Dandruff and Seborrheic Dermititis (complete) Flashcards
what is the medical term of dandruff?
pityriasis simplex capitis
what are 2 papulosquamous cutaneous disroders that may be difficult to distinguish from one another?
dandruff and seborrheic dermatitis (SD)
what is SD?
inflammatory condition with erythematous and scaling eruptions primarily in “seborrheic areas” (high number of sebaceous glands - scalp, face (eyelashes & brows, beard and mustache), and upper trunk)
what questions do you need to ask to assess dandruff and SD?
- onset, frequency, duration of symptoms
- area and extent of involvment
- description of skin lesions
- associated systemic symptoms?
- aggravating factors?
- current hygiene practices
- attempted treatments
when sudden onset in a young patient occurs, what needs to be ruled out?
cutaneous lymphoma, Langerhans cell histocytosis, HIV, etc.
what are the typically affected areas for SD?
hairy areas of the head (scalp, scalp margin, eyelashes, brows, beard, mustache);
nasolabial folds, forehead, outer ear canals and in the creases behind the ears (facial skin sites predisposed to SD are generally those with increased skin temperature);
SD of the torso may be present in the area of the sternum and in body folds (under the breasts, underarms, navel, groin, anogenital area)
what does SD look like?
It begins in small patches, rapidly spreading, with diffuse fine scales that in lightly coloured skin can be white, off-white or yellow with no signs of acute dermatitis such as oozing or weeping.
Exudation may be seen in facial SD from time to time. In darkly coloured skin, SD may appear as scaly, hypopigmented macules and patches in typical areas of involvement. Arched or petal-shaped patches may be seen.[12] SD typically flares and resolves in a cyclic or seasonal fashion, often in response to stress.[1]
for infants, the entire scalp may be covered with thick, dry, adherent, yellowish-brown scales overlying erythema, often called cradle cap. what can you tell mom?
cradle cap is self-limiting, appear in 1-4 weeks of life, usually disappears after first 3 months.
Scalp SD must be distinguished from what condition?
dandruff, psoriasis, tinea capitis, atopic dermatitis, rosacea, systemic lupus erythematosus, fungal skin infections
when do you have to refer SD patients?
when diagnostic uncertain,
when first line treatment failure after 4 weeks
The development of SD is thought to be related to …
hormone levels, increased sebum production and skin lipid composition.
Factors that increase risk of developing SD or provoking flares include:
-genetic
-HIV
-nerologic condition (Parkinson disease, cranial nerve palsies, mojor truncalparalyses)
-pityriasis versicolor, psychiatric disorders, alcoholic pancreatitis or hepatitis C, hyperandrogen syndromes in females
-middle-age or elderly (most common inflammatory skin conditions in these patients)
-environmental factors (change in humidity or cold and dry weather)
-infection stress, sleep deprivation, sweat, emotional stress
-diet (western diet)
what are the drugs known to trigger SD?
Arsenic
Ethionamide
Auranofin
Gold
Methyldopa
Buspirone
Penicillamine
Chlorpromazine
Haloperidol
Phenothiazines
Cimetidine
Interferon, alfa
Psoralens
Danazol
Lithium
what is the common sites of psoriasis?
scalp, elbows, knees, sacrum
what is the common site for SD?
central face, scalp, mid-chest
SD - skin fold involvement?
yes - inverse type, glans penis, mostly infants
does SD itchy?
varies - more common with involvement of scalp or ear canal
does psoriasis itchy?
sometimes
for baby SD, what are non-pharm measures?
frequent cleansing with mild, nonmedicated shampoo;
gentle brushing on the scalp with a soft baby brush
what is non-pharm measure for SD?
avoid irritating soaps, heavy gels, hairsprays and greasy creams;
keep hair short / beard trimmed;
avoid use of excessively hot water;
use a cool air humidifier ro dish of water to add moisture to the indoor environment and prevent provocation of symptoms due to dry air;
exposure of the affected area to sunlight and warm weather;
treat eyelid with warm to hot compresses and wash with diluted baby shampoo or specialized eyelid cleansing products, followed by gentle cotton tip removal of thick scales;
frequent shampooing at least 3 times weekly is key to controlling symptoms;
shampoos with surfactants (e.g. sodium lauryl sulfate) and detergents are better able to remove unsightly scales and will elad to clinical improvement and decreased scaling.
Pharmacological treatment of dandruff and SD generally consists of three classes of medications. what are they?
antifunal,
anti-inflammatory,
keratolytics
how to use medicated shampoo for SD?
massage shampoo into the scalp for 4-5 minutes;
rinse thoroughly;
part their hair in small sections, and apply and massage the medicated shampoo or scalp treatment into the scalp at the hair roots;
medicated therapies should be left in contact with the scalp or beard for 2-20 minutes depending on the product.
for more severe cases, therapies can be left on overnight under a shower cap;
shampoos may be used on the scalp, beard and chest but may cause the disease to flare if used on the face or other intertriginous areas for extended periods
what are the antifungals that can be used for SD?
ketoconazole, clotrimazole, miconazole, ciclopirox olamine, selenium sulfide, zinc pyrithione, oral antifungals
