMMON in immune compromised + Parkinsons

Well demarcated lesions

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8
Q

LOOKALIKE Diseases

A

Atopic Dermatitis

Allergic/Irritant Dermatitis

Rosacea

Cutaneous Fungal Infection

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9
Q

S/Sx of Psoriasis

A

SHARPLY Demarcated

SILVERY-WHITE scales

Commonly found on :
scalp / Elbows / Knees / Back

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10
Q

What Treatment Mechanism do these medications ACT ON?

Pyrithione Zinc / Ciclopirox

Keto/sertaconazole / Selenium Sulfide

Tea Tree Oil

A

DIRECTLY on the MALASSEZIA FUNGUS

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11
Q

What Treatment Mechanism do these medications ACT ON?

Corticosteroids

Calcineurin Inhibitors

Tea Tree Oils

A

INFLAMMATION

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12
Q

What Treatment Mechanism do these medications ACT ON?

Coal Tar

Selenium Sulfide

Pyrithione Zinc

A

CYTOSTATIC:

Proliferation + Differentiation

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13
Q

What Treatment Mechanism do these medications ACT ON?

Salicylic Acid

A

Keratolytic –> Proliferation & Differentiation

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14
Q

What ST-Medications are FIRST LINE for

DANDRUFF?

A
  • *Selenium Sulfide**
  • hair discoloration + oily scalp*

Pyrithione Zinc

Ketoconzole 1%

skin irritation / contact dermatitis

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15
Q

What ST-Medications are Second LINE for

DANDRUFF?

A
  • *Coal Tar**
  • hair discoloration / staining / PHOTOsensitivity / folliculitis*

Salicylic Acid

  • Natural = Tea Tree Oil*
  • allergic rxns*
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16
Q

Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE’s

of (serta)KETOCONAZOLE

A

Act Directly on Malassezia

Interferes with Membrane Synthesis

ST: 1st line for Dandruff & SD

​RX: 1st line for S​D
2% Keto Shampoo / Cream / Foam / Gel, BID F8W
photosensitivity
2% Sertaconozole Cream, BID F4W

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17
Q

Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE’s

of CICLOPIROX?

A

Act DIRECTLY on the Malassezia Fungus

Disrupt Metabolism

RX Only: 1st Line
1% Shampoo = QD -> Twice a Week
0.77% Gel / Cream = BID for 4 weeks

18
Q

Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE’s

of PYRITHIONE ZINC?

A

Act DIRECTLY on the Malassezia Fungus + Cytostatic-Prolif/Differentiation

INCREASED Copper + Disrupt Metabolism

ST: 1st Line for Dandruff + SD

found in head & shoulders

19
Q

Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE’s

for SELENIUM SULFIDE?

A

Act on BOTH the Malessezia Fungus + Cytostatic -Prolif+Differentiation

Promote Shedding of the stratum corneum + Anti-Fungal properties

ST: 1st line for Dandruff

20
Q

​1st line Self Treatment for SD

A

Anti-Malassezia Shampoos
can be used in facial areas as well

Phyrithione Zinc

Selenium Sulfide

Ketoconazole 1%

21
Q

Self treatment for SD

if patient has ERYTHEMA / yellow or oily lesions

A

HYDROCORTISONE

Erythema after use of MEDICATED shampoos

along with the medicated shampoos

22
Q

Self Treatment for Infants/Cradle Cap (Mild cases) for

Seborrheid Dermatitis

A

Massage w/ BABY OIL

Non-residue / Non-medicated Baby Shampoo, to REMOVE Scales

No medicated shampoos approved for Children
<2 years old

23
Q

Application + Frequency of use for

MEDICATED SHAMPOOS

Ex. Pyrithione Zinc + Selenium Sulfide + Ketoconazole

A
  • *Scalp = Adequate Contact**
  • Before using medicated shampoo,*
  • *Use Non-medicated/nonresidue shampoo FIRST**

Massage into scalp and leave it on for 3-5 minutes

2-3x/week for 2-3 Weeks –> 1x/week to control

Ketoconozole = Twice a Week F4W, w/ at least 3 days between each treatment

24
Q

1st like PRESCRIPTION treatment for

Seborrheic Dermititis

A

ANTIFUNGALS
burning / contact dermatitis

Ciclopirox 1%

  • *Ketoconazole 2%**
  • photosensitivity*

Sertaconazole 2%

25
Q

Second Line PRESCRIPTION treatment for

Seborrheic Dermatitis

A
  • *Corticosteroids**
  • hypopigmentation / skin atrophy / telangiectasia*
  • *Calcineurin Inhibitors**
  • *Pimecrolimus 1% ,** BID HA + URI
  • *Tacrolimus 0.1%,** BID pruritus + flu like symptoms
  • burning*
26
Q

