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Flashcards in 3 - Therapeutic Shampoos Deck (112):
1

Therapeutic shampoos are used to eliminate scaling (dandruff) and pruritus of the scalp

True

2

Therapeutic shampoos cleanse the scalp by emulsifying oily secretions

True

3

Dandruff is a scaling condition of the scalp

True

4

Cradle cap is a scaling condition of the scalp

True

5

Seborrheic dermatitis is a scaling condition of the scalp

True

6

Psoriasis is a scaling condition of the scalp

True

7

Atopic dermatitis is a scaling condition of the scalp

True

8

Irritant or contact dermatitis is a scaling condition of the scalp

True

9

Cradle cap is a variant of seborrheic dermatitis often seen 1-2 weeks after birth, but can occur anytime during the first 6 months of life

True (associated with yellowish scales on the scalp with I distinct borders often associated with underlying erythema and pruritus. May also involve retroauricular skim, nasolabial folds, skin folds of the neck, axillae, diaper area. Usually clear in 2-8 weeks)

10

Dandruff (seborrhoea capitis sicca) is the dry form of seborrheic dermatitis which presents with dry, greyish white scales scattered over scalp with indistinct borders, may or may not be associated with pruritus

True (in contrast to psoriasis with distinct borders)

11

When scaling of the scalp is associated with excessive sebum production, it is seborrhoea capitis oleosa (pruritus commonly present and characterised by remissions and exacerbation a with stress being a common precipitating factor)

True (involvement of the scalp, eyebrows, post auricular area, nasolabial folds, body folds, V shape of central chest and back - often in patients with Parkinson's disease or HIVas as a marker of early disease)

12

In some cases psoriasis can overlap with seborrheic dermatitis (sebo-psoriasis)

True

13

Shampoos containing Salicylic acid or Salicylic acid and Sulfur are keratolytic

True

14

Shampoos containing selenium sulfide and zinc pyrithione are Cytostatic (inhibition of cell growth and multiplication)

True

15

Shampoos containing tar are Antimitotic (antiproliferative) and cytostatic, suppressing epidermal cell DNA synthesis

True

16

Shampoos containing ketoconazole, ciclopirox and iodophors are antimicrobial

True

17

Shampoos containing the corticosteroids fluocinolone Acetonide and clobetasol propionate are anti-inflammatory

True

18

Irritant contact dermatitis and atopic dermatitis are often termed lichen simplex chronicus when they occur on the scalp, and is often extremely itchy where rubbing and scratching are a central part of the disease process

True

19

Lichen simplex chronicus on the scalp commonly involve the occipital scalp

True

20

Dermatophyte infection (times capitis) must be ruled out in all scaling scalp conditions, particularly in children, since this infection requires oral antifungal therapy

True

21

Scalp conditions which may reflect serious systemic disease (SLE, dermatomyositis, mycosis fungoides) or can result in permanent scarring alopecia of the scalp (lichen planopilaris, discoid lupus etc) need to be ruled out before choosing a therapeutic shampoo

True

22

Scalp conditions that result in severe accumulation of adherent scale and matted hair in the scalp is referred to as tinea amiantacea

True (even though the name suggests tinea, it is not a tinea infection)

23

Most of the therapeutic shampoos contain wetting agents, also known as surfactants

True

24

The wetting agents (surfactants) in therapeutic shampoos have hydrophilic and hydrophobic portions of the molecule

True

25

Therapeutic shampoos degrease the skin of the scalp through emulsification of sebum, thus promoting "wetting" of the scalp, which then enhances the effect of the active ingredients

True

26

Wetting agents (surfactants) degrease the skin of the scalp through emulsification of sebum, thus enhancing the effect of the active ingredients

True (thus facilitating separation of scale into smaller, less visible flakes)

27

Therapeutic shampoos for seborrheic dermatitis reduce high skin surface lipid levels

True (perhaps the high surface lipid levels provide the substrate required for growth of pityrosporum yeast, or for inflammatory prostaglandins and resultant cell signalling)

28

Amphoteric and anionic surfactants (wetting agent) serve as the base of many shampoos

