3 - Therapeutic Shampoos Flashcards
Therapeutic shampoos are used to eliminate scaling (dandruff) and pruritus of the scalp
True
Therapeutic shampoos cleanse the scalp by emulsifying oily secretions
True
Dandruff is a scaling condition of the scalp
True
Cradle cap is a scaling condition of the scalp
True
Seborrheic dermatitis is a scaling condition of the scalp
True
Psoriasis is a scaling condition of the scalp
True
Atopic dermatitis is a scaling condition of the scalp
True
Irritant or contact dermatitis is a scaling condition of the scalp
True
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
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)
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
True (in contrast to psoriasis with distinct borders)
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)
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)
In some cases psoriasis can overlap with seborrheic dermatitis (sebo-psoriasis)
True
Shampoos containing Salicylic acid or Salicylic acid and Sulfur are keratolytic
True
Shampoos containing selenium sulfide and zinc pyrithione are Cytostatic (inhibition of cell growth and multiplication)
True
Shampoos containing tar are Antimitotic (antiproliferative) and cytostatic, suppressing epidermal cell DNA synthesis
True
Shampoos containing ketoconazole, ciclopirox and iodophors are antimicrobial
True
Shampoos containing the corticosteroids fluocinolone Acetonide and clobetasol propionate are anti-inflammatory
True
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
True
Lichen simplex chronicus on the scalp commonly involve the occipital scalp
True
Dermatophyte infection (times capitis) must be ruled out in all scaling scalp conditions, particularly in children, since this infection requires oral antifungal therapy
True
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
True
Scalp conditions that result in severe accumulation of adherent scale and matted hair in the scalp is referred to as tinea amiantacea
True (even though the name suggests tinea, it is not a tinea infection)
Most of the therapeutic shampoos contain wetting agents, also known as surfactants
True
The wetting agents (surfactants) in therapeutic shampoos have hydrophilic and hydrophobic portions of the molecule
True
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
True
Wetting agents (surfactants) degrease the skin of the scalp through emulsification of sebum, thus enhancing the effect of the active ingredients
True (thus facilitating separation of scale into smaller, less visible flakes)
Therapeutic shampoos for seborrheic dermatitis reduce high skin surface lipid levels
True (perhaps the high surface lipid levels provide the substrate required for growth of pityrosporum yeast, or for inflammatory prostaglandins and resultant cell signalling)
Amphoteric and anionic surfactants (wetting agent) serve as the base of many shampoos
True
Cationic and non-ionic surfactants (wetting agents) are added to shampoos to condition damaged hair
True
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
True
The quarternary ammonium compound Benzalkonium chloride is a Cationic surfactant (wetting agent) useful for conditioning negatively charged damaged hair
True
The quarternary ammonium compound cetyl trimethyl ammonium bromide is a Cationic surfactant (wetting agent) useful for conditioning negatively charged damaged hair
True
Anionic surfactants (wetting agents) are used for cleansing and lathering, including sulphates, sulfonates, and soaps such as sodium lauryl sulfate and dioctyl sodium sulfosuccinate
True
Non-ionic surfactants (wetting agents) are mild surfactants, making them useful in baby shampoos and include propylene glycol, spans and tweens
True
Propylene glycol is a non-ionic surfactant (wetting agent)
True
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
True
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
True
Many shampoos and scalp lotions or sprays contain topical corticosteroids which have potent anti-inflammatory and antipruritic effects
True
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
True
Topical ketoconazole and ciclopirox may also have anti-inflammatory effects in addition to their antifungal effects
True
Tea tree oil shampoo has effectively treated dandruff mediated by their anti-inflammatory effects
True (has also demonstrated anti fungal properties)
Coal tar may be immunosuppressive via an action on T cells or the Langerhans calls that present antigens to the T cells
True
Tar shampoos appear to have Antimitotic (antiproliferative) and cytostatic effects
True suppressing epidermal DNA synthesis)
Tar shampoos may have antibacterial and antimycotic activity
True
Tar products disperse scales, which in and of itself may reduce pityrosporum colonisation
True
Selenium sulfide may also benefit scaling scalp conditions because of its cytostatic effects on hyperproliferative keratinocytes
True (may also have antipityrosporum effects)
Zinc pyrithione reduces cell turnover rate significantly (cytostatic)
True (also has anti pityrosporum effects through iron starvation)
Ketoconazole shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)
True
Ciclopirox shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)
True
Zinc pyrithione shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects) through iron starvation
True
Selenium sulfide shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)
True
Tea tree oil shampoo have demonstrated antifungal properties
True
Japanese cypress oil shampoo has demonstrated antifungal properties
True
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
True
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
True (although this systemic absorption has not been reported from currently available salicylic acid shampoos)
The small amounts of salicylic acid that are absorbed are metabolised by the liver and excreted by the kidneys
True
There is some extent of systemic absorption of selenium sulfide shampoos, though generally there is a high safety margin
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)
Selenium sulfide and zinc pyrithione shampoos may cause minor skin irritation