EX-ST for Dandruff + SD + Psoriasis

A

<2 y/o

Worsening or NO improvement within 2 weeks of treatment

27
Q

EX-ST for PSORIASIS

A

<2 y/o** + no improvement/worse within **2wks of treatment

>5%** **BSA

Lesions >Quarter in size

FACIAL Lesions / JOINT Pain

28
Q

Chart for Treating Scaly Dermatosis

A
29
Q

Risk / Triggers for PSORIASIS

A

Genetics

Infections: Strep Throat = Guttate psoriasis

Skin Trauma

Smoking / Alcohol

Obesity / Hormonal Changes / Emotional STRESS

Medications
Beta Blockers (-olol) + Lithium + Anti-Malarials + Steroid Withdrawal
+ NSAIDS + Tetracyclines + Ace-I

30
Q

Types of Psoriasis:

A

Chronic Plaque Psoriasis
most common, erythema + raised + sharply defined
silvery scales + asymptomantic, some prurtus

Pustular Psoriasis
Erythema + scaling + pustules
accompanied by systemic complications –> life threatening

Psoriatic Arthritis, SYSTEMIC involved

Other less common types:
Erythrodermic / Inverse / Nail

31
Q

Medications Associated W/ PSORIASIS

A
  • *Beta Blockers**
  • olol

Lithium

Anti-Malarials
Chloroquine + ydroxychloroquine -> exacerbate psoriasis

Steroid Withdrawal

Nsaids / Tetracyclines / Ace Inhibitors

32
Q

Pathophysiology of PSORIASIS

A

Abnormal Immune Mediation

  1. Trigger = Trauma / Infection / Stress / ??
  2. Stressed Keratinocytes
  3. INFLAMMATION
  4. Keratinocyte:
    1. Division + Plaque Formation
    2. Activation -> Cytokine Production
33
Q

Non-RX, Self-Treatment for PSORIASIS

A

Appropriate for MILD Psoriasis
<5% BSA, lesions <quarter></quarter>

<p>Remove scales w/ <strong>soft cloth</strong> after bathing</p>

<p>Use of <strong>EMOLLIENTS</strong> after bathing up to <strong>QID</strong></p>

<p><strong><u>Hydrocortisone ointment</u></strong>, BID</p>

<p> </p>

<p><u><strong>SEE DR AFTER 2 WEEKS of no improvement or worsening</strong></u></p>

</quarter>

34
Q

Topical Prescription Treatment for

PSORIASIS

A

For MILD - MODERATE Psoriasis

Corticosteroids

Vitamin D Analogs
Calcipotriene / Calcitriol - BID

Calcineurin Inhibitor
Tacrolimus / Pimecrolimus - BID, okay for FACE + Intertriginous

Vitamin A Derivative
Tazarotene = QD

35
Q

Treatment for Mild-Moderate PSORIASIS

A

1st: Topical Corticosteroids

ALT: Topical Vitamin D Analogs + Topical Retinoids

Face or Intertriginous = Calcineurin Inhibitors

Can use corticosteroids + Vitamin D analogs in COMBO or Intermittently

36
Q

Treatment for SEVERE PSORIASIS

>5-10% BSA

A

PHOTOTHERAPY
Narrow Band UVB > UVB, both TID

Photochemotherapy (PUVA) - TID

Excimer Laser - Twice a week

SYSTEMIC TREATMENTS
Systemic Retinoid = Acitretin

Immune Supression/modulatory = Methotrexate + cyclosporine

37
Q

Systemic Treatment for PSORIASIS

A

Systemic Retinoid
Acitretin
effect epidermal proliferation + immunomodulation

Immune Suppresion / Immunomodulatory
Methotrexate / Cyclosporine / Apremilast / Biologics

38
Q

UV Treatment for PSORIASIS

A

MOA = Anti-Proliferative + Anti Inflammatory
erythema / blistering / HYPERpigmentation / photodamage / malignancy

Narrow Band UVB > UVB
both TID, Narrow band is more effective, effects T-cells

Photochemotherapy = PUVA
BID, combo oral / topical, deeper

Excimer Laser
2x/week, UVB at targeted area

39
Q

Treatment Mechanism / Uses (1st/2nd line?) / AE’s

of CORTICOSTEROIDS

A

Act on Inflammation

ST for SD: Used AFTER shampoos if ERYTHEMA

  • *1st line for Mild to Moderate Psoriasis**
  • skin atrophy / hypo pigmentation / acne / bruising*
40
Q

Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE’s

for CALCINEURIN INHIBITORS?

A

Act on INFLAMMATION

  • *Topical RX treatment for Mild/Moderate PSORIASIS**
  • *FACIAL or Intertriginous**

BID, Tacrolimus / Pimecrolimus

41
Q

Mechanism of Action of Topical Psoriasis Treatments:

Vitamin D Analogs / Vitamin A Derivatives / Coal Tar

A

ACT ON CYTOKINE PRODUCTION

Keratinocyte Activation

PDAT1 (27 decks)

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