Dandruff and Seborrheic Dermatitis

Question 1

What is dandruff vs seborrheic dermatitis?

Answer 1

Dandruff: mild, noninflammatory form of SD.

Seborrheic dermatitis: inflammatory condition, primarily in seborrheic areas (scalp, face, upper trunk)

Question 2

What is the pathogenesis of seborrheic dermatitis?

Answer 2

Considerable controversy, thus proposed treatments vary

Question 3

How do sebaceous glands affect SD?

Answer 3

No direct relationship between the amount or composition of sebum and the condition

Question 4

How does seborrheic dermatitis present as?

Answer 4

Greasy, scaling eruption

Yellow-brown, greasy or bran-like scaling patches and plaques

Question 5

How does SD affect the eyes?

Answer 5

Eyelids: can have honey-coloured crusting (blepharitis), erythema and scaling, mild granular conjunctivitis or ocular irritation.

Question 6

How can SD present in infants?

Answer 6

Cradle cap– entire scalp is covered in thick, dry adherent yellow-brown scales

Question 7

What can happen with chronic cases of SD?

Answer 7

Nonscarring alopecia

Question 8

What are risk factors of seborrheic dermatitis? (8)

Answer 8

Genetic predisposition
HIV or AIDS
Neurologic conditions (parkinsons, cranial nerve palsies, major truncal paralyses)
Other comorbid conditions
Being middle-aged or elderly
Environmental factors
Stress, sleep deprivation, sweat, emotional stress
Maybe diet

Question 9

Which of the following can be self-treated, and which need to be referred?
Dandruff
Scalp SD
Facial SD
Body SD

Answer 9

Self-treat: dandruff, scalp SD

Refer; facial SD, body SD

Question 10

How can we treat cradle cap?

Answer 10

Frequent cleansing with a mild, nonmedicated shampoo
Brushing
Should be conservative with treatment, as it is benign and self-limiting

Question 11

How do you properly apply medicated shampoos?

Answer 11

Part hair into small sections and apply and massage into the scalp for 4-5 minutes, rinse and repeat.
Medicated shampoos should be left in contact with the area for 2-20 minutes
Therapy can be left on overnight for more severe cases.
If used for extended periods, can cause the disease to flare

Question 12

What is first line treatment for SD and dandruff?

Answer 12

Antifungals that decrease colonization by lipophilic yeasts

Question 13

Which antifungals are most effective in treating SD and dandruff?

Answer 13

Ketoconazole, but recurrence is constant.
Ciclopirox olamine
Selenium sulfide (limited evidence of efficacy, more side effects)
Zinc pyrithione (clinical evidence is limited and low quality)
Oral antifungals are for severe or refractory cases

Question 14

How do anti-inflammatory agents help treat SD and dandruff?

Answer 14

Topical corticosteroids help reduce itching and inflammation
Topical calcineurin inhibitors are immunomodulators and may be alternatives when topical corticosteroids are not tolerated or inappropriate

Question 15

How do topical corticosteroids work?

Answer 15

Hydrocortisone 1% can be used on the face and folds
Can also be applied overnight and occluded with a shower cap if there are severe and thick scales.
Ointments are preferred for dry/scaly areas
Creams should be used in moist areas due to their drying effect
Lotions and solutions are best for scalp and hairy areas,

Question 16

What are topical calcineurin inhibitors?

Answer 16

Tacrolimus
Pimecrolimus
Intermittent use may maintain remission in facial SD

Question 17

What keratolytic agents can be used in the treatment of dandruff/seborrheic dermatitis?

Answer 17

Salicylic acid and sulfur

Coal tar

Question 18

Rank the treatments for dandruff/SD in order of efficacy

Answer 18

Ketoconazole, ciclopirox, or moderate-potency corticosteroids
Hydrocortisone or calcineurin inhibitors
Selenium sulfide
Zinc pyrithione
Keratolytics
Coal tar

Question 19

What NHPs can be used to treat dandruff/SD?

Answer 19

Quassia amara gel
Tea tree oil
Aloe vera
Solanum chrysotrichum