True

29

Cationic and non-ionic surfactants (wetting agents) are added to shampoos to condition damaged hair

True

30

Cationic surfactants (wetting agents) are useful for conditioning more negatively charged damaged hair and include quarternary ammonium compounds I.e. Benzalkonium chloride and cetyl trimethyl ammonium bromide

True

31

The quarternary ammonium compound Benzalkonium chloride is a Cationic surfactant (wetting agent) useful for conditioning negatively charged damaged hair

True

32

The quarternary ammonium compound cetyl trimethyl ammonium bromide is a Cationic surfactant (wetting agent) useful for conditioning negatively charged damaged hair

True

33

Anionic surfactants (wetting agents) are used for cleansing and lathering, including sulphates, sulfonates, and soaps such as sodium lauryl sulfate and dioctyl sodium sulfosuccinate

True

34

Non-ionic surfactants (wetting agents) are mild surfactants, making them useful in baby shampoos and include propylene glycol, spans and tweens

True

35

Propylene glycol is a non-ionic surfactant (wetting agent)

True

36

In psoriasis (and to a lesser extent in seborrheic dermatitis), hyperproliferation is associated with a more rapid transit time from the basal layer to the outer stratum corneum (3 days rather than the usual 25-30 days), leading to imperfect keratinisation and faulty desquamation of the cornfield layer

True

37

Keratolytic agents (salicylic acid and Sulfur) used in some therapeutic shampoos loosen the cement (lipids, cholesterol, free saturated fatty acids, and ceramides within the intercellular space which increases cohesion between the cells) between the corneocytes

True

38

Many shampoos and scalp lotions or sprays contain topical corticosteroids which have potent anti-inflammatory and antipruritic effects

True

39

Because the underlying pityrosporum infection is not being directly treated with corticosteroid shampoos in patients with seborrheic dermatitis, recurrence is prompt and relapse rates are high

True

40

Topical ketoconazole and ciclopirox may also have anti-inflammatory effects in addition to their antifungal effects

True

41

Tea tree oil shampoo has effectively treated dandruff mediated by their anti-inflammatory effects

True (has also demonstrated anti fungal properties)

42

Coal tar may be immunosuppressive via an action on T cells or the Langerhans calls that present antigens to the T cells

True

43

Tar shampoos appear to have Antimitotic (antiproliferative) and cytostatic effects

True suppressing epidermal DNA synthesis)

44

Tar shampoos may have antibacterial and antimycotic activity

True

45

Tar products disperse scales, which in and of itself may reduce pityrosporum colonisation

True

46

Selenium sulfide may also benefit scaling scalp conditions because of its cytostatic effects on hyperproliferative keratinocytes

True (may also have antipityrosporum effects)

47

Zinc pyrithione reduces cell turnover rate significantly (cytostatic)

True (also has anti pityrosporum effects through iron starvation)

48

Ketoconazole shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)

True

49

Ciclopirox shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)

True

50

Zinc pyrithione shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects) through iron starvation

True

51

Selenium sulfide shampoo suppresses superficial fungal infection of the scalp (antipityrosporum effects)

True

52

Tea tree oil shampoo have demonstrated antifungal properties

True

53

Japanese cypress oil shampoo has demonstrated antifungal properties

True

54

Even though there is a potential for significant systemic absorption of tar compounds (and mutagenic effects) when the normal scalp is shampooed with tar shampoo, the use of tar products in shampoos for decades has not been shown to induce localised or systemic tumour formation

True

55

Absorption of salicylic acid leading to salicylate intoxication has been reported when patients use salicylic acid concentrations > 10% over more than 50% of their body surface in ointment forms

True (although this systemic absorption has not been reported from currently available salicylic acid shampoos)

56

The small amounts of salicylic acid that are absorbed are metabolised by the liver and excreted by the kidneys

True

57

There is some extent of systemic absorption of selenium sulfide shampoos, though generally there is a high safety margin

True (there is an isolated report of a patient with selenium intoxication from using selenium sulfide shampoo 2-3 times weekly for 8 months on damaged scalp skin)

