3 - Scaly Dermatitis Flashcards
What is coal tar?
A keratolytic, antiseptic that reduces local swelling & inflammation
What does keratolytic mean?
Breaks down skin cells
Does coal tar have any antifungal properties?
Minimal
What are side effects to coal tar?
- Acne
- Folliculitis (infection of hair follicles)
- Stains to skin and air
- Photosensitization
- Irritant contact dermatitis
What is zinc pyrithione generally found in?
Anything to treat dandruff or itchy scalp
What is zinc pyrithione?
Cytostatic and keratolytic agent
What does cytostatic mean?
Decreases rate of epidermal cell replication
Zinc pyrithione has ____ and ____ properties
Bacteriostatic and fungistatic
Is zinc pyrithione or selenium sulfide slower acting?
Zinc pyrithione
What is one side effect of zinc pyrithione?
Rare cases of contact dermatitis if used on broken or abraded skin
What is selenium sulfide?
A keratolytic that slows down scale production and epidermal proliferation
Does selenium sulfide have some fungicidal or fungistatic effects?
Both
Why must selenium sulfide be washed through hair thoroughly?
Hair discolouration may result
What does frequent use of selenium sulfide typically cause?
Residual odour, oily scalp, and hair loss
Does selenium sulfide cause irritation when used topically?
Minimal
Ketoconazole is an _____
Antifungal
What is ketoconazole available as OTC?
2% shampoo
What schedule is ketoconazole?
- Schedule 1 in everything except for topical use in a shampoo
- Unscheduled as a shampoo
What are some side effects to ketoconazole?
- Minimal scalp and skin irritation
- Greasy or dry hair/scalp
- Itching or stinging
Salicylic acid is ______
Keratolytic
What is the mechanism of action for salicylic acid?
Decreases skin pH, which increases hydration of keratin, facilitating loosening and removal
When should salicylic acid NOT be used and why?
- In patients with greater than 20% BSA involvement
- May cause salicylate toxicity
What is the characterizing symptom of salicylate toxicity?
Tynitis (ringing in the ear)
Is psoriasis contagious?
No
What is psoriasis?
Life-long chronic inflammatory disease of the skin
What is the typical onset of psoriasis?
16-22 (more severe) and 57-60 (less severe)
What is the most common form of psoriasis?
Plaque psoriasis
What are the common sites of psoriasis?
Scalp, buttocks, arms, legs, elbows, knees, ears, palms, and soles
What are the risk/aggravating factors of psoriasis?
- Genetic predisposition
- Skin trauma
- Environmental (alcohol ingestion, obesity, stress, pregnancy)
- Medications (beta-blockers, NSAIDs, anti-malarial, lithium)
- Infections (respiratory, HIV, streptococcal)
What are the signs and symptoms of psoriasis?
- Thickened red plaque with silvery-white scales
- Bleed easily (if plaque is removed)
- Most have symmetrical lesions
- Minimal itching
What questions should be asked during assessment for psoriasis?
- How severe are the symptoms?
- Duration of irritation?
- Area of involvement?
- How often do symptoms occur?
- Medical history?
- Has anything been tried yet?
When should you refer for psoriasis?
- Under 2 years of age
- If diagnosis has not been made
- No improvement of symptoms after 2 weeks
- Over 3% of BSA involved
- Severity and type of psoriasis
- Location of lesions - hands, nails, forearms, and face (b/c may impact patients quality of life)
What are the treatment goals of psoriasis?
- Control or eliminate the signs and symptoms
- Prevent or minimize the likelihood of flares
Only ____ cases of psoriasis may be self-treated
Mild
What determines the choice of treatment for psoriasis?
- Severity
- Location of plaques
- Convenience
- Patient compliance
- Financial considerations
- Physical accessibility to treatment
What are some non-pharms for psoriasis?
- Do not rub, scratch, or pick skin
- Dab (don’t rub) medication onto area
- Mild cleansers and warm water used for cleaning
- Moisturize skin
- Avoid triggers (dry skin)
- Reduce risk for infections (avoid smoking, alcohol, stress)
- Moisturize air in home
What are the types of treatment for psoriasis?
- Topical therapy (first line therapy for mild to moderate psoriasis)
- Phototherapy
- Systemic therapy
- Biologic therapy
- Combination therapy
What are common topical prescription products for psoriasis?
- Corticosteroids (medium - high potency)
- Compounds w/ coal tar or salicylic acid
- Tazarotene
- Calcipotriol (alone or combined w/ corticosteroid)
What is a common oral therapy prescription for psoriasis?
Various immunosuppression medications
When is biological therapy used for psoriasis?
For chronic moderate to severe plaque psoriasis
What types of corticosteroids are used for psoriasis?
- Hydrocortisone 0.5% and 1% (OTC, used for mild cases)
- Clobetasone 0.05% cream (schedule 2, moderate potency)
When is coal tar used for psoriasis treatment?
- Mild to moderate psoriasis
- In combination w/ other topical treatments
When are keratolytic agents used for psoriasis treatment?
- Mild to moderate psoriasis
- In combination w/ other topical treatments
What are the most effective moisturizers for psoriasis?
Ointments
What are the monitoring parameters for psoriasis?
- Thickness of scales should decrease 50% in 6-8 weeks
- Scaling should decrease 50% in 7-10 days
- Itching should go away in 1-2 weeks
- Redness should decrease 50% in 8-12 weeks
- Side effects of treatment
Can pharmacists prescribe for psoriasis?
No
Can pharmacists prescribe for seborrhea dermatitis?
Yes
What is seborrhea dermatitis?
- Sub-acute or chronic inflammatory disorder
- Accelerated cell turnover (9-10 days; normal is 30)
Where is seborrhea dermatitis primarily found?
