Scalp And Hair Conditions

Question 1

Dandruff is considered to be a mild form of _______________

Answer 1

seborrhoeic dermatitis

Question 2

Shampoos containing _____________ agents such as pyrithione zinc (which are widely available) and selenium may have beneficial effects in the treatment of dandruff

Answer 2

antimicrobial

Question 3

Shampoos containing antimicrobial agents such as ______________ (which are widely available) and ______________ may have beneficial effects

Answer 3

pyrithione zinc

selenium

Question 4

Shampoos containing _____________ extracts may be useful and they are also used in psoriasis

Answer 4

tar

Question 5

_____________ shampoo should be considered for more persistent or severe dandruff or for seborrhoeic dermatitis of the scalp

Answer 5

Ketoconazole

*Corticosteroid gels and lotions can also be used

Question 6

Cradle cap in infants may be treated with _____________ or _____________ applications followed by shampooing

Answer 6

coconut oil

olive oil

Question 7

What is cradle cap?

Answer 7

Seborrheic dermatitis; crusty or oily scaly patches on a baby’s sclap; probably caused by maternal hormones that cause oil glands on the skin to become overactive

Question 8

Which drugs may cause hirsutism? (6)

Answer 8

1. Minoxidil (used to promote hair growth)
2. Corticosteroids
3. Anabolic steroids
4. Androgens
5. Danazol
6. Progestogens

Question 9

What is the mechanism of action of minoxidil?

Answer 9

Shortens the telogen (resting) phase of the hair growth cycle, moving hair into the anagen (active growth) phase

Question 10

What are the phases of the hair growth cycle? (3)

Answer 10

1. Anagen phase: hair grows to its full length; 85-90% of hairs are in this phase at any one time; lasts 2-6 years, during which time the hair grows continuously
2. Catagen phase: transitional stage; lasts about 2-3 weeks; growth stops and outer root sheath shrinks and attaches to the root of the hair
3. Telogen phase: entire hair structure rests for several months; phase lasts for ~100 days; about 25-100 telogen hairs are shed normally each day
   (Then re-enters anagen phases)

*minoxidil improves blood flow to scalp, shortening telogen phase to promote hair growth and improve thickness, density, and overall health of hair

Question 11

_________________ can reduce hirsutism in obese women

Answer 11

Weight loss

Question 12

Women should be advised about local methods of ______________, and in the mildest cases of hirsutism this may be all that is required.

Answer 12

hair removal

Question 13

Eflornithine a(n) ______________ drug, inhibits the enzyme ornithine decarboxylase in hair follicles. Topical eflornithine can be used as an adjunct to laser therapy for facial hirsutism in women.

Answer 13

antiprotozoal

Question 14

Topical ______________, an antiprotazoal drug, can be used as an adjunct to laser therapy for facial hirsutism in women.

Answer 14

eflornithine

Question 15

_______________ (cyproterone acetate with ethinylestradiol) may be effective for moderately severe hirsutism

Answer 15

Co-cyprindiol

Question 16

Co-cyprindiol (_____________ with ______________) may be effective for moderately severe hirsutism

Answer 16

cyproterone acetate (an anti-androgen)

ethinylestradiol

Question 17

______________ is an alternative to co-cyprindiol in women with hirsutism secondary to polycystic ovary syndrome [unlicensed indication]

Answer 17

Metformin hydrochloride

• Systemic treatment is required for 6–12 months before benefit is seen

Question 18

The MHRA/CHM have released important safety information regarding the use of cyproterone acetate and the risk of _______________.

Answer 18

meningioma

Cyproterone acetate is a component of co-cyprindiol

Question 19

______________ is licensed for the treatment of androgenetic alopecia in men

Answer 19

Finasteride

• Continuous use for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued

Question 20

Finasteride is licensed for the treatment of _____________ alopecia in men

Answer 20

androgenetic

• Continuous use for 3–6 months is required before benefit is seen, and effects are reversed 6–12 months after treatment is discontinued

Question 21

Topical application of minoxidil may stimulate limited hair growth in a small proportion of adults but only for as long as ______________

Answer 21

it is used

Question 22

What are the common side effects of eflornithine? (4)

Answer 22

1. Alopecia
2. Increased risk of infection
3. Paresthesias
4. Skin reactions

(Rarely face edema, flushing, oral disorders, skin hemorrhage, and skin neoplasms)

Question 23

Is eflornithine safe to use in pregnancy and breastfeeding?

