Seborrhoeic Dermatitis and Dandruff Flashcards
What is seborrhoeic dermatitis
Chronic relapsing skin eruption usually occruing around oily areas producing sebum.
Endogenous form of eczema.
Men more than women, cradle cap.
Charaterisation of SD
Chronic relapsing skin eruption
Erythema and scaling
Increased cell turnover
Inflammatory response
Sebum-rich areas affected
Indicate increased sebaceous gland activity
Begins in late adolescence or 3 months of age
Pathophysiology of SD
Possible causes:
Proliferation of non-pathogenic yeast, Malassezia, causes inflam
Immunological - immunocompromised
Oily skin - seborrhoea
Hormone - andorgens
Nutrition, medication, genetics
Signs and symptoms of SD
Flaky, greasy, red patches
Minimal itch
Flares in winter, improves in summer
Affected areas include hairy areas (moustache, eyebrows, scalp), face, upper back and chest.
Signs and symptoms of dandruff
Mild form of seborrhoeic
White oily skin flakes
Itchy scalp
Signs and symptoms of SD in infants
Cradle cap- diffuse, yellow scale, greasy.
Nappy rash- salmon pink flaky patches, skin folds, flexures.
Minimal itch
Risk of secondary bacterial infection
Avoid picking scales off
Golden yellow - staph possible
Treatment for SD
Non-medicated shampoo
Keratolytics - remove scales
Topical antifungals - reduce malassezia
Mild topical corticosteroids - reduce inflammation
Topical calcineurin inhibitors - corticosteroid alternative
Dandruff treatment
First line: daily non-medicated shampoo
Then: anti-dandruff/medicated shampoos and lotions
Scalp SD treatment
First line: daily standard shampoo until scalp is clear.
Second: Anti-yeast shampoo (2x a week to daily) - ketoconazole, miconazole. May need to rotate between shampoos to avoid adaptation.
Third: add corticosteroid lotion, wash off w/ anti-yeast shampoo. CS for 7 days: betamethasone dipropionate 0.05%, methylprednisolone 0.1%, mometasone furoate 0.1%.
PLUS coal tar 1% emulsion.
If all else fails, add topical corticosteroid shampoo (clobetasol propionate 0.05%, twice weekly), use anti-yeast shampoo for 5 days
Face SD treatment
Cleanse w/ non-soap cleanser
Wash hair w/ anti-yeast shampoo to reduce spread
Best results: combined topical corticosteroid w/ antifungal agent
If ineffective: apply topical corticosteroid and antifungal cream SEPERATELY for 2 weeks
If this fails: use weak LPC 1-2% (od for 2 weeks)
Chest/back SD treatment
Treat as per face
Stronger tar preparations can be used if required (3-6% LPC, od-bd for 4 weeks)
Likely need moderately potent corticosteroid
Cradle cap treatment
Can clear itself
Daily use of shampoo and sot brush to remove scales
Massage baby oil or emollient to loosen crusts overnight
AVOID olive oil or food products
If no improvement: keratolytics (egozite lotion) bd for 3-5 days
topical corticosteroid lotion (significant erythema) - desonide 0.05% od after bath
If it spreads to neck and arms:
desonide 0.5% lotion bd until clear
OR hydrocortisone 1% ointment bd until skin clears.
Referral
Bacterial infection signs
Unsure of diagnosis
Treatment failure
Lifestyle changes
Shampoo hair regularly if you have oily scalp
Brush hair regularly
Save daily hair wash until after exercise
Limit use of styling products that make more oil
Use conditioner or leave-in conditioner
Avoid hair gels or alcohol containing products
Avoid hair dryers/straightners
Relaxation to manage stress
Eat regular, healthy meals, limit high fat, sugar, salt.
