Seborrheic Dermatitis and Dandruff

Question 1

What is seborrhoeic dermatitis?

Answer 1

Chronic relapsing skin eruption of sebum rich areas

May indicate inc sebaceous gland activity

Diff presentations = May be due to difference in skin condition

Question 2

What dermatitis characterised by?

Answer 2

erythema and scaling

Inc cell turnover

inflammatory response

Question 3

What are the adult signs and symptoms of seborrheic dermatits?

Answer 3

Flaky, greasy red patches

minimal itch

Flare up in winter, improv ein summer

Question 4

What areas are usually affected in seborrhoeic dermatitis?

Answer 4

Hair bearing areas = scalp, eyebrows, moustache, eyelid margins (blepharitis)

Face = cheeks, nose, nasolabial folds

Upper back and chest

Question 5

What are signs and symptoms of Dandruff?

Answer 5

White, oily skin flakes or scales on scalp in air or on clothing

Flakes on eyebrows, in beard, on neck and shoulders

itchy scalp

Question 6

What are the signs of seborrhoeic dermatitis on baby’s scalp?

Answer 6

diffuse, greasy, yellowish scaling on scalp

Question 7

What are the signs of seborrhoeic dermatitis on baby’s bottom?

Answer 7

Nappy rash

Salmon pink flaky patches, in skin folds, check other areas

May have minimal itch

Question 8

What are some risks of seborrhoeic dermatitis in infants? (infection)

Answer 8

Risk of secondary bacterial infections = don’t pick scales off (Dry)

Golden yellow staph infection possible

Question 9

What are some characteristic features of atopic dermatitis and psoriasis as differential diagnoses for seb dermatitis/dandruff?

Answer 9

Atopic dermatitis = Very itchy, scalp involvement is less common

Psoriasis = Thicker plaques (silver), larger scales and typical distribution
- may have nail involvement, unlikely to affect eyelids and eyebrows

Question 10

What are some characteristic features of candidiasis and tinea capitis/corporis as differential diagnoses for seb derm/dandruff?

Answer 10

Candidiasis = Confined to mucous membranes, red papules and plaque
- Can be painful

Tinea corporis/capitis = dermatophyte infections, usually have define edge (active border)
- scaly, red, elevated w/ central clearing

Question 11

What are some characteristic features of contact dermatitis and rosacea as differential diagnoses for seb derm/dandruff?

Answer 11

contact dermatitis = Characterised distribution pattern from irritant or allergen

Rosacea = affect face mostly, flushing w/ dome shaped papules and pustules, rare under age of 25

Question 12

Summarise the available treatments for seborrhoeic dermatitis

Answer 12

Non-medicated shampoo

Keratolytics -> remove scales

Topical antifungals - reduce malaassezia

Mild topical corticosteroids - reduce inflammation

Topical calcineurin inhibitors - corticosteroid alternative

Question 13

Summarise the treatment of dandruff

Answer 13

Non-medicated shampoos (first-line)

anti-dandruff or medicated shampoo/otion

Question 14

What is the 1st line treatment for mild scalp seborrhoeic dermatitis?

Answer 14

daily standard shampoo until scalp is clear

Question 15

What is the second line treatment for seborrhoeic dermatitis?

Answer 15

Anti-yeast shampoo (twice weekly)

may need to rotate between different shampoos

Question 16

What are some anti-yeast shampoos?

Answer 16

ketoconazole

miconazole

ciclopirox

selenium sulfide

pyrithione zinc

coal tar

Question 17

What is treatment of seborroeic dermatitis if anti-yeast shampoo is ineffective? (third line)

Answer 17

Anti-yeast ashampoo + corticosteroid lotion for 7 days (at night)

+/- coal tar 1% emulsion OR LPC w/ salicylic acid

Question 18

What is fourth line treatment for seborroeic dermatitis (scalp)?

Answer 18

add topical corticosteroid shampoo to treatment regimen

e.g. clobetasol propionate = twice weekly, use anti-yeast on the 5 other days

Question 19

Outline the treatment of seborrhoeic dermatitis on face

Answer 19

1) non-soap cleanser (wash hair w/ anti-yeast) + topical antifungal/corticosteroid agents = hydrocortisone + miconazole/clotrimazole

2) if not work, apply topical corticosteroid and antifungal separately

3) use weak LPC for up to 2 weeks

Question 20

Outline the treatment of seborrheic dermatitis in chest/back

Answer 20

Treat same as face

stronger tar preparation can be used = 3-6%

Question 21

Summarise the non-pharm treatment of cradle cap

Answer 21

Can clear self

Daily shampoo + soft brush = remove scales

massage baby oil or emollient to loosen crusts overnight, wash next morning

Question 22

How is cradle cap treated if non-pharm methods are ineffective?

Answer 22

keratolytics = egozite lotion

Topical corticosteroid lotions = desonide after bathing

Question 23

What should be avoided in cradle cap treatment?

Answer 23

Olive oil or other household/food products

Question 24

How is cradle cap treated if its spreads to neck and under arms?

Answer 24

1) desonide lotion bd until skin clears

1) hydrocortisone ointment bd until skin clears

Question 25

What are some self-care tips for dandruff?

Answer 25

Shampoo hair often if you have oily scalp

Brush hair regularly

If scalp is dry, use conditioners

Avoid hair dryers and hair straighteners

Avoid using hair products that contain alcohol