Seborrhoeic Dermatitis Flashcards
Seborrhoeic Dermatitis and hair health.
Hair washing
-person specific
-frequency should not cause dryness or damaged hair
Afro/curly hair
-once per week to once per month
-more prone to break
-often use of a permade (oil based product)
Straight hair
-at least alternate days
Scalp presentations often mean a body skin problem so the shampoo or suds can be used anywhere else on body (including groin- suds)
Seborrhoeic Dermatitis
1) excess oil
2) Malassezia overgrowth (feeds on the oil)
3) inflammation
-poor demarcated erythema
-non adherent scale
-bran like
-oily/yellow colour
Non inflammatory seborrhoeic dermatitis = dandruff
DDX
-seborrhoeic psoriasis (worse than seborrhoeic dermatitis but not as bad as psoriasis)
-atopic dermatitis/contact dermatitis (ITCH, atopy, flexural regions)
-psoriasis (defined erythema, cling on sliver scale)
-pitysporium veriscolour
-rosacea
-tinea
-sun damage
look at nails and joints and natal cleft/genitalia, umbilicus to pick up Psoriasis/Psoriatic Arthritis
Management
-reduce oil burden
-reduce fungal burden
-reduce inflammation
-reduce relapse
be clear it is not curable
**you need 2 rotating antidandruff shampoos to prevent resistance and hair damage
Active Shampoos:
-Zinc
-Piroctone olamine
-Selenium (Selsun Gold)
-Ketoconazole (Nizoril 2%)
-Dercos (chemist warehouse)
-Exederm shampoo and conditioner (free of lots - order online)
Rest day shampoo:
-CeraVe Baby wash/handwash/bodywash
-QV Gentle
-Dermaveen
-Aveeno
-Dermeze
“active shampoo” (medicated)
-must have good contact
-massage into scalp part then repeat moving the part until head is covered
-Leave for 2-5minutes minimum before washing out
-they do tend to dry hair (so reverses condition; 1) apply conditioner and leave it in (acts as a barrier) 2) apply active shampoo 3) the rinse it off and can recondition if needed
Steroids:
Clobetasole 0.05% (clobex)
Novasone lotion
Diprosone lotion
Cream/ Ointment - are ok in curlier hair type
OR
Tacrolimus/Pimecrolimus
Crisaborole
JAK inhibitors
Bacterial concern
Triclosan 1% wash (put in to a pump)
Plaque/adherant
-coconut oil (keratolytic - break skin down) - not long term just to remove plaque
Emollients:
Light - CeraVe lotion
Medium - QV daily eczema cream (cheap, slick)
Thick - Dermeze ointment
Strategy of use
1) frequent initially to control symptoms
2) wean back frequency to minimum amount of time needed to keep symptoms at bay
at any time if flares go back to frequent use to gain control again
Plan:
** everynight until symptom free (normal skin)**
1) Steroid use to reduce inflammation
2) Alternate ACTIVE shampoos
3) have a “rest” day in between ACTIVE shampoos to prevent hair damage/dryness
**oral antifungal can be used while getting control
OR antifungal topical
**resistant forms can be bacterial infective driven also
