10 - Scaly Dermatosis Flashcards Preview

PDAT1 > 10 - Scaly Dermatosis > Flashcards

Flashcards in 10 - Scaly Dermatosis Deck (41)
Loading flashcards...
1

Definition + Types of Scaly Dermatoses

Involve epidermis + Scales are primary manifestation

Dandruff -> Seborrheic Dermatitis -> PSORIASIS

increasing Severity + Inflammation

2

Seborrheic Dermatitis

SD

NOT a disease of the sebaceous glands
Rate of sebum production is NOT necessarily increased

Found in areas w/ larger or higher amounts of glands

Can be in association with MALASSEZIA

Immunologic + Hyperproliferative

3

Malassezia

YEAST found on NORMAL skin
metabolize fatty compounds in sebum

Can be Directly Pathologic:
Pityriasis Versicolor / Systemic Infections

Also Indirectly Pathalogic:
in Dandruff & Seborrheic Dermatitis

4

Pathophysiology of SD

Seborrheic Dermatitis

In combination, make an 
Exaggerated Immune Response to Malassezia Yeast:

Malassezia
metabolize FATTY compounds, found in LIPID-RICH location

Immunologic
common in immune supressed, more CYTOKINES

HYPERproliferative
Overlap with PSORIASIS, lack of efficacy of antifungals

5

Combined PATHWAY of Scaly Dermatosis

Malassezia Fungus influences Dandruff & SD,
not thought to be a factor in Psoriasis

  1. Inflammation
    1. varies between diseases
  2. Proliferation + Differentiation
    1. also varies between diseases, tied with inflammation:
      1. normal = 25-30 days  >> dandruff = 13-15 days
        1. >> SD = 9-10 days >> psoriasis = 4 days
  3. Barrier Disruption

6

S/S of Dandruff

Fine / White Flakes

SCALP involvement

Diffuse distribution

Can have Pruritus

Usually NO Erythema

 

7

S/Sx of  ​Seborrheic Dermatitis

Yellow + Greasy scales, can be scalp involved
facial & other areas w/ HIGH amounts of sebaceous glands

Pruritus
Presence of Erythema

Seen in adolescents + adults
MORE COMMON in immune compromised + Parkinsons

Well demarcated lesions

8

LOOKALIKE Diseases

Atopic Dermatitis

Allergic/Irritant Dermatitis

Rosacea

Cutaneous Fungal Infection

9

S/Sx of Psoriasis

SHARPLY Demarcated

SILVERY-WHITE scales

Commonly found on :
scalp / Elbows / Knees / Back

10

What Treatment Mechanism do these medications ACT ON?

Pyrithione Zinc / Ciclopirox

Keto/sertaconazole / Selenium Sulfide

Tea Tree Oil

DIRECTLY on the MALASSEZIA FUNGUS

11

What Treatment Mechanism do these medications ACT ON?

Corticosteroids

Calcineurin Inhibitors

Tea Tree Oils

INFLAMMATION

12

What Treatment Mechanism do these medications ACT ON?

Coal Tar

Selenium Sulfide

Pyrithione Zinc

CYTOSTATIC:

Proliferation + Differentiation

13

What Treatment Mechanism do these medications ACT ON?

Salicylic Acid

Keratolytic --> Proliferation & Differentiation

14

What ST-Medications are FIRST LINE for 

DANDRUFF?

Selenium Sulfide
hair discoloration + oily scalp

Pyrithione Zinc

Ketoconzole 1%

 

skin irritation / contact dermatitis

15

What ST-Medications are Second LINE for 

DANDRUFF?

Coal Tar
hair discoloration / staining / PHOTOsensitivity / folliculitis

Salicylic Acid

 

Natural = Tea Tree Oil
allergic rxns

16

 Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE's

of (serta)KETOCONAZOLE 

Act Directly on Malassezia

Interferes with Membrane Synthesis

ST: 1st line for Dandruff & SD


 ​RX: 1st line for S​D
2% Keto Shampoo / Cream / Foam / Gel, BID F8W
photosensitivity
2% Sertaconozole Cream, BID F4W

17

 Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE's

of CICLOPIROX?

