acne and scaly dermatoses Flashcards
define scaly dermatoses
rapid turnover of epidermal cells creating scaly lesions; may be caused by microorganism Malassezia
types of scaly dermatoses
dandruff, seborrheic dermatitis, psoriasis
exclusions for self treatment of dermatoses
- less than 2 years of age
- worsening or no improvement after 2 weeks
- > 5% involvement of BSA
dandruff appears
at puberty and peaks during early adulthood
symptoms of dandruff
non-inflammatory; diffuse sloughing of the scalp with white/grey scales with or without pruritus; often seen on crown of head
goals of treatment for dandruff
reduce epidermal turnover rate, minimize cosmetic embarrassment, minimize itch
non pharm treatment of dandruff
wash hair with general purpose non-medicated shampoo leaving 3-5 minutes of contact with scalp and wash every day or every other day
medicated shampoo directions
- wash hair non-medicated first; leave medicated on for 3-5 minutes, rinsing 2-3 times then repeat
- use daily for one week, then 2-3 times weekly for 2-3 weeks, then once weekly or every other week
- use non medicated in between days
- should see improvement in 1-2 weeks
medicated shampoo examples
- pyrithione zinc
- selenium sulfide
- ketoconazole
- coal tar
- salicylic acid/sulfur
pyrithione zinc moa
anti-malassezia
pyrithione zinc
first line - most cost effective, best cosmetic appearance, slower onset than selenium sulfide
selenium sulfide moa
anti-malassezia
selenium sulfide
rinse well from scalp to avoid staining of hair, ADE: oiliness of scalp, staining hair, eye irritation
ketoconazole moa
azole antifungal
ketoconazole application
apply to scalp for 3-5 minutes 2x weekly for 4 weeks, then once weekly for prevention (allow three days in between treatments)
ketoconazole
expensive and no more effective
ADE: skin irritation/burning, may change appearance/texture of hair, hair loss
coal tar moa
cytostatic - inhibits cell growth and multiplication and proliferation
coal tar
usually not first line due to AE and limited efficacy
AE: unpleasant odor; may stain hair, skin, and clothing; photosensitivity; irritant contact dermatitis
salicylic acid/sulfur moa
keratolytic - loosens and lyses keratin aggregates, facilitating removal or flakes from scalp
salicylic acid/sulfur
very limited efficacy, very slow acting
ADE: scalp irritation or burning; sulfur has strong odor; may change appearance/texture of hair
seborrheic dermatitis
sub-acute or chronic inflammatory disorder producing red, itchy skin with prominent yellow or oily lesions/scaly patches
seborrheic dermatitis most common in
infancy and middle age
goals of treatment for seborrheic dermatitis
reduce inflammation/epidermal turnover rate; minimize or eliminate visible erythema and scaling; minimize itch
non medicated shampoo first with 3- 5 minutes of contact (SD)
cradle cap: use Johnson’s baby oil followed by J&J shampoo
adults: non medicated shampoo or dawn dishwashing soap to soften and remove scales
medicated shampoo treatment for SD
use daily for first 1-2 weeks then 2-3 times per week for 4 weeks; apply once weekly to prevent relapse
SD of the skin
hydrocortisone cream 0.5-1% cream or ointment for inflammation/itching of the skin, apply 1-2 times daily up to 7 days
ointment formulation for SD of the skin preferred when
thick crusts/scales present
psoriasis
chronic, relapsing, inflammatory disease; accelerated epidermal proliferation leads to excessive scaling, causing raised flat plaques with a silver-white scale
t/f psoriasis is typically symmetrical
true
psoriasis treatment goals
control/eliminate signs and symptoms and prevent/minimize flare-ups
non pharm treatment of psoriasis
- avoid psychological stress; avoid physical, chemical, or UV injury
- bathe with lubricating bath products 2-3 times per week, remove scales with soft cloth
- apply emollients 4 times daily, within 3 minutes of bathing
pharm treatment to loosen scalp psoriasis
salicylic acid or coal tar
salicylic acid most useful in psoriasis if
thick scales are present; soak in warm water for 10-20 min before applying product
use of coal tar in psoriasis
typically last line and most useful for psoriasis of the scalp; apply coal tar at bedtime followed by bathing in the am
inflammation of the skin in psoriasis
topical hydrocortisone ointment 0.5-1% for inflammation, apply BID for up to 7 days; good for acute flares
acne definition
common skin condition, especially in adolescence; often goes into spontaneous remission, but can progress in adulthood and lead to scarring
comedones
open (blackhead) or closed (whitehead); often seen in early stages of puberty; often start on the forehead but can progress to the chest and back; typically little or no inflammation
papules
characterized by redness and inflammation in and around the follicular canal
pustules
have the same qualities as papules, but have visible purulence in the center of the lesion
nodules
result from disruption of the follicular wall and release of its contents into the surrounding dermis
exclusions for self-treatment
- moderate to severe acne
- exacerbating factors
- possible rosacea
moderate acne
many erythematous papules and pustules and prominent scarring
severe acne
extensive pustules, erythematous papules, and multiple nodules in an inflamed background
non pharm treatment of acne
- eliminate/minimize exacerbating factors
- stay hydrated
- cleanse skin 2x daily with warm water and mild soap
non pharm physical treatments of acne
- self applied acrylate glue-based material strips can aid in the extraction of comedones
- professional comedo extraction
- light based treatments
standard of care for acne
topical therapy
properties of acne agents
- antibacterial
- keratolytic
- comedolytic
- retinoid
- anti-inflammatory
- against skin P. acnes
- exfoliates skin by causing sloughing/peeling
- resolves existing comedones
- modulates epithelial cell differentiation, keratinization, and inflammation
first line topical agent for acne treatment
adapalene (differin)
MOA of differin
modulates epithelial cell differentiation, keratinization, and inflammation
ADE for differin
redness, scaling, dryness, itching, burning; increased photosensitivity
application of differin
apply thin layer once daily; full effect in 8-12 weeks; acne may worsen at first
differin and pregnancy
do not use
most effective and widely used topical agent for acne
benzoyl peroxide
BP properties
keratolytic and antibacterial
t/f BP high concentration have same antibacterial effect of low concentration
true, but high causes more skin irritation
BP application
15-20 minutes after washing; after initial 1-2 weeks of treatments then applications can be increased up to 2-3 times per day
AE of BP
mild erythema, stinging and peeling in first few days; avoid contact with hair or clothes bc of bleaching; 3-6 weeks for full effect
hydroxy acid properties
keratolytic; BHA also has mild comedolytic properties
agent reserved for use in pts who can not tolerate other topicals
Hydroxy acids
BHA - salicylic acid
AHAs are natural
exfoliating acids (may be used as a light chemical peel)
BHA available in
05.-2% creams or gels; used 1-3 times daily
BHA contraindicated in
diabetes and patients with poor circulation disorders
BHA absorbed
systemically, can lead to salicylate poisoning and Drug Interactions
ADE for hydroxy acids
dryness, itching, redness, peeling
sulfur properties
keratolytic
sulfur application
thin film to area 1-3 times daily
ADE of sulfur
odor, yellow chalky color, can stain clothes and fabrics, dry skin, can produce reversible dark brown scale on darker skinned individuals
gel products are
usually most effective because they remain on the skin the longest
creams and loti9ons are
less irritating
acne medications and pregnancy
generally avoid
