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Derm Pharm 2020 > 3 - Therapeutic Shampoos > Flashcards

3 - Therapeutic Shampoos Flashcards

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1
Q

Therapeutic shampoos are used to eliminate scaling (dandruff) and pruritus of the scalp

A

True

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2
Q

Therapeutic shampoos cleanse the scalp by emulsifying oily secretions

A

True

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3
Q

Dandruff is a scaling condition of the scalp

A

True

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4
Q

Cradle cap is a scaling condition of the scalp

A

True

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5
Q

Seborrheic dermatitis is a scaling condition of the scalp

A

True

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6
Q

Psoriasis is a scaling condition of the scalp

A

True

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7
Q

Atopic dermatitis is a scaling condition of the scalp

A

True

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8
Q

Irritant or contact dermatitis is a scaling condition of the scalp

A

True

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9
Q

Cradle cap is a variant of seborrheic dermatitis often seen 1-2 weeks after birth, but can occur anytime during the first 6 months of life

A

True (associated with yellowish scales on the scalp with I distinct borders often associated with underlying erythema and pruritus. May also involve retroauricular skim, nasolabial folds, skin folds of the neck, axillae, diaper area. Usually clear in 2-8 weeks)

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10
Q

Dandruff (seborrhoea capitis sicca) is the dry form of seborrheic dermatitis which presents with dry, greyish white scales scattered over scalp with indistinct borders, may or may not be associated with pruritus

A

True (in contrast to psoriasis with distinct borders)

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11
Q

When scaling of the scalp is associated with excessive sebum production, it is seborrhoea capitis oleosa (pruritus commonly present and characterised by remissions and exacerbation a with stress being a common precipitating factor)

A

True (involvement of the scalp, eyebrows, post auricular area, nasolabial folds, body folds, V shape of central chest and back - often in patients with Parkinson’s disease or HIVas as a marker of early disease)

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12
Q

In some cases psoriasis can overlap with seborrheic dermatitis (sebo-psoriasis)

A

True

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13
Q

Shampoos containing Salicylic acid or Salicylic acid and Sulfur are keratolytic

A

True

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14
Q

Shampoos containing selenium sulfide and zinc pyrithione are Cytostatic (inhibition of cell growth and multiplication)

A

True

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15
Q

Shampoos containing tar are Antimitotic (antiproliferative) and cytostatic, suppressing epidermal cell DNA synthesis

A

True

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16
Q

Shampoos containing ketoconazole, ciclopirox and iodophors are antimicrobial

A

True

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17
Q

Shampoos containing the corticosteroids fluocinolone Acetonide and clobetasol propionate are anti-inflammatory

A

True

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18
Q

Irritant contact dermatitis and atopic dermatitis are often termed lichen simplex chronicus when they occur on the scalp, and is often extremely itchy where rubbing and scratching are a central part of the disease process

A

True

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19
Q

Lichen simplex chronicus on the scalp commonly involve the occipital scalp

A

True

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20
Q

Dermatophyte infection (times capitis) must be ruled out in all scaling scalp conditions, particularly in children, since this infection requires oral antifungal therapy

A

True

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21
Q

Scalp conditions which may reflect serious systemic disease (SLE, dermatomyositis, mycosis fungoides) or can result in permanent scarring alopecia of the scalp (lichen planopilaris, discoid lupus etc) need to be ruled out before choosing a therapeutic shampoo

A

True

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22
Q

Scalp conditions that result in severe accumulation of adherent scale and matted hair in the scalp is referred to as tinea amiantacea

A

True (even though the name suggests tinea, it is not a tinea infection)

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23
Q

Most of the therapeutic shampoos contain wetting agents, also known as surfactants

A

True

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24
Q

The wetting agents (surfactants) in therapeutic shampoos have hydrophilic and hydrophobic portions of the molecule

A

True

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25
Q

Therapeutic shampoos degrease the skin of the scalp through emulsification of sebum, thus promoting “wetting” of the scalp, which then enhances the effect of the active ingredients

A

True

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26
Q

Wetting agents (surfactants) degrease the skin of the scalp through emulsification of sebum, thus enhancing the effect of the active ingredients

A

True (thus facilitating separation of scale into smaller, less visible flakes)

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27
Q

Therapeutic shampoos for seborrheic dermatitis reduce high skin surface lipid levels

A

True (perhaps the high surface lipid levels provide the substrate required for growth of pityrosporum yeast, or for inflammatory prostaglandins and resultant cell signalling)