Act DIRECTLY on the Malassezia Fungus

Disrupt Metabolism

 

RX Only: 1st Line
1% Shampoo = QD -> Twice a Week
0.77% Gel / Cream = BID for 4 weeks

18

 Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE's

of PYRITHIONE ZINC?

Act DIRECTLY on the Malassezia Fungus + Cytostatic-Prolif/Differentiation

INCREASED Copper + Disrupt Metabolism

ST: 1st Line for Dandruff + SD

found in head & shoulders

19

 Treatment Mechanism / MoA / Uses (1st/2nd line?) / AE's

for SELENIUM SULFIDE?

Act on BOTH the Malessezia Fungus + Cytostatic -Prolif+Differentiation

Promote Shedding of the stratum corneum + Anti-Fungal properties

 

ST: 1st line for Dandruff

20

​1st line Self Treatment for SD 

Anti-Malassezia Shampoos
can be used in facial areas as well

Phyrithione Zinc

Selenium Sulfide

Ketoconazole 1%

21

Self treatment for SD

if patient has ERYTHEMA / yellow or oily lesions

HYDROCORTISONE

Erythema after use of MEDICATED shampoos

along with the medicated shampoos

22

Self Treatment for Infants/Cradle Cap (Mild cases) for

Seborrheid Dermatitis

Massage w/ BABY OIL

Non-residue / Non-medicated Baby Shampoo, to REMOVE Scales

 

No medicated shampoos approved for Children
<2 years old

23

Application + Frequency of use for 

MEDICATED SHAMPOOS

Ex. Pyrithione Zinc + Selenium Sulfide + Ketoconazole

Scalp = Adequate Contact
Before using medicated shampoo,
 Use Non-medicated/nonresidue shampoo FIRST

Massage into scalp and leave it on for 3-5 minutes

 

2-3x/week for 2-3 Weeks --> 1x/week to control

Ketoconozole = Twice a Week F4W, w/ at least 3 days between each treatment

 

24

1st like PRESCRIPTION treatment for 

Seborrheic Dermititis

ANTIFUNGALS
burning / contact dermatitis

Ciclopirox 1%

Ketoconazole 2%
photosensitivity

Sertaconazole 2%

25

Second Line PRESCRIPTION treatment for

Seborrheic Dermatitis

Corticosteroids
hypopigmentation / skin atrophy / telangiectasia

 

Calcineurin Inhibitors
Pimecrolimus 1% , BID HA + URI
Tacrolimus 0.1%, BID pruritus + flu like symptoms
burning

 

26

EX-ST for Dandruff + SD + Psoriasis

<2 y/o

Worsening or NO improvement within 2 weeks of treatment

27

EX-ST for PSORIASIS

<2 y/o + no improvement/worse within 2wks of treatment

>5% BSA

Lesions >Quarter in size

FACIAL Lesions / JOINT Pain

 

28

Chart for Treating Scaly Dermatosis

29

Risk / Triggers for PSORIASIS

Genetics

Infections: Strep Throat = Guttate psoriasis

Skin Trauma

Smoking / Alcohol

Obesity / Hormonal Changes / Emotional STRESS

Medications
Beta Blockers (-olol) + Lithium + Anti-Malarials + Steroid Withdrawal
+ NSAIDS + Tetracyclines + Ace-I

30

Types of Psoriasis:

Chronic Plaque Psoriasis
most common, erythema + raised + sharply defined
silvery scales + asymptomantic, some prurtus

Pustular Psoriasis
Erythema + scaling + pustules
accompanied by systemic complications --> life threatening

Psoriatic Arthritis, SYSTEMIC involved

Other less common types:
Erythrodermic / Inverse / Nail