True
There is some extent of systemic absorption of zinc pyrithione shampoos, though generally there is a high safety margin
True
Percutaneous corticosteroid absorption occurs with topical use of shampoos containing topical corticosteroids
True (although there is relatively low absorption through scalp skin)
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
True
Scalp skin thinning and telengiectasia (corticosteroid atrophy) can occur with repeated heavy use of superpotent topical corticosteroids such as clobetasol
True
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
True
Ketoconazole persists in the hair keratin for up to 72 hours after shampoo application
True (usually used 3 times weekly as the benefits plateau beyond this frequency of use)
No systemic adverse effects have been reported in patients using ketoconazole or ciclopirox shampoo
True
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
True
Salacylic acid, selenium sulfide, zinc pyrithione p, tar and ketoconazole shampoos are FDA approved for scaling scalp and dandruff
True
Ketoconazole, ciclopirox, tar, fluocinonide (corticosteroid) and selenium sulfide shampoos are FDA approved for seborrheic dermatitis
True
Tar and clobetasol shampoos are FDA approved for psoriasis
True
Selenium sulfide and ketoconazole shampoos are used with oral antifungal therapy as adjunctive treatment of tinea capitis
True
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
True (with the exception of ketoconazole shampoo which is safe and effective in infants with cradle cap)
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
True
Preliminary information suggests that ketoconazole shampoo is safe and effective in infants with cradle cap
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)
Salicylic acid shampoos should be completely avoided in children less than 6 years old due to the risk of salicylate intoxication
True
Tar shampoos with or without topical corticosteroids are generally safe to use in children
True
Salicylic acid shampoos can be used as an adjunct for more severe cases of psoriasis in children over 6 years old
True (in children less than 6 years old,salicylic acid use should be completely avoided due to risk of salicylate intoxication)
Therapeutic shampoos may cause drying, burning, stinging, irritation and discomfort
True (most commonly irritant in nature)
Therapeutic shampoos most commonly causes an irritant dermatitis
True
Irritation commonly occurs with keratolytic agents
True (the short contact time, dilution with water, and subsequent quick rinse reduce the sensitisation potential of these products)
Allergic contact dermatitis is possible either to the active ingredients I.e. Topical corticosteroids, or to the other components of the shampoo products
True
The potential allergens from therapeutic shampoos include (in order of prevalence) fragrance, cocamidopropyl betaine, MCI/MI , formaldehyde releasers, propylene glycol and vitamin E
True
Fragrance is the most prevalent allergen in therapeutic shampoos
True
Cocamidopropyl betaine (amphoteric detergent) is a potential allergen from therapeutic shampoos
True
Methylchloroisothiazolinone/methylisothiazolinone MCI/MI (non-formaldehyde preservative) is a potential allergen from therapeutic shampoos
True
Formaldehyde releasers (preservative) is a potential allergen from therapeutic shampoos
True
Propylene glycol (preservative) is a potential allergen from therapeutic shampoos
True
Vitamin E (preservative) is a potential allergen from therapeutic shampoos
True
Rarely contact dermatitis to zinc pyrithione has been reported
True
Allergic contact dermatitis to shampoo ingredients generally spare the scalp and commonly appear on the postauricular, posterolateral neck and eyelids
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)
Shampoos containing tea tree oil have caused allergic contact dermatitis
True
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
True
Tachyphylaxis has not been documented with corticosteroid shampoos
True
Tachyphylaxis is postulated to occur in anti dandruff shampoos
True
Avoiding eye contact is roc mended for shampoos containing tars, salicylic acid, selenium sulfide, and topical corticosteroids
True
Tar shampoos can stain blonde, white/grey or dyed hair a greenish or brown colour
True
Selenium sulfide shampoos may leave a residual smell, discolour hair, and make hair more oily
True
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)
True
Patients using tea tree oil shampoo chronically should be aware of their possible estrogenic and amtiandrogenic properties
True
Clobetasol shampoo should be rubbed into a moist scalp and allowed to stay in place for 15 minutes before shampooing and rinsing
True
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
True (ketoconazole beneficial effects plateau at 2-3 times weekly)
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
True
Ketoconazole shampoo suppresses pityrosporum organisms more effectively than either zinc pyrithione or selenium sulfide shampoo
True
Selenium sulfide shampoo is somewhat more efficacious than zinc pyrithione
True
Salicylic acid lotions may be applied to the scalp 2-8 hours before shampooing with a tar shampoo
True
Tar shampoo may be used as maintenance therapy in psoriasis following treatment with other topical agents to keep patients in remission
True
Chronic use of 2% ketoconazole shampoo has been shown to be safe
True
Many patients with scaling scalp diseases benefit from rotational therapy
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)
Topical corticosteroid solutions or lotions are an appropriate adjunctive therapy in psoriasis if the scalp pruritus is not adequately controlled by a shampoo alone
True
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
True (therefore should be used in conjunction with systemic antifungal agents)
Contacts of patients with tinea capitis should be screened for infection and subsequently treated with ketoconazole 2% shampoo
True
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
True
There are no known drug interactions of therapeutic shampoo agents in routine use
True