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28
Q

Amphoteric and anionic surfactants (wetting agent) serve as the base of many shampoos

A

True

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29
Q

Cationic and non-ionic surfactants (wetting agents) are added to shampoos to condition damaged hair

A

True

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30
Q

Cationic surfactants (wetting agents) are useful for conditioning more negatively charged damaged hair and include quarternary ammonium compounds I.e. Benzalkonium chloride and cetyl trimethyl ammonium bromide

A

True

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31
Q

The quarternary ammonium compound Benzalkonium chloride is a Cationic surfactant (wetting agent) useful for conditioning negatively charged damaged hair

A

True

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32
Q

The quarternary ammonium compound cetyl trimethyl ammonium bromide is a Cationic surfactant (wetting agent) useful for conditioning negatively charged damaged hair

A

True

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33
Q

Anionic surfactants (wetting agents) are used for cleansing and lathering, including sulphates, sulfonates, and soaps such as sodium lauryl sulfate and dioctyl sodium sulfosuccinate

A

True

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34
Q

Non-ionic surfactants (wetting agents) are mild surfactants, making them useful in baby shampoos and include propylene glycol, spans and tweens

A

True

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35
Q

Propylene glycol is a non-ionic surfactant (wetting agent)

A

True

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36
Q

In psoriasis (and to a lesser extent in seborrheic dermatitis), hyperproliferation is associated with a more rapid transit time from the basal layer to the outer stratum corneum (3 days rather than the usual 25-30 days), leading to imperfect keratinisation and faulty desquamation of the cornfield layer

A

True

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37
Q

Keratolytic agents (salicylic acid and Sulfur) used in some therapeutic shampoos loosen the cement (lipids, cholesterol, free saturated fatty acids, and ceramides within the intercellular space which increases cohesion between the cells) between the corneocytes

A

True

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38
Q

Many shampoos and scalp lotions or sprays contain topical corticosteroids which have potent anti-inflammatory and antipruritic effects

A

True

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39
Q

Because the underlying pityrosporum infection is not being directly treated with corticosteroid shampoos in patients with seborrheic dermatitis, recurrence is prompt and relapse rates are high

A

True

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40
Q

Topical ketoconazole and ciclopirox may also have anti-inflammatory effects in addition to their antifungal effects

A

True

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41
Q

Tea tree oil shampoo has effectively treated dandruff mediated by their anti-inflammatory effects

A

True (has also demonstrated anti fungal properties)

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42
Q

Coal tar may be immunosuppressive via an action on T cells or the Langerhans calls that present antigens to the T cells

A

True

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43
Q

Tar shampoos appear to have Antimitotic (antiproliferative) and cytostatic effects

A

True suppressing epidermal DNA synthesis)

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44
Q

Tar shampoos may have antibacterial and antimycotic activity

A

True

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45
Q

Tar products disperse scales, which in and of itself may reduce pityrosporum colonisation

A

True

46
Q

Selenium sulfide may also benefit scaling scalp conditions because of its cytostatic effects on hyperproliferative keratinocytes

A

True (may also have antipityrosporum effects)

47
Q

Zinc pyrithione reduces cell turnover rate significantly (cytostatic)

A

True (also has anti pityrosporum effects through iron starvation)

48
Q

Ketoconazole shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)

A

True

49
Q

Ciclopirox shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)

A

True

50
Q

Zinc pyrithione shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects) through iron starvation

A

True

51
Q

Selenium sulfide shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)

A

True

52
Q

Tea tree oil shampoo have demonstrated antifungal properties

A

True

53
Q

Japanese cypress oil shampoo has demonstrated antifungal properties

A

True

54
Q

Even though there is a potential for significant systemic absorption of tar compounds (and mutagenic effects) when the normal scalp is shampooed with tar shampoo, the use of tar products in shampoos for decades has not been shown to induce localised or systemic tumour formation

A

True

55
Q

Absorption of salicylic acid leading to salicylate intoxication has been reported when patients use salicylic acid concentrations > 10% over more than 50% of their body surface in ointment forms

A

True (although this systemic absorption has not been reported from currently available salicylic acid shampoos)

56
Q

The small amounts of salicylic acid that are absorbed are metabolised by the liver and excreted by the kidneys

A

True

57
Q

There is some extent of systemic absorption of selenium sulfide shampoos, though generally there is a high safety margin

A

True (there is an isolated report of a patient with selenium intoxication from using selenium sulfide shampoo 2-3 times weekly for 8 months on damaged scalp skin)

