Dandruff & Seborrheic Dermatitis Flashcards
similarities/diff b/w dandruff and seborrheic derm?
Papulosquamous cutaneous disorders that may be difficult to distinguish from one another but have similar origins
Dandruff is milder, non-inflammatory and limited to scalp
Seborrheic derm. is inflammatory, scaling in areas of high sebaceous activity
scaly papules and plques due to high turnover rate of skin cells
dandruff pathophys and presentation (pityriasis simplex capitas)
aggravating factors?
Non-inflammatory desquamation
- Dry, white scales scattered within the hair-bearing areas of the scalp
- Primarily a cosmetic problem
- Usually begins between 10-20 years of age
- Affects 40% of people over 30 years of age
- Caused by increased cell turnover and Malassezia yeast may be present
- detaches with fritction or combing
- minimal erythema
- Risk and aggravating factors:
Dry environments
Poor hygiene
seb derm pathophys and presentation
An inflammatory, greasy, yellow-brown scaling eruption
Erythema may be present
Occurs in “seborrheic areas” – the scalp, upper trunk and face (eyelids may be involved; blepharitis)
- common in first 3 months of life - cradle cap
- more common in men due to androgens
- adult 30-50 years
Flares occur when sebaceous glands are most active and due to humidity and stress
Controversy over pathogenesis
Malassezia yeast may play a role or may be fungal disease
- some say its papulosquamous due to abnormal cell turnover
seb derm risk factors
Family history of psoriasis or allergy
Immunocompromised state
Neurologic conditions such as Parkinson’s - overactivity of parasymp NS and increased action of androgens and melanocytes
Age (middle-age or elderly)
Cold, dry weather
Stress (sleep deprivation, sweat, emotional stress)
Diet? - Western” diet in females to be associated with a higher incidence
Drugs (cimetidine)
infantile seb derm
also known as cradle cap (diffuse, greasy scaling on scalp most often)
Thick, yellow-brown/grey patches that may flake or peel
May have widespread erythema with “cheesy” exudate in flexural folds
Not especially itchy, baby usually appears undisturbed
Disappears by the first 3 months
red flags
Diagnosis in doubt Treatment failure Widespread area of involvement Systemic symptoms present Immunocompromised Sudden onset in young patient
dandruff goals of therapy
Reduce or eliminate scales and flaking
Prevent recurrence by improving scalp hygiene
Eliminate or reduce environmental triggers
seb derm goals of therapy
Control (not cure) symptoms
Reduce fungus and resulting scaling/inflammation
Relief symptoms (e.g., pruritis)
Education importance of control through good hygiene
Eliminate or reduce environmental triggers
non-pharm management
Avoid harsh soaps, hairsprays, and alcohol-containing products
Use warm (not hot) water to remove scales daily and shampoo ~3x week (nonmedicated shampoos) Suggest oil to soak scales to ease removal
Moisturize daily (conditioner) Stress reduction Cool air humidifier Warm compresses for affected eyelids Cleansing eyelids or eyebrows with a mild shampoo (baby shampoo) more often to remove scales
Cradle cap
Use mild shampoo / bath oil to remove scales
Use a soft brush to gently remove scales (soft toothbrush)
suggest a few for the pt - add or remove in f/u
pharm
what is first line therapy?
pdt name
MOA?
Antifungals – first-line in both conditions
Nizoral® – ketoconazole (first line therapy)
MOA: fungistatic, helps with inflammation
SE: minimal irritation
Use 2-4x week
Widely studied; good response in 4 weeks
also an antifungal cream for other areas
pharm
what are 2 second line therapies?
pdt name
MOA?
Selsun® blue – selenium sulfide
MOA: fungistatic on scalp, keratolytic
Do not use > 3x/week
SE: irritation of broken skin; may affect hair dye or damage jewelry
Skin needs enough exposure - 5 mins and rinse it out and repeat one more time
Head and Shoulders® products – zinc pyrithione
MOA: cytostatic and keratolytic properties
Use: 2-3x week
SE: may discolor hair
pharm
what is an alternative to ketoconazole?
Stieprox® – ciclopirox shampoo – Rx (alternative to ketoconazole) MOA: cytostatic (slows fungal growth) Use: 2-3x week SE: well tolerated, minimal irritation - costly but also 1st line
Name 3 keratolytics (may be added to other topical therapies)
Keratolytics – may be added to other topical therapies
- Salicylic acid – helps detach flakes / allows penetration of other agents
- Sulfur – antifungal, antibacterial, and keratolytic effect
- Coal tar – reduces swelling, inflammation, and itching, but minimal antifungal activity
SE: messy, staining, and unpleasant odor
- fallen out of favour
Sebcur has coal tar and salicylic acid
Denorex has coal tar
Anti-inflammatories (3)
Topical corticosteroids (TCS) Reduce pruritus and inflammation Generally, have patient stay on corticosteroid for 2-3 weeks until antifungal exerts its action then withdraw TCS Intended for temporary use e.g., hydrocortisone 1% Scalp solutions available
Topical calcineurin inhibitors – second line option Prescription-only e.g., tacrolimus or pimecrolimus - NO side effects, prescription only - for thin skin only
Oral antifungals – for severe or refractory cases
For seb derm as areas can be inflamed and in other places which is added to antifungal
Pt education
how can shampoos be used effectively?
Effective use of shampoos:
Use a mineral oil or bath oil on scalp the night before to loosen scales
Can be used on scalp, beard, or chest
Can cause flares if left on skin too long
Generally, massage agent into scalp for 4-5 minutes, rinse, then repeat
Prophylaxis/maintenance: Treat once every 1–2 wk
Other medicated therapies
Should be left in contact with scalp or beard for 2-20 minutes, depending on product or severity
- use antifungal shampoos 2-4 times a week
- antifungal cream for toher areas
- sever cases - left overnight
- treatment failure - suggest a second antifungal shampoo and if it fails, add corticosteroids or keratolytics
