Scaly Dermatosis Flashcards
What layer of the skin is involved in scaly dermatosis?
Epidermis
What are the 3 chronic cases of scaly dermatoses?
- Dandruff
- Seborrhea
- Psoriasis
Of the 3 chronic cases of scaly dermatosis, OTC products can be used for…?
Dandruff and seborrhea
Psoriasis may respond to OTC, however you still need an initial diagnosis and management by a DR
At what age does dandruff peak at? When does it start?
Early adulthood
Puberty
What season is dandruff less severe?
During the summer
What fungus causes dandruff?
Yeast Malassezia
How is dandruff exacerbated?
Stress + cold temperatures
What is the pathophysiology behind dandruff?
Increased cell turnover and irregular keratin breakup which causes shedding white scales (crevice occurs at corneum)
What is the first line treatment for dandruff?
Hair washing w/ non-medicated shampoo
What is the second line treatment for dandruff?
Medicated shampoos (contact time is key)
When should you see the PCP on dandruff pts?
If resistant after 4-8 weeks
What do DHS-Zn, Selsun Blue, and Nizoral have in common?
They are agents that suppress Malassezia
What does coal tar do for dandruff?
Decreases cell turnover rate (can discolor hair, clothes, etc)
What’s wrong with using keratolytic shampoos on dandruff?
Longer treatment with limited efficacy
What is seborrhea?
Subacute / chronic inflammation that involves sebaceous glands
Who has a higher chance of getting seborrhea, males or females?
Males
How often does seborrhea show up in adults?
1-3%
What is the normal cell turnover rate?
25-30 days
What is the turnover rate in dandruff?
13-15 days
What is the turnover rate in seborrhea?
9-10 days
How can you exacerbate seborrhea?
Emotional stress
What season makes seborrhea worse?
Winter
What is the main physical symptoms in seborrhea?
Dull, yellow, greasy scales with erythema, v-shaped chest and back areas
With seborrhea, what is common in infants?
Cradle cap
How long can seborrhea last?
Years
Can you cure seborrhea?
No, but can be managed
How would you treat seborrhea in infants?
Massage scalp with baby oil, follow directions on non medicated shampoo
How would you treat seborrhea in adults?
Use shampoo,
If it last more than 7 days, then refer to PCP
What is the most severe form of scaly dermatoses?
Psoriasis
Who is more likely to get psoriasis, males or females?
Equal distribution
In terms of race, who is not likely to get psoriasis?
African and Native Americans, Asians
When does seborrhea in infants usually resolve w/o treatment?
8-12 months
What is Type 1 psoriasis?
Early age with family history
What is Type 2 psoriasis?
Later in life w/o family history
What can trigger psoriasis?
Environment, drugs, endocrine changes, drugs, infections, stress
What is the cell turnover in psoriasis?
4 days
What is the most common form of psoriasis?
Plaque psoriasis (90%)
What is the pathophysiology behind psoriasis?
Epidermal proliferation, which results in excessive scaling on raised plaques
What body part is psoriasis common in?
Elbows, knees, back, scalp, ears, and genitals
How do the lesions in psoriasis look like?
Well circumscribed, light pink to red/maroon
What are the exclusions for all scaly dermatoses?
- <2 yrs old
- No improvement after 2 weeks of treatment
- For psoriasis, >5% of body surface area
For scaly dermatosis, which is better, ointment or cream?
Ointment
What are the adverse effects of topical hydrocortisone?
Thins skin w/ prolonged use
Possible local skin infections
How could you enhance the activity of hydrocortisone on psoriasis?
Wait 30 minutes after application then apply emollients (petrolatum)
What is the OTC and RX % strength of Selenium Sulfide?
OTC: 1%
RX: 2.5%
What is the Selenium Sulfide’s MOA?
Decrease yeast count as it binds to hair and skin
How long should you leave medicated shampoo on?
3-5 minutes
What is an adverse effect of selenium sulfide?
Hair discoloration if you dont rinse thoroughly
What is Coal Tar’s MOA?
Cross-link with DNA and stops skin cell proliferation
What is Keratolytic agent’s MOA?
Contains salicyclic acid and sulfur to loosen and lyse keratin and helps remove the stuff off the scalp
Dissolves the “cement” between the cells
What is Ketoconazole’s adverse effects?
Hair loss
Abnormal hair texture
Dry skin
Sulfur can only be used to treat…?
Dandruff
