Dandruff, Seborrhea, and Tinea Flashcards
What is Dandruff?
Dry, powdery scales (minimal scales) to yellow oily greasy scales (inflammation)
Once scales become yellow, might be time to see doctor
Caused by a yeast-like/ fungal organism (Malassezia)
worse in…
males
HIV patients
psoriasis patients
How to differentiate tinea from dandruff?
Typical cases of tinea are characterized by circular red spots within a clearing of hair.
Dandruff on the other hand is more diffuse
How to differentiate psoriasis from dandruff?
In psoriasis, hypergrowth of skin cells causes skin to become elevated. Silver scales form
Dandruff tends to be flush to surrounding tissue
What is the first thing people should try for dandruff?
Start with unmedicated shampoo, but people expect something medicated if they ask a pharmacist for a reccomendation
selenium sulfide, zinc pyrithione, and ketoconazole are common agents found in medicated shampoos
Is coal tar an antifungal agent?
No, coal tar and salicylic acid are not antifungal.
Selenium, zinc pyrithione, and ketoconazole(strongest) are all antifungals
How often should dandruff shampoos be used?
Up to 2 times per week
Are topical (scalp) steroids a valid option for dandruff?
No, it is most likely overkill if there is inflammation. It also does not treat the fungal infection.
Topical steroids are indicated more for seborrhea vs. dandruff
How does seborrhea/seborrheic dermatitis present itself?
Yellow-ish scales
Possibly some redness
Found more often in men
Chest, armpits, face are common regions affected
Where does seborrhea appear attypically?
Eyelid
ear canal
scalp (cradle cap)
Referral is key in this situation
What are some conditions that may look like seborrhea?
Eczema
Psoriasis
Tinea corporis
Perioral dermatitis
How to differentiate between Rosacea and seborrhea?
Rosacea is characterized by acne type lesions with redness
Seborrhea on the other hand has scales, while rosacea does not show scaling
What is the treatment for seborrhea/
anti-fungal products:
ketconazole topical cream 2% (once daily-BID) for 4 weeks
Topical steroids (for inflammation)
Pimecrolimus cream (non-steroid anti-inflammatory)
Topical steroids and pimecrolimus do not treat the fungus itself, they just dial down the body’s reaction
Apply agent to affected area
What is diagnosis by treatment?
Sometimes diagnoses are not 100% confirmed, but we can start patients on therapy and confirm diagnosis if treatment works. If treatment works, try agent for adifferent diagnosis
What is cradle cap?
Incidence is between 3rd-4th week of infancy
Scales on baby’s scalp and no oozing or weeping.
disappears within 8 months
use baby oil/vaseline to soften scales
Probably a different form of seborrhea
What are the different types of tinea?
Tinea….
capitis (ringworm of the scalp)
corporis (ringworm)
cruris (jock itch)
pedis (Athelete’s foot)
finger/toenail (Onychommychosis)
versicolor (done later in suntan material)
Describe the presentation and treatment of tinea capitis (scalp)?
Characteristic circular lesion is not visible nor is redness. Need dermatologist to diagnose this condition after testing. Tinea capitis is characterized by small patches of itchy, scaly scalp
Highly contagious
Hard to treat scalp issues due to concerns with ability of agents to penetrate (topical agents are ineffective)
Therapy is not under pharmacist’s realm, there are no OTC products
common agents:
griseofulvin
terbfinare hydrochloride
Describe the presentation and treatment of tinea corporis (body)?
People can catch tinea corposis from animals like cats, dogs, and horses
Itchiness and burning sensation is common, but mild compared to eczema or hives
Men are more affected than women
usually found on smooth, hairless areas, but it isn’t a hard rule
antifungals work great on all species that cause tinea corporis
common agents:
clomitrazole 1% (OTC)
ketoconazole (Rx)
terbinafine (Rx)
Is ketoconazole prescribed?
Yes, it is prescribed. But it doesn’t mean that it is a much better agent for tinea compared to OTC -azole agents like clotrimazole
How long should tinea treatments last?
Massage cream into area BID for at least 4 weeks. Once tinea has cleared up, use agent for at least 1 week to prevent recurrent infection
Is Canesten(offcially indicated for vaginitis) a valid agent for tinea treatment?