Answer 23

No, avoid

Question 24

Use of cyproterone acetate, including co-cyprindiol, for all indications is contra-indicated in those with _____________ or a history of ______________

Answer 24

meningioma

meningioma

Question 25

What are the contra-indications to using co-cyprindiol? (13)

Answer 25

1. Acute porphyrias
2. Current breast cancer
3. Heart disease associated with pulmonary HTN and risk of embolus
4. History of stroke or TIA
5. IHD
6. Known thrombogenic mutations
7. Medical treatment of varicose veins
8. Migraine with aura
9. Positive antiphospholipid antibodies
10. Presence or history of liver tumors
11. Previous or current venous or arterial thrombosis
12. Severe or multiple risk factors for arterial or venous thrombosis may
13. SLE with antiphospholipid syndrome

(Same contraindications as for estrogen)

Question 26

There is an increased risk of ________________ in women taking co-cyprindiol, particularly during the first year of use.

Answer 26

venous thromboembolism

• The incidence of venous thromboembolism is 1.5–2 times higher in women using co-cyprindiol than in women using combined oral contraceptives containing levonorgestrel, but the risk may be similar to that associated with use of combined oral contraceptives containing third generation progestogens (desogestrel and gestodene) or drospirenone. Women requiring co-cyprindiol may have an inherently increased risk of cardiovascular disease.

Question 27

What are the common side effects of co-cyprindiol? (7)

Answer 27

1. Abdominal pain
2. Breast abnormalities
3. Depression
4. Headache
5. Mood altered
6. Nausea
7. Weight changes

Question 28

Is co-cyprindiol an effective contraceptive?

Answer 28

Yes; however it should not be used solely for contraception but reserved for women who require treatment for androgen-dependent skin conditions. Patients should not take other hormonal contraceptives while being treated with co-cyprindiol.

Question 29

Is co-cyprindiol safe to use during pregnancy and breastfeeding?

Answer 29

Avoid during pregnancy due to risk of feminization of male fetus with cyproterone (anti-androgen)

Avoid if breastfeeding due to anti-androgen effects

Question 30

Is co-cyprindiol safe to use in hepatic and/or renal impairment?

Answer 30

Caution in hepatic impairment; avoid in severe or active disease

Question 31

What is the mechanism of action of finasteride?

Answer 31

A specific inhibitor of the enzyme 5α-reductase, which metabolises testosterone into the more potent androgen, dihydrotestosterone

Question 32

What are the indications of finasteride? (2)

Answer 32

1. BPH

2. Androgenetic alopecia in men

Question 33

The MHRA has received reports of _____________ and, in rare cases, _____________ in men taking finasteride (Propecia®) for male pattern hair loss; _____________ is also associated with Proscar® for benign prostatic hyperplasia.

Answer 33

depression

suicidal thoughts

depression

• Patients should be advised to stop finasteride immediately and inform a healthcare professional if they develop depression

Question 34

Finasteride should be used with caution in which patients?

Answer 34

Those with obstructive uropathy

Question 35

What is the common side effect of finasteride?

Answer 35

Sexual dysfunction

Rarely breast abnormalities, depression, infertility, testicular pain, palpitations, and angioedema

Question 36

Finasteride is excreted in semen and use of a condom is recommended if sexual partner is _______________.

Answer 36

pregnant or likely to become pregnant

Question 37

How does finasteride effect laboratory tests?

Answer 37

Decreases serum concentration of prostate cancer markers such as prostate-specific antigen; reference values may need adjustment.

Question 38

what patient and carer information should be given regarding finasteride? (2)

Answer 38

1. Women of childbearing potential should avoid handling crushed or broken tablets
2. Cases of male breast cancer have been reported; promptly report any changes in breast tissue such as lumps, pain, or nipple discharge

Question 39

Finasteride _____ (is/is not) prescribable in NHS primary care for the treatment of androgenetic alopecia in men.

Answer 39

Is NOT (in primary care)