Dandruff and Seborrhea Flashcards
What is the relationship between dandruff and seborrheic dermatitis?
They both cause scaling which could be associated with itching but dandruff is a milder, noninflammatory form of SD limited to the scalp
How does SD present?
Inflammatory condition with erythematous and scaling eruptions primarily in “seborrheic areas” –> high #s of sebaceous glands like scalp, face and upper trunk
Chronic condition in adults
- manifested as scaling and erythema of nasolabial folds
- ranging in intensity with instances of flare up
When is SD most common and what are the risk factors/who is it most common in?
first 3 months of life and between 30-50 years of age
Found in 1-5% of the general population, ~30% of immunocompromised patients and up to 83% of individuals with HIV –> may be a cutaneous indicator of HIV and AIDS especially when severe, atypical or therapy resistant
What are the goals of therapy for dandruff? (3)
- Reduce or eliminate scaling
- Prevent recurrence by improving scalp hygiene
- Eliminate or reduce environmental triggers
What are the goals of therapy for Seborrheic dermatitis? (5)
- Control, not cure
- Reduce fungus and resulting scaling & inflammation
- Relieve symptoms of pruritus
- Educate on importance of control through good hygiene
- Eliminate or reduce environmental triggers
What are the s/s of dandruff?
- lesions often asymptomatic w mild clinical course, itching may develop
- variations in intensity of episodes affected by fatigue, stress, and cold weather
- scales are silver/grey in patches or diffuse
- scales separate fully or become detached after combing
- usually symmetrical and absent in bald areas
- no evidence of other skin disease on scalp or elsewhere
What are the s/s of seborrheic dermatitis?
Symptoms:
- lesions often asymptomatic w mild clinical course
- variations in intensity common with fatigue, stress and cold weather
- pruritus varies; common in scalp and ear canal, can be intense
Signs:
- inflammatory, erythematous, greasy, scaling eruption
- sharply demarcated yellow/brown, greasy or bran-like scaling patches
- typically symmetrical in scalp, scalp margin, eyelashes, brows, facial hair
- other sites: nasolabial folds, forehead, outer ear canals, creases of ears, under breasts, forearms, navel, groin, urogenital area
- begins in small patches and rapidly spreads
- no signs of acute dermatitis (weeping, oozing)
- eyelids may be affected
- non-scarring alopecia may occur secondary to inflammation and scratching
What are the risk factors for seborrheic dermatitis?
- genetic predisposition
- HIV or AIDS positive
- neurologic conditions like parkinsons
- hyperandrogen syndrome in females
- middle-age or elderly
- changes in humidity, cold or dry weather
- infection stress, sleep depravation, sweat, emotional stress
- possibly “western” diet
What are the red flags warranting referral of those presenting with dandruff or seborrhea?
- unsure of diagnosis
- sudden onset in young patient
- patient not responding to treatment
- condition is widespread
- facial SD; refer to HC practitioner
- involvement of palms of hands, soles of feet or nails
What are the non-pharmacologic strategies for infantile seborrheic dermatitis?
benign and self limiting, take conservative approach
- frequent cleansing with mild, non-medicated shampoo
- gentle brushing of scalp with soft baby brush to remove scales
- do NOT change diet or supplement; not effective
What are the non-pharmacological measures for the treatment of dandruff and adult seborrheic dermatitis?
- avoid irritating soaps
- keep hair short and beard trimmed
- avoid use of excessively hot water
- use cool air humidifier or dish of water to add moisture to the indoor environment
- exposure of affected area to sunlight and warm air
- warm to hot compress for eyelid effected
- use of non-medicated shampoos to remove scales 3x/week at least
What are the three classes of medications used to treat dandruff and seborrhea?
- Anti-fungal agents
- Anti-inflammatory agents
- Keratolytics
What is the first line therapy for the treatment of dandruff and seborrhea and what are some key counselling points to communicate? (how to use, how long, onset of action, adverse effects)
Ketoconazole –> topical anti-fungal
Ciclopirox shampoo –> alternative to ketoconazole
Use shampoo 2-4 times weekly; wet hair and rub into scalp at roots in small sections, leave on for at least 5 minutes then rinse
Use cream QD on effected areas; can be used on face and beard
Can take 2-3 weeks to see onset of effect and 4 weeks to full effect
AE: minimal scalp and skin irritation, itching and stinging, may cause greasy or dry hair/scalp, avoid on eye area
What are the second line options for the treatment of dandruff and seborrhea?
Selenium Sulfide –> topical anti-fungal (shampoo 1%, lotion 2.5%)
Apply no more than 3x/week, cannot be used on damaged or inflamed skin
Zinc Pyrithione –> topical anti-fungal known commonly as head and shoulders
Coal Tar –> keratolytic agent, more effective with prolonged contact time
If the trial of 2 or more anti-fungal shampoos fail the patient, what should you try next?
- add keratolytic agent (salicylic acid with or without sulfur)
- soften scales overnight with oils or bath oils
- add anti-proliferative agent (coal tar)
- add hydrocortisone for 1-2 weeks
