Scaly Dermatoses Flashcards
Dandruff: Sx, Location, Appearance, Time Course
- Sx: often itchy
- Location: scalp only (even/spares bald areas)
- Appearance: flakes are thin, white/gray, minimal skin inflammation
- Time Course: appears in puberty, peaks in early adulthood, lessens with older age
Seborrheic Dermatitis: Sx, Location, Appearance, Time Course
- Sx: often itchy
- Location: scalp, face, trunk (patchy)
- Appearance: scales are thin, yellow/oily, underlying plaques of red/inflamed skin
- Time Course: chronic, relapsing/remitting
SD in Infants “Cradle Cap”: Sx, Location, Appearance, Time Course
- Sx: does not disturb sleep or feeding, rarely itchy
- Location: scalp is most common (cradle cap) face, trunk, or diaper areas (patchy)
- Appearance: crusts or scales are thin, yellow/oily, underlying plaques of red/inflammed skin
- Time Course: begins ~3 wks old, resolves before 12 mo old
Plaque Psoriasis: Sx, Location, Appearance, Time Course
- Sx: itchy or painful, non-derm complications are common
- Location: scalp, trunk, extremities, extensor surfaces (elbow/knee), symmetrical
- Appearance: bleeding spots if scales are removed, thick, silvery white, red underlying plaque with sharp borders
- Time Course: chronic, relapsing/remitting
Etiology
• Dandruff & seborrheic dermatitis: Unknown
– Colonizing microbes, Malassezia yeast
– Immune hyperactivity, inflammation
• Psoriasis: Unknown
– Genetics
– Immune hyperactivity, inflammation
Triggers
• Dandruff & Seborrheic Dermatitis:
– Dry or cold climate
– Physical or emotional stress
• Psoriasis: – Dry or cold climate – Physical or emotional stress – Skin irritation or injury – Infections – Alcohol or tobacco use – Some medications (ex: beta blockers, lithium)
Risk Factors
• Dandruff & Seborrheic Dermatitis: – HIV or AIDS – Parkinson’s Disease – Epilepsy – Recent stroke or heart attack – Depression – Eating disorders
• Psoriasis:
– Family history
Exclusions for OTC Medical Self-Treatment
- Age < 2 years
- Worsening or no improvement after 2 weeks of appropriate OTC medication use
- Involvement of eyes or inner ear canal
- Extensive disease (>5% body surface area)
Non-pharmacological Treatment
• Dandruff & Seborrheic Dermatitis:
– Residue free, non-medicated shampoo or soap
– Avoidance of triggers
• Psoriasis:
– Residue free, non-medicated shampoo or soap
– Avoidance of triggers
– Sunlight or UV therapy
– Emollients, lubricants, or warm soaks for dry, cracked skin
OTC Treatment Options
Antifungals
- Kills yeast, Malassezia
- Pyrithione zinc, selenium sulfide, ketoconazole
Cytostatics
- Reduce skin cell turnover
- Coal tar
Keratolytics
- Soften and break up flakes
- Salicylic acid, sulfur
Corticosteroids
- Reduce inflammation
- Hydrocortisone
Dandruff OTC Treatment
- Shampoos are the preferred product form
- Usual dose: Apply for 5 minutes 2-3x weekly until sx control, then decrease to q1-2 weeks
– Antifungals: 1st choice (good efficacy, few AE’s)
– Coal tar: Useful in refractory cases (more significant AE’s)
– Keratolytics: Useful in select cases (patient preference)
– Hydrocortisone: Not used for dandruff
Seborrheic Dermatitis OTC Treatment
• Same options, usually dosed more aggressively:
– Daily (1st wk), then 2-3x weekly (4 wks), then weekly
• Product selection depends on area:
– Scalp & hairy areas: Shampoo preferred > cream or gel
– Skin of face & body: Ointment or cream preferred
• Hydrocortisone preferred for acute exacerbations
Cradle Cap Treatment
• Emphasize non-pharm therapy, refer to MD if severe or no response after 2 weeks
– Frequent shampooing with non-medicated shampoo
– Emollients (petrolatum, vegetable oil, mineral oil, baby oil) to soften & loosen scales, may apply and leave overnight
– Gentle brushing to remove scales
Psoriasis OTC Treatment
• Only mild cases can be self-treated
• Product selection depends on disease phase:
– Chronic phase (scales): Coal tar, salicylic acid
– Acute phase (flares): Hydrocortisone
• Antifungals generally not useful
– Possible exception: Chronic, mild cases of the scalp
Monitoring
• Therapeutic – Resolution of symptoms (already discussed) • Toxic – Adverse effects (already discussed) • Follow-uptime – Dandruff: 1-2 months – Seborrheic dermatitis: 1-2 weeks – Psoriasis: 1-2 weeks
