Skin & Psoriasis & Dandruff

Question 1

What questions might you consider when taking a dermatological history?

Answer 1

1. Where did the problem first appear? certain type of conditions start from one area then spread
2. Are there any other symptoms? - itch or pain
   mild itch - psoriasis/medicine eruptions
   severe itch - scabies, atopic/contact dermatitis
3. occupational hx?
4. General medical hx?
5. Travel?
6. Family and household contact hx -
7. Pts thoughts on the cause of the problem

Question 2

What is psoriasis?

Answer 2

chronic relapsing inflammatory disorder

immune-mediated disorder with a genetic influence

Question 3

What are the symptoms of psoriasis?

Answer 3

Silvery-white scales associated with inflamed, red, patchy plaques on the extensor surfaces of the elbow and knee
pitting fingernails

Question 4

What are symptoms triggered by?

Answer 4

Stress

Question 5

What medicines can aggravate psoriasis?

Answer 5

Li, antimalarials, BB, ACEI, NSAIDS

Question 6

When to refer a pt with psoriasis?

Answer 6

pts presenting with symptoms with no prior diagnosis should be referred.

pts with moderate to severe psoriasis may required tx under the supervision of a dermatologist

Question 7

What tx is necessary for psoriasis?

Answer 7

1. Emollients - keratolytics have been incorporated into emollients
2. POM include vit D derivatives (calcipotriol), topical steroids, dithranol
3. Coal tar preparations

Question 8

What are side effects that can occur with these products?

Answer 8

possibility of skin sensitisation

Question 9

What are some tar-based products?

Answer 9

Alphosyl 2 in 1 shampoo 
Capasal 
Cocois
Exorex 
Polytar, Polytar Plus 
Psoriderm 
SebCo 
T/Gel

Question 10

What is Dandruff?

Answer 10

chronic, relapsing, non-inflammatory hyper-proliferative skin condition

Question 11

What are symptoms of dandruff?

Answer 11

Greyish-white flakes or scales on the scalp which is often itchy
The scalp is the ONLY area affected unlike in seborrhoeic dermatitis
scalp is very dry, itchy, flaky

Question 12

When to refer a pt with dandruff?

Answer 12

• suspected psoriasis
• Signs of infection
• symptoms of unresponsive to tx

Question 13

What tx is required for dandruff?

Answer 13

• Ketoconazole 2% shampoo (Nizoral) is first line for moderate-severe dandruff - Use TWICE a week for 2-4 weeks after which used weekly or fortnightly as needed to prevent recurrence
• Selenium sulphide 2.5% (Selsun) - cytostatic effect - reduces the cell turnover rate
  Used twice weekly for the first 2 weeks then weekly for the next 2 weeks and thereafter as required
• Coal tar - least effective for tx of dandruff but may still be used as an alternative
• Zinc pyrithione - head and shoulders

Question 14

What side effects can occur with using these products for dandruff?

Answer 14

cause allergic or sensitisation reactions and coal tar can cause photosensitivity

Question 15

Can all shampoos be used at any age?

Answer 15

All except Selsun only use in children >5 years

Question 16

ANy counselling points for pts with dandruff and their use of tx?

Answer 16

• Dandruff should start to improve within 12 weeks of initiating tx.
• Tx should be applied to the scalp and left on for at least 5 minutes before rinsing for best effect