58
Q

Selenium sulfide and zinc pyrithione shampoos may cause minor skin irritation

A

True

59
Q

There is some extent of systemic absorption of zinc pyrithione shampoos, though generally there is a high safety margin

A

True

60
Q

Percutaneous corticosteroid absorption occurs with topical use of shampoos containing topical corticosteroids

A

True (although there is relatively low absorption through scalp skin)

61
Q

The relatively low absorption of topical corticosteroids through scalp skin, relatively infrequent use of shampoo (daily), relatively small percentage of body surface area treated, limit the post entail for systemic corticosteroid absorption that could suppress the hypothalamo-pituitary-adrenal axis

A

True

62
Q

Scalp skin thinning and telengiectasia (corticosteroid atrophy) can occur with repeated heavy use of superpotent topical corticosteroids such as clobetasol

A

True

63
Q

Only small amounts of ketoconazole are absorbed when this agent is used in shampoo form, and metabolism of this small amount by the liver ensures that significant serum levels are not achieved

A

True

64
Q

Ketoconazole persists in the hair keratin for up to 72 hours after shampoo application

A

True (usually used 3 times weekly as the benefits plateau beyond this frequency of use)

65
Q

No systemic adverse effects have been reported in patients using ketoconazole or ciclopirox shampoo

A

True

66
Q

Therapeutic shampoos are used to control scaling and inflammation, rather than to cure scalp conditions and prolonged or intermittent use is the rule rather than the exception

A

True

67
Q

Salacylic acid, selenium sulfide, zinc pyrithione p, tar and ketoconazole shampoos are FDA approved for scaling scalp and dandruff

A

True

68
Q

Ketoconazole, ciclopirox, tar, fluocinonide (corticosteroid) and selenium sulfide shampoos are FDA approved for seborrheic dermatitis

A

True

69
Q

Tar and clobetasol shampoos are FDA approved for psoriasis

A

True

70
Q

Selenium sulfide and ketoconazole shampoos are used with oral antifungal therapy as adjunctive treatment of tinea capitis

A

True

71
Q

Although none of the therapeutic shampoo products have been adequately tested in pregnancy, but the small surface as of the scalp, short contact treatment and lack of reports suggesting fetal harm over many years suggest there is no significant risk to the fetus

A

True (with the exception of ketoconazole shampoo which is safe and effective in infants with cradle cap)

72
Q

Except in products labeled for use in cradle cap (I.e. Ketoconazole), use of therapeutic shampoos in infants is not recommended as the amount of skin surface in proportion to body weight is greater than in older children and adults, and the hepatic enzyme systems in infants are not fully developed to handle toxic substances that might be absorbed

A

True

73
Q

Preliminary information suggests that ketoconazole shampoo is safe and effective in infants with cradle cap

A

True (although the rare occurrence of idiosyncratic hepatotoxicity with systemic ketoconazole must be kept in mind if significant and prolonged exposure to ketoconazole shampoo is contemplated in this age group)

74
Q

Salicylic acid shampoos should be completely avoided in children less than 6 years old due to the risk of salicylate intoxication

A

True

75
Q

Tar shampoos with or without topical corticosteroids are generally safe to use in children

A

True

76
Q

Salicylic acid shampoos can be used as an adjunct for more severe cases of psoriasis in children over 6 years old

A

True (in children less than 6 years old,salicylic acid use should be completely avoided due to risk of salicylate intoxication)

77
Q

Therapeutic shampoos may cause drying, burning, stinging, irritation and discomfort

A

True (most commonly irritant in nature)

78
Q

Therapeutic shampoos most commonly causes an irritant dermatitis

A

True

79
Q

Irritation commonly occurs with keratolytic agents

A

True (the short contact time, dilution with water, and subsequent quick rinse reduce the sensitisation potential of these products)

80
Q

Allergic contact dermatitis is possible either to the active ingredients I.e. Topical corticosteroids, or to the other components of the shampoo products

A

True

81
Q

The potential allergens from therapeutic shampoos include (in order of prevalence) fragrance, cocamidopropyl betaine, MCI/MI , formaldehyde releasers, propylene glycol and vitamin E

A

True

82
Q

Fragrance is the most prevalent allergen in therapeutic shampoos

A

True

83
Q

Cocamidopropyl betaine (amphoteric detergent) is a potential allergen from therapeutic shampoos