58

Selenium sulfide and zinc pyrithione shampoos may cause minor skin irritation

True

59

There is some extent of systemic absorption of zinc pyrithione shampoos, though generally there is a high safety margin

True

60

Percutaneous corticosteroid absorption occurs with topical use of shampoos containing topical corticosteroids

True (although there is relatively low absorption through scalp skin)

61

The relatively low absorption of topical corticosteroids through scalp skin, relatively infrequent use of shampoo (daily), relatively small percentage of body surface area treated, limit the post entail for systemic corticosteroid absorption that could suppress the hypothalamo-pituitary-adrenal axis

True

62

Scalp skin thinning and telengiectasia (corticosteroid atrophy) can occur with repeated heavy use of superpotent topical corticosteroids such as clobetasol

True

63

Only small amounts of ketoconazole are absorbed when this agent is used in shampoo form, and metabolism of this small amount by the liver ensures that significant serum levels are not achieved

True

64

Ketoconazole persists in the hair keratin for up to 72 hours after shampoo application

True (usually used 3 times weekly as the benefits plateau beyond this frequency of use)

65

No systemic adverse effects have been reported in patients using ketoconazole or ciclopirox shampoo

True

66

Therapeutic shampoos are used to control scaling and inflammation, rather than to cure scalp conditions and prolonged or intermittent use is the rule rather than the exception

True

67

Salacylic acid, selenium sulfide, zinc pyrithione p, tar and ketoconazole shampoos are FDA approved for scaling scalp and dandruff

True

68

Ketoconazole, ciclopirox, tar, fluocinonide (corticosteroid) and selenium sulfide shampoos are FDA approved for seborrheic dermatitis

True

69

Tar and clobetasol shampoos are FDA approved for psoriasis

True

70

Selenium sulfide and ketoconazole shampoos are used with oral antifungal therapy as adjunctive treatment of tinea capitis

True

71

Although none of the therapeutic shampoo products have been adequately tested in pregnancy, but the small surface as of the scalp, short contact treatment and lack of reports suggesting fetal harm over many years suggest there is no significant risk to the fetus

True (with the exception of ketoconazole shampoo which is safe and effective in infants with cradle cap)

72

Except in products labeled for use in cradle cap (I.e. Ketoconazole), use of therapeutic shampoos in infants is not recommended as the amount of skin surface in proportion to body weight is greater than in older children and adults, and the hepatic enzyme systems in infants are not fully developed to handle toxic substances that might be absorbed

True

73

Preliminary information suggests that ketoconazole shampoo is safe and effective in infants with cradle cap

True (although the rare occurrence of idiosyncratic hepatotoxicity with systemic ketoconazole must be kept in mind if significant and prolonged exposure to ketoconazole shampoo is contemplated in this age group)

74

Salicylic acid shampoos should be completely avoided in children less than 6 years old due to the risk of salicylate intoxication

True

75

Tar shampoos with or without topical corticosteroids are generally safe to use in children

True

76

Salicylic acid shampoos can be used as an adjunct for more severe cases of psoriasis in children over 6 years old

True (in children less than 6 years old,salicylic acid use should be completely avoided due to risk of salicylate intoxication)

77

Therapeutic shampoos may cause drying, burning, stinging, irritation and discomfort

True (most commonly irritant in nature)

78

Therapeutic shampoos most commonly causes an irritant dermatitis

True

79

Irritation commonly occurs with keratolytic agents

True (the short contact time, dilution with water, and subsequent quick rinse reduce the sensitisation potential of these products)

80

Allergic contact dermatitis is possible either to the active ingredients I.e. Topical corticosteroids, or to the other components of the shampoo products

True

81

The potential allergens from therapeutic shampoos include (in order of prevalence) fragrance, cocamidopropyl betaine, MCI/MI , formaldehyde releasers, propylene glycol and vitamin E

True

82

Fragrance is the most prevalent allergen in therapeutic shampoos

True

83

Cocamidopropyl betaine (amphoteric detergent) is a potential allergen from therapeutic shampoos

