Dermatology 2 Scaly Dermatoses - Dermatology 2 Scaly...

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
