Scaly Dermatoses/Diaper Dermatitis

Nonpharm Treatment

Scaly Dermatitis

Diaper Dermatitis

Dandruff Routine shampooing with non-medicated shampoos (daily or every other day) Avoid shampoos with sodium lauryl/laureth sulfate Seborrheic Dermatitis Mineral oil or olive oil to loosen scales Washing with dishwasher liquid Cradle cap (Infant Seborrheic Dermatitis) Non-medicated shampoos to soften and remove scales Baby oil Psoriasis Avoidance of known triggers Using lubricating bath products 2-3x per week Using tepid water for bathing Non-medicated emollients after bath/shower

Change diapers frequently Clean area with baby wipes OR use soft cloth and warm water Allow area to air dry before rediapering Use skin protectants Consider diaper holiday Use disposable diapers

Diaper Dermatitis - Pharm

• Skin Protectants

  • Zinc Oxide (Desitin)

    • Requires soap for removal

  • Petrolatum (A&D, Vaseline)

    • Ointment bases

  • Talc and Cornstarch

    • Reduces moisture and friction

    • Inhalation warning

    • Talc probably carcinogenic

Scaly Dermatoses -

• Pyrithione zinc 2% (Head and Shoulders)

  • Counseling Points:

    • Wash with nonmedicated, nonresidue shampoo first

    • More effective with longer contact time

    • Massage on scalp and leave for 3-5 minutes

    • Use QD x1-2week; BIW-TIW x2-¾ weeks, then QW- QOW

    • Avoid contact with eyes to avoid stinging

    • Contact dermatitis when on broken or abraded skin

• Selenium sulfide 1% (Selsun Blue)

  • Counseling Points: 

    • Wash with nonmedicated, nonresidue shampoo first

    • More effective with longer contact time

    • Massage on scalp and leave for 3-5 minutes

    • Use QD x1-2week; BIW-TIW x2-¾ weeks, then QW- QOW

    • Avoid contact with eyes to avoid stinging

    • Contact dermatitis when on broken or abraded skin

    • Frequent use may leave residual odor and oily scalp

• Coal tar (T-Gel)

  • MOA: cross-links with DNA to reduce epithelial turnover

  • AE: folliculitis (axilla and groin area); staining of skin, hair, clothing; photosensitivity; contact dermatitis

    • Contact dermatitis may worsen on exposure to coal tar

    • Use topical corticosteroids to reduce inflammation BEFORE using coal tar

  • Counseling: 

    • Apply at bedtime then bathe in the morning to remove residual coal tar and loosen scales

    • May stain skin and clothing, wash thoroughly 

    • Avoid sun exposure for 24 hours after application

Exclusions

Scaly Dermatitis	Diaper Dermatitis
Exclusions: Dandruff, Seborrheic Dermatitis, Psoriasis < 2 years of age Worsening of symptoms or no improvement after 2 weeks of self care treatment Exclusions: Psoriasis > 5% of BSA  Involvement of the face Joint pain (possible psoriatic arthritis) More than a few lesions Lesions greater than a size of a quarter	Lesions >7 days or lack of improvement S/Sx of secondary infection Diaper dermatitis outside diaper area Possible UTI Broken skin, blood, vesicles, or pus Comorbid conditions Severe or systemic symptoms Chronic, frequent or recurrent symptoms Significant behavioral changes associated with rash (incessant crying, lethargy)