10/23 (SCALY DERMATOSIS)

What are the three common chronic scaly dermatoses

Seborrhea(seborrheic dermatitis)

Dandruff

Psoriasis

What is the pathophysiology of Dandruff

Accelerated epidermal proliferation; role of malassezia yeast and skin barrier disruption

What is the pathophysiology of Seborrheic dermatitis?

Overgrowth of Malassezia high sebaceous gland activity, and prominent inflammation.

First line Treatment for Dandruff and Seborrheic dermatitis

Pyrithione Zinc (1%-2%); slows cell turnover inhibits Malassezia

Selenium sulfide (1% OTC/ 2.5 Rx): reduce Malassezia growth

What is the first line antifungal option?

Ketoconazole 1% shampoo: imidazole antifungal that inhibits yeast and reduces cooling/inflammation. Used twice weekly for 4 weeks, then maintenance.

What is the second-line option?

Coal Tar: suppress keratinocyte proliferation (can stain hair/skin and cause photosensitivity)

Keratolytics(salicylic acid 1%-6%, sulfur 2%-5%) Softens and removes thick scales to enhance penetration of other agents.

Psoriasis

They have faster cell turnover (more dandruff)

It’s a systemic immune-mediated disease; rapid cell turnover (3-4 days instead of 28 days) leading to epidermal thickening

*you can only treat mild

For wheeping lesion you don’t want to use?

Oitnment, you want to use cream

What is the mid self treamnet for Psoriasis?

Localized lesions, can use topical hydrocortisone 0.5%-1% oittment combined with emollients, Oitments are preferred for better penetrationa dn occlusion

What is the nonpharmacological measures for psoriasis

Use tepid water for bath (2-3 times/week) and apply emollients immediately after. Scale removal improves drug penetration

Exclusion for self treatment for all

Symptoms worsen or show no improvement after 2 weeks of proper OTC treatmentInvolvement of > 5% of Body Surface Area (BSA)Involvement of the facePresence of joint pain (suggesting psoriatic arthritis)More than a few lesions or lesions larger than a quarter

Cytostatic agents(decrease epidermal cell replicaiton rate)

Pyrithione zinc/ selenium sulfide: slows scalp cell turnover and help reudce Malassezia yeast levels on the scalp.

Coal Tar: cross links DNA suppress keratinocytes proliferation; provides anti inflammatory and antipruritic effects.

Antifungal agents

Ketoconazole 1%; an imidazole antifungal that inhibits malassezia growth while also reducing inflammation, erythema, and scaling.

Keratolytic agents

Salicylic acid (1%-6%) dissolve intercellular cement between corneocytes, promoting desquamation (peeling/shedding) to soften thick scales and enhance the penetration of other agents

Sulfur (2%–5%): Acts as a keratolytic with mild antifungal and antibacterial activity to promote peeling and reduce scaling.

Corticosteroids

Topical Hydrocortisone (0.5%–1%): A low-potency (Class VII) corticosteroid with anti-inflammatory, vasoconstrictive, and immunosuppressive properties to decrease redness, pruritus, and irritation.

What is Diaper dermatitis (diaper rash)

Acute inflammation of the skin occuring in areas occluded by diapers (perineum, buttocks, lower abdomen, inner thighs, and genitals)

common affects new borns and infants ≤ 2 years old peeking between 9 and 12 months

What is the pathophysiology?

1. Exposure: urine hyperhydrates the skin and plugs sweat glands; feces enzymes raise skin ph

2. barrier compromise: mechanical friction tears waterlogged skin, dimishing tratum corenum function

3. Dermatitis; Epidermal breakdown cause infallmation,irritation, and increases the risk of secondary infections.

Types of diaper dermatitis

Irritant contact diaper dermatitis (ICCD); caused by urine,feces, friction and high ph

Allergic contact diaper dermatitis: delayed hypersensitivity reaction to wipes, dyes or fragances

Infection diaper dermatitis: secondary infection with candida albicans. Requires medical referral/antifungal therapy.

What is the nonpharmacological approach

air: Allow diaper free time to let skin air dry

barrier: apply skin protectants

cleansing: gently clanse with soft cloths and warm water

diaper: change diapers

education: proper hydrine

Pharmacological appoach

Skin protectants: Form physical carriers like Zinc, Oxide, petrolatum/white petrolatum (like Desitin, triple paste, aquaphor)

Contraindicated/supervised agents: topical antibiotics, antifungals, topical analgesics and hydrocortisone

Prickly Heat

A transient,mild self limiting inflammation of the skin caused by hot, humid weather or tight/occlusive clothing. Most common during first month of life and in adults in hot climates

pathphysiology of prickly heat

Partially clogged seat glands cause dilation and rupture of epidermal sweat pores, resulting in acute inflammation of the dermis, causes stinging, burning, or itching

Nonpharmacological treament

loose cloth, lightweight clothing, wash dry skin, allowing it to air dry

Pharmacological treament

Use cream or lotions, not ointment as it can trap moisture and block breathability) for itching and burning.

Examples of pharmacolgical treaments

Creams, Lotions, and Water-Washable Antipruritics: Menthol 0.1% creams (e.g., Eucerin Calming Itch Relief) or bland emollients like dimethicone/glycerin lotions to soothe burning and itching without trapping moisture.

Colloidal Oatmeal: Soothing bath treatments (e.g., Aveeno Soothing Bath Treatment).

Topical Hydrocortisone: Hydrocortisone 1% cream (used only if covering <10% of the body surface area and avoided in infants).

Topical Antihistamines/Anesthetics: Diphenhydramine HCl creams (e.g., Benadryl Itch Stopping Cream).