Scaly Dermatitis

Question 1

What are treatment options for scaly dermatitis?

Answer 1

Coal Tar
Zinc Pyrithione
Selenium Sulfide
Ketoconazole 2% shampoo
Salicylic Acid

Question 2

What is coal tar?

Answer 2

Keratolytic, antiseptic, reduces local swelling and inflammation
Minimal fungal activity

Question 3

What’s the problem with coal tar?

Answer 3

It stains the skin and hair
It smells (there are a variety of dosage forms available that try to mask the door, colour and staining properties
It contains some known human carcinogens (weigh the risks and the benefits)

Question 4

What are the side effects of coal tar?

Answer 4

Acne, folliculitis (inflammation of the hair follicles), photosensitization, irritant contact dermatitis

Question 5

What is zinc pyrithione?

Answer 5

Cytostatic and keratolytic agent, effect likely due to non-specific toxicity for epidermal cells
Has bacteriostatic and fungistatic properties

Question 6

What are the side effects of zinc pyrithione?

Answer 6

Few side effects, rare cases of contact dermatitis have been reported when this is used on broken or abraded skin

Question 7

What is selenium sulfide?

Answer 7

Keratolytic, slows down scale production and epidermal proliferation
It has some fungicidal/static effects
It must be rinsed from hair thoroughly because discolouration may result (blond, grey or dyed hair)
Frequent use tends to leave a residual door, an oily scalp and hair loss
Irritation is minimal when used topically but it is toxic if ingested

Question 8

What is ketoconazole 2% shampoo?

Answer 8

Cytostatic and fungistatic
It is available as an OTC 2% shampoo
Minimal scalp and skin irritation, greasy or dry hair/scalp, itching or stinging

Question 9

What is salicylic acid?

Answer 9

Keratolytic agent
Decreases skin pH, which increases hydration of keratin facilitating loosening and removal
Not to be used in patients with greater than 20% BSA involvement as may cause salicylate toxicity