Scalp, face, and trunk
Does seborrhea dermatitis affect men or women more often?
Men
What are 2 possible causes of seborrhea dermatitis?
- Yeast infection (Malassezia furfur)
- Abnormality of oil glands and hair follicles
When completing the differential diagnosis of seborrhea dermatitis, what other conditions should you consider?
Psoriasis
What are the risk/aggravating factors of seborrhea dermatitis?
- Increased incidence in HIV or AIDS patients
- Genetics (maybe)
- Medical conditions (Parkinson’s, depression, mood disorders)
- Environmental (low humidity and temp, stress)
- Medications (lithium, cimetidine, haloperidol, methyldopa)
What are the signs and symptoms of seborrhea dermatitis?
- Mild, greasy scaling of scalp area
- Starts as small patches and spreads
- Dull, yellowish, oily, scaly areas on red skin
- Itching
- Groin area and axillae show lesions that are bright red w/o scaling
- Cradle cap in infants
What are the symptoms of cradle cap?
Thick, dry, yellowish-brown scales on the face, forehead, ears, or entire scalp
When should you refer for seborrhea dermatitis?
- Under 2 years of age
- No improvement w/ OTC treatment after 2 weeks
- Symptoms are severe or spread to other parts of body
- Signs of infection
What are the treatment goals for seborrhea dermatitis?
- Reduce inflammation and epidermal turnover rate of scalp skin
- Minimize or eliminate visible erythema and scaling
What are some non-pharms for seborrhea dermatitis and dandruff?
- Remove triggers/aggravating factors
- Avoid irritating soaps, greasy creams
- Avoid excessive hot water
- Decrease exposure to cold, dry air
- Wash hair w/ general, non-medicated shampoo every 1-2 days
- Control stress
What should treatment include for seborrhea dermatitis?
- Loosening and removal of scale and crust
- Inhibit yeast
- Decrease redness and itching
What should be the initial OTC treatment for seborrhea dermatitis and dandruff?
Agent that reduces Malassezia (zinc pyrithione, selenium sulfide, or ketoconazole shampoo)
What should be the second line OTC treatment for seborrhea dermatitis and dandruff?
Agent that reduces scaling by decreasing epidermal turnover (keratolytic agent, antiproliferative agent, hydrocortisone cream)
What are the dosing instructions for hydrocortisone cream in the treatment of seborrhea dermatitis
- Once or twice daily until symptoms clear for 1-2 weeks
- Apply after shampooing to enhance absorption
How often should medicated shampoos be used?
2-4 times/week for approx. 4-5 weeks then reduce to once a week to prevent relapse
What medications can pharmacists provide for seborrhea dermatitis under the laws?
- Salicylic acid (available OTC so no use prescribing)
- Ciclopirox*
- Terbinafine*
- Tolnaftate (not appropriate)
- Combinations (not available)
What is ciclopirox?
- Broad spectrum agent
- Effective against dermatophytes, yeast, and some bacteria
What strengths is ciclopirox available as?
- 1% cream or lotion (Loprox)
- 1.5% shampoo (Stieprox)
What is the recommended use for Stieprox?
2-3 times/week for treatment of fungal infections associated w/ seborrheic dermatitis until remission, then once/week to prevent relapse
What are recommended treatments for non-scalp seborrhea dermatitis?
- Avoid harsh soaps
- Remove scales
- Warm (not hot) water to decrease dryness
- May want to apply medicated shampoo onto face and wash off in the shower (*don’t leave on too long or will irritate)
What are the monitoring parameters for seborrhea dermatitis and dandruff?
- Scaling should improve w/in 7-10 days
- Redness should improve w/in 8-12 weeks
- Thickness of plaques should decrease w/in 6-8 weeks
- Itching should improve w/in 1-2 weeks
Can pharmacists prescribe for seborrhea dermatitis in pediatrics (cradle cap)?
No, but the treatment is non-pharms only anyway
Does cradle cap make a child more prone to seborrhea dermatitis or dandruff in the future?
No
When does cradle cap usually start?
In infants first month
When does cradle cap usually resolve?
By age 3-4 months
What is the presentation of cradle cap?
Yellowish, greasy scale on scalp
What is the treatment for cradle cap?
- Wash hair daily w/ mild baby shampoo
- Loosen scales w/ soft brush before rinsing
- Gently massage in mineral oil or baby oil to loosen scales, then wash w/ baby shampoo
- If on face, use mild soap and moisturizer
Dandruff is a mild form of _____
Seborrhea dermatitis
What is dandruff?
- Chronic, non-inflammatory scalp condition
- Excessive scaling of scalp, characterized by accelerated epidermal cell turnover (13-15 days)
Is dandruff common in children?
No
When does dandruff usually appear?
During puberty (10-20 years old)
What are the risk/aggravating factors of dandruff?
- Environmental (dry climate, extremes in weather)
- Increased stress
- Obesity
- Inadequate hair washing (?)
- Possibly caused by Malassezia furfur
What are the signs and symptoms of dandruff?
- Dry, white or silver-gray flakes
- Scaling w/ accumulation of flakes
- Detached by combing of hair
- Some itching
- Usually symmetrical
- May be in patches, but most often not
What are the treatment goals for dandruff?
- Reduce of eliminate flaking and associated symptoms
- Minimize cosmetic embarrassment of visible flakes
- Prevent recurrences
What is important to tell a patient who is using a medicated shampoo to treat dandruff?
- Contact time is vitally important for effectiveness of medicated shampoos
- Used only 2-4 times/week until controlled (about 2-3 weeks) then reduce to once per week or 2 weeks to maintain control
Can you prescribe Cicloprix for dandruff?
No, only seborrhea dermatitis