Yes, the active ingredient (clotrimazole) is perfectly fine for tinea
How long does terbinafine 1% cream/spray treatment for tinea last?
Once daily for 7 days
Treatment lasts shorter vs. clottimazole or ketoconazole
This can be prescribed by pharmacists.
Should steroids or steroid/antifungal combination products be used to treat tinea?
Steroids mask the severity of a case of tinea. The medsask resources do not reccomend use of steroids in tinea.
Just use an antifungal alone
Describe the presentation and treatment of tinea pedis?
Athlete’s foot
Most commonly found between the toes, but it can spread to the instep or sole
if athlete’s foot is very widespread, scales might have to be removed physically before treatment
OTC -azole (clotrimazole) BID for 4 weeks
What conditions look like tinea pedis (Athlete’s Foot)?
Allergic contact dermatitis
Erythasma (bacterial infection between toes)
Candidiasis (yeast infection on the feet is quite rare)
Seborrheic dermatitis (not common on foot)
When should pharmacists refer tinea pedis (Athlete’s Foot)?
Extensive (both top and bottom of foot affected)
No improvement after 1 week
Patient has diabetes
Onychomycosis (toenail infection)
Are antifungal powders better than creams?
No, creams are better because they have better contact with the skin.
Sprays and powders are better for oozing lesions and as preventative agents
Describe the presentation and treatment of tinea cruris?
The areas affected are the insides of the upper thigh (groin area), but the genitals are spared
The patient will report burning, itching, and skin colour change
Can affect men and women
Often co-morbid with tinea pedis and onychomycosis
Skin should be kept dry to help stop spread
Regular antifungal agents are totally fine
ex. prescribed (Terbinafine 1% Cream once daily for 7 days)
OTC (clotrimazole BID for 4 weeks)
What conditions can look like tinea cruris?
Candida (yeast infection that covers genitals, in tinea cruris genitals are spared)
Erythasma (common in tropical areas and is a chronic superficial bacterial infection)
Psoriasis
Seborrheic dermatitis
What are some non-pharmacological treatments for tinea cruris?
Skin should be kept dry
Launder items used by infected person
Une of non-medicated powders to help absorb moisture
Should corn starch be used for tinea cruris?
No, cornstarch could be used as a food source by the fungus that causes tinea cruris?
Why is talcum powder no longer in baby powder?
Talc was suggested to cause pulmonary issues due to application technique (dropping powder from distance, baby inhales in talc)
What is teh benefit of steroid and antifungal combination products?
These combination products are great for reducing inflammation and infection. The downside of these products is that a steroid is only needed for a few days, but it is usually used for the entire antifungal treatment duration (4 weeks)
Is erythasma a bacterial infection?
Erythasma are caused by bacterial and fungal pathogens. It is hard to determine between the two, so a diagnosis by treatment approach is used. If initial treatment approach doesn’t work, try the other agent
Describe the presentation of onychomychosis?
Initially, complaints about the appearance of the nail, with no physical symptoms
As the disease progresses, interference with standing, walking, and exercise
Paresthesia (burning/prickling sensation in limbs), pain, discomfort, and loss of dexterity
Onychomycosis accounts for 50-60% of cases of abnormal appearing nails
When should pharmacists refer onychomychosis?
More than 3 nails affected
More than 50% of any nail affected
Lunula involvement (Affects base of nail/white crescent)
What are some therapy options available to pharmacists for onychomychosis?
OTC: proplyene glycol/urea/lactic acid topical solution
Rx: Efinconazole 10% solution
(apply 1 drop once daily for up to 48 weeks)
How effective are onychomychosis treatments?
45-60% of cases treated with oral treatments (terbinafine) resolve in one year
6-23% of cases treated with efinaconazole resolve in one year
less than 10% of cases in placebo group resolved, therefore topical treatment should be resereved only for minimal cases (20-40% nail affected)
What are the different types of nail fungus?
DSO & DSLO: distal subungal lateral onychomychosis (can be treated with topical agents) This is also the most common form (75-85% of cases)
PSO: proximal subungal onychomychosis (more severe, need MD attention and oral agents)
WSO: white superficial onychomychosis (more severe, need MD and oral agents)
Candidal Onychomychosis: starts in the soft tissues before spreading to the nail (most common on fingernails)
