Dandruff, Seborrhea, Cradle Cap

Question 1

What are the classic symptoms of dandruff?

Answer 1

dry, powdery scales
minimal inflammation

Question 2

What are the classic symptoms of seborrhea?

Answer 2

yellow oily, greasy scales
inflammation (redness)

Question 3

What is the etiology of dandruff?

Answer 3

yeast-like/fungal organism (Malassezia)
puberty accelerates it via androgens

Question 4

Which group of patients tend to suffer more from dandruff?

Answer 4

males
highly stressed people
HIV patients
psoriasis patients

Question 5

True or false: there is no genetic component to dandruff

Answer 5

false

Question 6

What are some other conditions we must keep in mind before deciding that the condition is dandruff?

Answer 6

tinea
psoriasis

Question 7

What is the first level of therapy for dandruff?

Answer 7

non-medicated shampoos

Question 8

If regular shampoos havent worked in the control of dandruff then what should be tried next?

Answer 8

dandruff shampoos

Question 9

What are the three different mechanism of actions of the dandruff shampoos?

Answer 9

cytostatic: slows down the proliferation of those cells
antifungal: main focus
keratolytic: dissolves skin flakes and superficial levels of scalp

Question 10

What are the options for dandruff shampoos? List the mechanism of action applicable to each.

Answer 10

salicylic acid: keratolytic
coal tar: cytostatic
selenium sulfide: cytostatic, antifungal, maybe keratolytic
zinc pyrithione: cytostatic, antifungal, maybe keratolytic
ketoconazole: cytostatic, antifungal
ciclopirox: cytostatic, antifungal

Question 11

Which dandruff shampoo is only available through prescription?

Answer 11

ciclopirox

Question 12

True or false: all dandruff cases are fungal

Answer 12

cap
most are but not all

Question 13

What are the key aspects of dandruff treatment?

Answer 13

treat the scalp (not the hair)
generally used 2x/week
5-10 mins of contact

Question 14

How do you pick a dandruff shampoo?

Answer 14

simply pick one and then do some trial and error

Question 15

True or false: there is not really any difference in efficacy of different dandruff shampoos

Answer 15

true

Question 16

What is the difference between coal tar and coal tar solution?

Answer 16

coal tar (0.5%) is the mother compound and tar solution (10%) is a diluted down version

Question 17

Are topical steroids used for dandruff?

Answer 17

more so for seborrhea because there needs to be inflammation for the steroid to do its job

Question 18

Which topical steroid is used for seborrhea?

Answer 18

betamethasone dipropionate lotion/valerate foam

Question 19

What are some common sites for seborrhea?

Answer 19

chest
armpits
scalp
anogenital
nose
chin

Question 20

What are some uncommon spots for seborrhea? What should you do in these situations?

Answer 20

eyelid
ear canal
refer to MD in these situations

Question 21

If a patient comes in with a skin condition and you are leaning towards seborrhea, what are some other conditions to keep in mind?

Answer 21

eczema
psoriasis
tinea corporis
perioral dermatitis
rosacea

Question 22

Is seborrheic dermatitis primarily OTC treatment or MD?

Answer 22

MD

Question 23

What is an OTC option for seborrheic dermatitis?

Answer 23

tar shampoos

Question 24

What are the prescription options for seborrheic dermatitis?

Answer 24

anti-fungals:
-ketoconazole cream 2% (OD-BID x 4wks)
-ciclopirox shampoo
topical steroids
pimecrolimus cream

Question 25

What is the downside of using topical steroids or pimecrolimus for seborrheic dermatitis?

Answer 25

they do nothing for the fungus, so fungal activity persists

Question 26

What should patients expect with seborrheic dermatitis?

Answer 26

relapse over the years

Question 27

What are the most common agents for seborrheic dermatitis?

Answer 27

antifungals and steroids

Question 28

Describe cradle cap.

Answer 28

occurs during the 3rd or 4th week of infancy
scales on baby’s scalp
no oozing or weeping
quite common
disappears in ~8 months

Question 29

What is the etiology of cradle cap?

Answer 29

unknown

Question 30

What is the treatment of cradle cap?

Answer 30

baby oil or vaseline to soften scales
can use either one often and prn

Question 31

Why do we switch dosage forms when treating seborrhea compared to dandruff?

Answer 31

we need more contact time for seborrhea thus we use the cream version of ketoconazole