Seborrheic Dermatitis and Dandruff Flashcards
What is seborrhoeic dermatitis?
Chronic relapsing skin eruption of sebum rich areas
May indicate inc sebaceous gland activity
Diff presentations = May be due to difference in skin condition
What dermatitis characterised by?
erythema and scaling
Inc cell turnover
inflammatory response
What are the adult signs and symptoms of seborrheic dermatits?
Flaky, greasy red patches
minimal itch
Flare up in winter, improv ein summer
What areas are usually affected in seborrhoeic dermatitis?
Hair bearing areas = scalp, eyebrows, moustache, eyelid margins (blepharitis)
Face = cheeks, nose, nasolabial folds
Upper back and chest
What are signs and symptoms of Dandruff?
White, oily skin flakes or scales on scalp in air or on clothing
Flakes on eyebrows, in beard, on neck and shoulders
itchy scalp
What are the signs of seborrhoeic dermatitis on baby’s scalp?
diffuse, greasy, yellowish scaling on scalp
What are the signs of seborrhoeic dermatitis on baby’s bottom?
Nappy rash
Salmon pink flaky patches, in skin folds, check other areas
May have minimal itch
What are some risks of seborrhoeic dermatitis in infants? (infection)
Risk of secondary bacterial infections = don’t pick scales off (Dry)
Golden yellow staph infection possible
What are some characteristic features of atopic dermatitis and psoriasis as differential diagnoses for seb dermatitis/dandruff?
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
What are some characteristic features of candidiasis and tinea capitis/corporis as differential diagnoses for seb derm/dandruff?
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
What are some characteristic features of contact dermatitis and rosacea as differential diagnoses for seb derm/dandruff?
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
Summarise the available treatments for seborrhoeic dermatitis
Non-medicated shampoo
Keratolytics -> remove scales
Topical antifungals - reduce malaassezia
Mild topical corticosteroids - reduce inflammation
Topical calcineurin inhibitors - corticosteroid alternative
Summarise the treatment of dandruff
Non-medicated shampoos (first-line)
anti-dandruff or medicated shampoo/otion
What is the 1st line treatment for mild scalp seborrhoeic dermatitis?
daily standard shampoo until scalp is clear
What is the second line treatment for seborrhoeic dermatitis?
Anti-yeast shampoo (twice weekly)
may need to rotate between different shampoos
What are some anti-yeast shampoos?
ketoconazole
miconazole
ciclopirox
selenium sulfide
pyrithione zinc
coal tar
What is treatment of seborroeic dermatitis if anti-yeast shampoo is ineffective? (third line)
Anti-yeast ashampoo + corticosteroid lotion for 7 days (at night)
+/- coal tar 1% emulsion OR LPC w/ salicylic acid
What is fourth line treatment for seborroeic dermatitis (scalp)?
add topical corticosteroid shampoo to treatment regimen
e.g. clobetasol propionate = twice weekly, use anti-yeast on the 5 other days
Outline the treatment of seborrhoeic dermatitis on face
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
Outline the treatment of seborrheic dermatitis in chest/back
Treat same as face
stronger tar preparation can be used = 3-6%
Summarise the non-pharm treatment of cradle cap
Can clear self
Daily shampoo + soft brush = remove scales
massage baby oil or emollient to loosen crusts overnight, wash next morning
How is cradle cap treated if non-pharm methods are ineffective?
keratolytics = egozite lotion
Topical corticosteroid lotions = desonide after bathing
What should be avoided in cradle cap treatment?
Olive oil or other household/food products
How is cradle cap treated if its spreads to neck and under arms?
1) desonide lotion bd until skin clears
1) hydrocortisone ointment bd until skin clears
