Skin & Psoriasis & Dandruff Flashcards
What questions might you consider when taking a dermatological history?
- Where did the problem first appear? certain type of conditions start from one area then spread
- Are there any other symptoms? - itch or pain
mild itch - psoriasis/medicine eruptions
severe itch - scabies, atopic/contact dermatitis - occupational hx?
- General medical hx?
- Travel?
- Family and household contact hx -
- Pts thoughts on the cause of the problem
What is psoriasis?
chronic relapsing inflammatory disorder
immune-mediated disorder with a genetic influence
What are the symptoms of psoriasis?
Silvery-white scales associated with inflamed, red, patchy plaques on the extensor surfaces of the elbow and knee
pitting fingernails
What are symptoms triggered by?
Stress
What medicines can aggravate psoriasis?
Li, antimalarials, BB, ACEI, NSAIDS
When to refer a pt with psoriasis?
pts presenting with symptoms with no prior diagnosis should be referred.
pts with moderate to severe psoriasis may required tx under the supervision of a dermatologist
What tx is necessary for psoriasis?
- Emollients - keratolytics have been incorporated into emollients
- POM include vit D derivatives (calcipotriol), topical steroids, dithranol
- Coal tar preparations
What are side effects that can occur with these products?
possibility of skin sensitisation
What are some tar-based products?
Alphosyl 2 in 1 shampoo Capasal Cocois Exorex Polytar, Polytar Plus Psoriderm SebCo T/Gel
What is Dandruff?
chronic, relapsing, non-inflammatory hyper-proliferative skin condition
What are symptoms of dandruff?
Greyish-white flakes or scales on the scalp which is often itchy
The scalp is the ONLY area affected unlike in seborrhoeic dermatitis
scalp is very dry, itchy, flaky
When to refer a pt with dandruff?
- suspected psoriasis
- Signs of infection
- symptoms of unresponsive to tx
What tx is required for dandruff?
- Ketoconazole 2% shampoo (Nizoral) is first line for moderate-severe dandruff - Use TWICE a week for 2-4 weeks after which used weekly or fortnightly as needed to prevent recurrence
- Selenium sulphide 2.5% (Selsun) - cytostatic effect - reduces the cell turnover rate
Used twice weekly for the first 2 weeks then weekly for the next 2 weeks and thereafter as required - Coal tar - least effective for tx of dandruff but may still be used as an alternative
- Zinc pyrithione - head and shoulders
What side effects can occur with using these products for dandruff?
cause allergic or sensitisation reactions and coal tar can cause photosensitivity
Can all shampoos be used at any age?
All except Selsun only use in children >5 years