PDAT SELF CARE SCALY DERMATOSES

what are scaly dermatoses?

conditions that affect the epidermis where scaling is the main feature with increasing inflammation and severity

what is the role of malassezia in dandruff and seborrheic dermatitis?

it is a yeast found in skin it breaks down fatty compounds in sebum which can trigger an immune response, it is indirectly pathologic

where is scaly dermatoses usually found?

found in areas with larger/higher amount of glands so scalp, face, genitals, trunk, back of ear

Why is seborrheic dermatitis NOT actually a disease of sebaceous glands?

it is NOT a disease of the sebaccous glands because sebum production is not increased, glands are reqiured but not the cause, and occurs in rich areas of sebacous gland

what are the 3 steps in seborrheic dermatitis pathophysiology?

malassezia activity so lipid metabolism, hyperproliferation of skin cells (skin produces scales), and an immune response which increases inflammation

how does immune response contribute to seborrheic dermatitis?

There is an exaggerated immune response to Malassezia or its byproducts, leading to inflammation.

why is having a short skin turnover time important in seborrheic dermatitis?

the scaling experienced is due to the shorter turnover time

what does dandruff look like?

fine white flakes in the scalp with no redness

what does seborrheic dermatitis look like?

it is yellow, greasy scales. itchy with the presence of redness

what is the key difference in pathophysiology between psoriasis and dandruff/seborrheic dermatitis?

psoriasis is immune mediated disase there is no malassezia while dandruff involves malassezia, immune response, and proliferation

what do antifungal treatments (ketoconazole, selenium sulfide, and pyrithione zinc) do?

they target malaassezia yeast which reduces its growth and effects

what is the role of corticosteroids in dandruff?

they reduce inflammation and immune response

what do keratolytics (like salicylic acid) do?

they break down and remove scales by loosening dead skin cells

what are the first lines of treatment for dandruff and seborrheic dermatitis?

selenium sulfide (selsun blue), pyrithione zinc (head and shoulders), and ketoconazole 1% (nizoral a-d)

what are adverse effects of selenium sulfide and pyrithione zinc?

hair discoloration and oily scalp

what are adverse effects of ketoconazole 1%?

hair loss, abnormal hair texture, and dry skin

what is second line treatment for dandruff?

coal tar, salicylic acid, and sulfur

what are adverse effects of coal tar, salicyclic acid, and sulfur?

hair discoloration, staining, photosensitivity, and follicultis

what is a natural treatment option for dandruff?

tea tree oil

what is an adverse effect of tea tree oil?

allergic reaction

if a patient has seborrheic dermatitis and presents with redness what should we give them?

hydrocortisone

how can we treat infants with cradle cap?

massage scalp with baby oil and use baby shampoo to remove scales

if a patient is under 2 can they use medicated shampoo?

no they cant

where is psoriasis usually found and what does it look like?

found on scalp, elbows, knees, and back. it looks like silvery white scales

how should medicated shampoos be used?

leave on scalp for 3 to 5 minutes

what is the frequency of selenium sulfide or pyrithione zinc?

daily for 1 week then 2 to 3 times weekly for 2-3 weeks

how is ketoconazole shampoo used?

twice weekly for 4 weeks then weekly or every other week

what medications can worsen psoriasis?

beta blockers, lithium, anti malarials, interferons, NSAIDS, and steroid withdrawal

what are the qualities of mild psoriasis?

<5% BSA, lesions smaller than a quarter, no facial involvement, and no joint pain

if someone has mild psoriasis what are self treatment options?

removal of scales with soft cloth after bathing, use of emollients after bathing and up to 4 times daily, hydrocortisone ointment

if someone has mild psoriasis when should we refer them after seeing no improvement?

refer after 2 weeks of no improvement

when should a patient be referred instead of self treating for psoriasis?

no improvement in 2 weeks, severe disease (large lesions, >5% BSA), and facial involvement or joint pain

a patient presents with fine white flakes on the scalp, diffuse distribution, and mild itching but no redness. what is most likely diagnosis?

dandruff

a patient using selenium sulfide shampoo reports a side effect. what should you warn them about?

hair discoloration and oily scalp

a patient still has redness after using antifungal shampoo. what can you add?

hydrocortisone for inflammation

a patient with HIV or parkinson's develops seborrheic dermatitis. why are they at higher risk?

due to immune related factors and increased inflammatory response

what is the underlying cause of psoriasis?

abnormal immune mediated inflammation so rapid skin turnover

a patient is using salicyclic acid for scaling. what is its role?

its a keratolytic it removes scales

a patient uses coal tar for psoriaisis. what is its function?

cytostatic, slows skin cell growth