A

True

84
Q

Methylchloroisothiazolinone/methylisothiazolinone MCI/MI (non-formaldehyde preservative) is a potential allergen from therapeutic shampoos

A

True

85
Q

Formaldehyde releasers (preservative) is a potential allergen from therapeutic shampoos

A

True

86
Q

Propylene glycol (preservative) is a potential allergen from therapeutic shampoos

A

True

87
Q

Vitamin E (preservative) is a potential allergen from therapeutic shampoos

A

True

88
Q

Rarely contact dermatitis to zinc pyrithione has been reported

A

True

89
Q

Allergic contact dermatitis to shampoo ingredients generally spare the scalp and commonly appear on the postauricular, posterolateral neck and eyelids

A

True (may be related to poorly understood differences in the local immunology of these an atomic areas or protective effects of thicker skin producing a more effective barrier to allergens I’m scalp skin)

90
Q

Shampoos containing tea tree oil have caused allergic contact dermatitis

A

True

91
Q

Topical corticosteroid shampoos could induce the same local adverse effects as other topical corticosteroid use I.e. Folliculitis, skin atrophy, telengiectasia, hypertrichosis, hypopigmentation, secondary infection and striae

A

True

92
Q

Tachyphylaxis has not been documented with corticosteroid shampoos

A

True

93
Q

Tachyphylaxis is postulated to occur in anti dandruff shampoos

A

True

94
Q

Avoiding eye contact is roc mended for shampoos containing tars, salicylic acid, selenium sulfide, and topical corticosteroids

A

True

95
Q

Tar shampoos can stain blonde, white/grey or dyed hair a greenish or brown colour

A

True

96
Q

Selenium sulfide shampoos may leave a residual smell, discolour hair, and make hair more oily

A

True

97
Q

Tar shampoo should be avoided in patients receiving PUVA therapy on the day of a treatment to avoid ‘tar smarts’ (a type of photosensitivity associated with other topical tar preparations)

A

True

98
Q

Patients using tea tree oil shampoo chronically should be aware of their possible estrogenic and amtiandrogenic properties

A

True

99
Q

Clobetasol shampoo should be rubbed into a moist scalp and allowed to stay in place for 15 minutes before shampooing and rinsing

A

True

100
Q

Therapeutic shampoos are safe with daily use, although they may also be effective by shampooing as little as once or twice weekly for maintenance in patients with dandruff, seborrheic dermatitis or cradle cap

A

True (ketoconazole beneficial effects plateau at 2-3 times weekly)

101
Q

In contrast to the benefits of ketoconazole shampoo, which plateau at 2-3 times weekly use, selenium sulfide and other medicated shampoos continue to improvemscalp scaling with increased use up to daily

A

True

102
Q

Ketoconazole shampoo suppresses pityrosporum organisms more effectively than either zinc pyrithione or selenium sulfide shampoo

A

True

103
Q

Selenium sulfide shampoo is somewhat more efficacious than zinc pyrithione

A

True

104
Q

Salicylic acid lotions may be applied to the scalp 2-8 hours before shampooing with a tar shampoo

A

True

105
Q

Tar shampoo may be used as maintenance therapy in psoriasis following treatment with other topical agents to keep patients in remission

A

True

106
Q

Chronic use of 2% ketoconazole shampoo has been shown to be safe

A

True

107
Q

Many patients with scaling scalp diseases benefit from rotational therapy

A

True (a shampoo used for 3-4 weeks followed by another shampoo from a different class vs. 2 products used on alternative days with less frequent application as the condition improves vs. ketoconazole 2X weekly and a keratolytic or anti-inflammatory shampoo 5X weekly)

108
Q

Topical corticosteroid solutions or lotions are an appropriate adjunctive therapy in psoriasis if the scalp pruritus is not adequately controlled by a shampoo alone

A

True

109
Q

Both selenium sulfide and ketoconazole shampoo reduce the dermatophyte presence in the scale and the infectivity of patient with tinea capitis, but neither eradicates the disease

A

True (therefore should be used in conjunction with systemic antifungal agents)

110
Q

Contacts of patients with tinea capitis should be screened for infection and subsequently treated with ketoconazole 2% shampoo

A

True

111
Q

OVer the counter selenium sulfide 1% was found to be just as effective as prescription strength 2.5% when used as an adjunct to oral treatment of tinea capitis

A

True

112
Q

There are no known drug interactions of therapeutic shampoo agents in routine use

A

True

Derm Pharm 2020 (47 decks)

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