True

84

Methylchloroisothiazolinone/methylisothiazolinone MCI/MI (non-formaldehyde preservative) is a potential allergen from therapeutic shampoos

True

85

Formaldehyde releasers (preservative) is a potential allergen from therapeutic shampoos

True

86

Propylene glycol (preservative) is a potential allergen from therapeutic shampoos

True

87

Vitamin E (preservative) is a potential allergen from therapeutic shampoos

True

88

Rarely contact dermatitis to zinc pyrithione has been reported

True

89

Allergic contact dermatitis to shampoo ingredients generally spare the scalp and commonly appear on the postauricular, posterolateral neck and eyelids

True (may be related to poorly understood differences in the local immunology of these an atomic areas or protective effects of thicker skin producing a more effective barrier to allergens I'm scalp skin)

90

Shampoos containing tea tree oil have caused allergic contact dermatitis

True

91

Topical corticosteroid shampoos could induce the same local adverse effects as other topical corticosteroid use I.e. Folliculitis, skin atrophy, telengiectasia, hypertrichosis, hypopigmentation, secondary infection and striae

True

92

Tachyphylaxis has not been documented with corticosteroid shampoos

True

93

Tachyphylaxis is postulated to occur in anti dandruff shampoos

True

94

Avoiding eye contact is roc mended for shampoos containing tars, salicylic acid, selenium sulfide, and topical corticosteroids

True

95

Tar shampoos can stain blonde, white/grey or dyed hair a greenish or brown colour

True

96

Selenium sulfide shampoos may leave a residual smell, discolour hair, and make hair more oily

True

97

Tar shampoo should be avoided in patients receiving PUVA therapy on the day of a treatment to avoid 'tar smarts' (a type of photosensitivity associated with other topical tar preparations)

True

98

Patients using tea tree oil shampoo chronically should be aware of their possible estrogenic and amtiandrogenic properties

True

99

Clobetasol shampoo should be rubbed into a moist scalp and allowed to stay in place for 15 minutes before shampooing and rinsing

True

100

Therapeutic shampoos are safe with daily use, although they may also be effective by shampooing as little as once or twice weekly for maintenance in patients with dandruff, seborrheic dermatitis or cradle cap

True (ketoconazole beneficial effects plateau at 2-3 times weekly)

101

In contrast to the benefits of ketoconazole shampoo, which plateau at 2-3 times weekly use, selenium sulfide and other medicated shampoos continue to improvemscalp scaling with increased use up to daily

True

102

Ketoconazole shampoo suppresses pityrosporum organisms more effectively than either zinc pyrithione or selenium sulfide shampoo

True

103

Selenium sulfide shampoo is somewhat more efficacious than zinc pyrithione

True

104

Salicylic acid lotions may be applied to the scalp 2-8 hours before shampooing with a tar shampoo

True

105

Tar shampoo may be used as maintenance therapy in psoriasis following treatment with other topical agents to keep patients in remission

True

106

Chronic use of 2% ketoconazole shampoo has been shown to be safe

True

107

Many patients with scaling scalp diseases benefit from rotational therapy

True (a shampoo used for 3-4 weeks followed by another shampoo from a different class vs. 2 products used on alternative days with less frequent application as the condition improves vs. ketoconazole 2X weekly and a keratolytic or anti-inflammatory shampoo 5X weekly)

108

Topical corticosteroid solutions or lotions are an appropriate adjunctive therapy in psoriasis if the scalp pruritus is not adequately controlled by a shampoo alone

True

109

Both selenium sulfide and ketoconazole shampoo reduce the dermatophyte presence in the scale and the infectivity of patient with tinea capitis, but neither eradicates the disease

True (therefore should be used in conjunction with systemic antifungal agents)

110

Contacts of patients with tinea capitis should be screened for infection and subsequently treated with ketoconazole 2% shampoo

True

111

OVer the counter selenium sulfide 1% was found to be just as effective as prescription strength 2.5% when used as an adjunct to oral treatment of tinea capitis

True

112

There are no known drug interactions of therapeutic shampoo agents in routine use

True