Dandruff, Seborrhea, Cradle Cap Flashcards
What are the classic symptoms of dandruff?
dry, powdery scales
minimal inflammation
What are the classic symptoms of seborrhea?
yellow oily, greasy scales
inflammation (redness)
What is the etiology of dandruff?
yeast-like/fungal organism (Malassezia)
puberty accelerates it via androgens
Which group of patients tend to suffer more from dandruff?
males
highly stressed people
HIV patients
psoriasis patients
True or false: there is no genetic component to dandruff
false
What are some other conditions we must keep in mind before deciding that the condition is dandruff?
tinea
psoriasis
What is the first level of therapy for dandruff?
non-medicated shampoos
If regular shampoos havent worked in the control of dandruff then what should be tried next?
dandruff shampoos
What are the three different mechanism of actions of the dandruff shampoos?
cytostatic: slows down the proliferation of those cells
antifungal: main focus
keratolytic: dissolves skin flakes and superficial levels of scalp
What are the options for dandruff shampoos? List the mechanism of action applicable to each.
salicylic acid: keratolytic
coal tar: cytostatic
selenium sulfide: cytostatic, antifungal, maybe keratolytic
zinc pyrithione: cytostatic, antifungal, maybe keratolytic
ketoconazole: cytostatic, antifungal
ciclopirox: cytostatic, antifungal
Which dandruff shampoo is only available through prescription?
ciclopirox
True or false: all dandruff cases are fungal
cap
most are but not all
What are the key aspects of dandruff treatment?
treat the scalp (not the hair)
generally used 2x/week
5-10 mins of contact
How do you pick a dandruff shampoo?
simply pick one and then do some trial and error
True or false: there is not really any difference in efficacy of different dandruff shampoos
true
What is the difference between coal tar and coal tar solution?
coal tar (0.5%) is the mother compound and tar solution (10%) is a diluted down version
Are topical steroids used for dandruff?
more so for seborrhea because there needs to be inflammation for the steroid to do its job
Which topical steroid is used for seborrhea?
betamethasone dipropionate lotion/valerate foam
What are some common sites for seborrhea?
chest
armpits
scalp
anogenital
nose
chin
What are some uncommon spots for seborrhea? What should you do in these situations?
eyelid
ear canal
refer to MD in these situations
If a patient comes in with a skin condition and you are leaning towards seborrhea, what are some other conditions to keep in mind?
eczema
psoriasis
tinea corporis
perioral dermatitis
rosacea
Is seborrheic dermatitis primarily OTC treatment or MD?
MD
What is an OTC option for seborrheic dermatitis?
tar shampoos
What are the prescription options for seborrheic dermatitis?
anti-fungals:
-ketoconazole cream 2% (OD-BID x 4wks)
-ciclopirox shampoo
topical steroids
pimecrolimus cream
What is the downside of using topical steroids or pimecrolimus for seborrheic dermatitis?
they do nothing for the fungus, so fungal activity persists
What should patients expect with seborrheic dermatitis?
relapse over the years
What are the most common agents for seborrheic dermatitis?
antifungals and steroids
Describe cradle cap.
occurs during the 3rd or 4th week of infancy
scales on baby’s scalp
no oozing or weeping
quite common
disappears in ~8 months
What is the etiology of cradle cap?
unknown
What is the treatment of cradle cap?
baby oil or vaseline to soften scales
can use either one often and prn
Why do we switch dosage forms when treating seborrhea compared to dandruff?
we need more contact time for seborrhea thus we use the cream version of ketoconazole