Dermatology 2 Scaly Dermatoses Objectives Identify signs and symptoms of different types of scaly dermatoses: Dandruff, seborrhea, psoriasis Provide non pharmacologic treatment options for scaly dermatoses Recommend appropriate nonprescription therapy for scaly dermatoses given patient specific presentation and history Recognize when self-care is not appropriate (when to refer to primary care provider) Scaly Dermatoses Chronic Scaly Dermatoses Dandruff Seborrheic dermatitis Psoriasis Involve uppermost layer of skin (epidermis) Scales = primary manifestation Accelerated epidermal cell turnover Normal Skin: 25 – 30 days Dandruff: 13 – 15 days Seborrheic Dermatitis: 9 – 10 days Counseling Rarely cured – OTC agents help control s/s of mildmoderate scaly dermatoses Severity fluctuation is common Seborrheic dermatitis, psoriasis Emotions, physical, environmental factors may cause Appropriate treatment application and duration is very important Follow-up after 1 week of self-treatment Worsened? REFER Not worsened? Follow-up again in 1 week Symptoms persist/worsened? REFER
Dandruf Dandruff is also known as seborrhea Mild inflammatory scalp disorder - excessive scaling of scalp 1% - 3% of population affected Uncommon in children, generally appears at puberty No gender preference Responsible organism: Malassezia species of yeast Cosmetic concern, social stigma Clinical Presentation Diffuse, rather than patchy Minimally inflammatory Only visible manifestation: scaling Large white or gray scales Pruritus common Treatment Goals Treatment Goals Reduce epidermal turnover rate of scalp Reducing number of malassezia species in the scalp Minimize cosmetic embarrassment of visible scaling Minimize itch General Treatment approach Washing hair and scalp with general-purpose, non-medicated shampoo (every other day or daily) If not controlled → medicated antidandruff products Pharmacologic Treatment Overview Initial recommendation Agent that reduces malassezia counts on scalp Alternative: nonprescription ketoconazole shampoo Second-line therapy Shampoos with cytostatic agents E.g. coal tar May discolor light hair, clothing, jewelry; Limited efficacy Additional Options Keratolytic shampoo E.g. salicylic acid, sulfur Significantly longer treatment time Medicated shampoos Suppress replication of malassezia species Pyrithione zinc or Selenium sulfide Contact time = key to efficacy Directions for use Massage shampoo into scalp and leave on hair for 3-5 minutes before rinsing Selenium sulfide : repeated rinsing to ensure no residue (may cause discoloration) – Use daily for 1 wk, then 2-3 times weekly for 2-3 wk Medicated Shampoo Products Anti-Malassezia Agents Pyrithione Zinc 1% or 2% Reduces yeast count in the scalp and skin
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- Fall '08
- tinea pedis, tinea corporis, Antifungal drug, Ketoconazole, Terbinafine, Dandruff