Scaly Dermatitis

Question 1

What are 5 medications that can be used to treat scaly dermatitis?

Answer 1

coal tar
zinc pyrithione
selenium sulfide
ketoconazole 2% shampoo
salicylic acid (SA)

Question 2

what is coal tar? how does it work?

Answer 2

keratolytic and antiseptic; may also have anti-pruritic effects
works by increasing time it takes for cells to turnover because skin cells aren’t forming properly and start to clump together

Question 3

what are the side effects of coal tar?

Answer 3

acne
folliculitis
stains to skin/hair
photosensitization
irritant contact dermatitis

Question 4

what are two downsides to using coal tar?

Answer 4

unpleasant odour/colour, can stain

known to contain some human carcinogens

Question 5

what is zinc pyrithione?

Answer 5

cytostatic (decreases rate of epidermal skin cell replication) and keratolytic
also has bacteriostatic and fungistatic properties

Question 6

what is a benefit of using zinc pyrithione?

Answer 6

very well tolerated (few side effects)

Question 7

what is selenium sulfide?

Answer 7

keratolytic, slows down scale production and epidermal proliferation; some fungicidal/static properties

Question 8

what is one downside to using selenium sulfide?

Answer 8

frequent use tends to leave a residual odour, an oily scalp, and hair loss

Question 9

what is ketoconazole 2% shampoo?

Answer 9

cytostatic and fungistatic

Question 10

what is SA?

Answer 10

keratolytic
causes loosening and flaking off of skin (decreases pH, which increases hydration of keratin, facilitating loosening and removal

Question 11

what is a precaution with SA?

Answer 11

not to be used on over 20% of BSA as it may cause salicylate toxicity (tiredness, ringing in ears, GI symptoms)

Question 12

what is psoriasis?

Answer 12

life-long chronic inflammatory disease of the skin involving high turnover rate of skin cells

Question 13

what are some risk factors for psoriasis?

Answer 13

genetic predisposition
skin trauma
environmental (alcohol, obesity, stress, preggo)
medications (beta-blockers, NSAIDs)
infections (resp, strep, HIV)

Question 14

what are 4 signs and symptoms of psoriasis?

Answer 14

thickened red plaque with silvery-white scales
bleed easily
symmetrical lesions
minimal itching

Question 15

what are some assessment questions to ask the pt? (7 points)

Answer 15

1) how severe are the symptoms
2) duration of irritation
3) area of involvement
4) how often do symptoms occur
5) med history
6) has anything been tried yet
7) has it been diagnosed by a physician

Question 16

what are some red flags for psoriasis? (6 points)

Answer 16

1) 3% of body surface area involved
5) severity and type of psoriasis (ie: mild vs severe)
6) location of lesions: hand, forearms, face

Question 17

What are 5 different modes of therapy for psoriasis?

Answer 17

topical therapy
phototherapy
systemic therapy
biologic therapy
combination therapy

Question 18

What are 5 non-pharms for psoriasis treatment?

Answer 18

1) don’t rub, scratch or pick skin
2) mild cleansers and warm water used for cleansing - avoid fragrances and irritating chemicals to reduce drying effects
3) moisturize skin and keep hydrated
4) avoid triggers (smoking, alcohol, stress)
5) moisturize air in home

Question 19

what are 4 topical treatment options for psoriasis?

Answer 19

1) corticosteroids (med-high potency)
2) compounds with coal tar or salicylic acid
3) tazarotene
4) calcipotriol

Question 20

what are some coal tar products used to treat psoriasis?

Answer 20

denorex regular or extra strength

Targel

Question 21

what are some SA products used to treat psoriasis?

Answer 21

dermarest medication shampoo
sebcur
psoriasis S/A therapeutic shampoo

Question 22

what are some combo products (SA and coal tar)

Answer 22

polytar AF shampoo
Sebcur/T
Tardan Shampoo
Targel SA

Question 23

what is a corticosteroid product that can be used to treat psoriaris?

Answer 23

hydrocortisone 0.5% cream

Question 24

What is dandruff?

Answer 24

Chronic, non-inflammatory scalp condition involving excessive scaling of the scalp

Question 25

what are 5 risk factors for dandruff?

Answer 25

Environmental (dry climate, weather extremes)
Increased stress
Obesity (increased sweat)
Inadequate hair washing
Possibly caused by fungus Malassezia furfur

Question 26

what are 6 signs and symptoms of dandruff?

Answer 26

1) dry, white, or silvery-gray flakes
2) scaling from accumulation of flakes
3) detached by combing hair
4) Usually symmetrical presentation
5) may be in patches (uncommon)

Question 27

What are 3 non-pharms for dandruff and seborrhea dermatitis treatment?

Answer 27

1) remove triggers and aggravating factors
2) wash hair with general, non-medicated shampoo every other day or daily
3) control stress

Question 28

what are 5 ways to remove triggers/aggravating factors in regards to dandruff and seborrhea dermatitis treatment?

Answer 28

avoid irritating soaps, gels, greasy creams, and hair products
avoid excessive hot water
avoid or decrease exposure to cold, dry air
use cool air humidifier
warm compresses to area

Question 29

What are the first and second line treatments for dandruff?

Answer 29

1st: zinc pyrithrione, selenium sulfide, ketoconazole shampoo to decrease Malassezia
2nd: keratolytic agent (SA) or antiproliferative agent (coal tar)

Question 30

What are some zinc pyrithione products for dandruff?

Answer 30

Head and shoulders

Pantene anti-dandruff

Question 31

What are some selenium sulfide products for dandruff?

Answer 31

Selsun
Selsun blue
Head and shoulders clinical strength

Question 32

what is a ketoconazole product for dandruff?

Answer 32

nizoral shampoo

Question 33

what are some SA products for dandruff?

Answer 33

Sebcur

Selsun blue deep cleansing

Question 34

What are some coal tar products for dandruff?

Answer 34

neutrogena T-gel
Denorex
Polytar
Sebcur/T

Question 35

What is seborrhea dermatitis?

Answer 35

sub-acute or chronic inflammatory condition involving accelerated turnover rate of skin cells

Question 36

What are two possible causes for seborrhea dermatitis?

Answer 36

yeast infection (Malassezia)
abnormality of the oil glands and hair follicles

Question 37

What are 6 risk factors for seborrhea dermatitis?

Answer 37

increased incidence in HIV/AIDS patients
genetics
med conditions (Parkinsons, depression, mood disorders)
environmental (low humidity and temp)
Stress
Meds (lithium, cimetidine , haloperidol, methyldopa)

Question 38

What are 5 signs and symptoms of seborrhea dermatitis?

Answer 38

1) mild greasy scaling of scalp area
2) starts as small patches and spreads
3) dull, yellowish oily scaly areas on red skin
4) itching is common
5) groin area, axillae show lesions that are bright red without scaling

Question 39

What are 5 red flags with seborrhea dermatitis?

Question 40

What are the 1st and 2nd line treatments for seborrhea dermatitis?

Answer 40

1st - zinc pyrithrione, selenium sulfide, ketoconazole

2nd - keratolytic, antiproliferative, hydrocortisone cream

Question 41

how do you use hydrocortisone cream to treat seborrhea dermatitis?

Answer 41

OD-BID for 1-2 weeks or until symptoms clear

apply after shampooing

Question 42

What are the instructions of use for medicated shampoos?

Answer 42

use 2-4 times per week until controlled

reduce to once per week to prevent relapse

Question 43

what is the medication pharmacists are allowed to prescribe in MB?

Answer 43

ciclopirox

broad spectrum agent that is effective against dermatophytes, yeast, and some bacteria