Scaly Dermatoses

Dandruff, seborrheic dermatitis, and psoriasis are chronic scaly dermatosis Dandruff inflammatory form and it has a substantial cosmetic concern Less Occurs in 1 to 3% of the population Uncommon in children and generally appears at puberty, peaks in early adulthood and levels off at middle age The specific cause of the accelerated cell growth is unknown Could be due to elevated microorganism level

Pathophysiology of Dandruff Hyperproliferative epidermal condition Accelerated epidermal cell turnover and irregular keratin breakup pattern Shedding of large non adherent white scales Keratinezed vs non keratinized cells Clinical Presentation: Diffuse, not patchy, minimally inflammatory. Scaling is the only visible manifestation, Pruritis is common, mostly in the crown

Treatment Treatment goals Reduce epidermal turnover rate of the scalp Minimize the cosmetic embarrassment Minimize itch Mild to moderate cases: frequent hair washing is sufficient Otherwise, medicated shampoos can be used

Medicated shampoos Cytostatic agents: pyrithione zinc, selenium sulfide: reduce scaling by decreasing epidermal growth rate Keratolytic shampoos: salicylic acid, sulphur Contact time is the key to effectiveness. The patient should massage the shampoo into the scalp. Leave the shampoo on the hair for 5 minutes before rinsing and washing Used only 2 to 3 times weekly for 2 to 3 weeks Ketoconazole can be used (non OTC)

Seborrheic dermatitis Subacute of chronic inflammatory disorder that occurs predominantly in the areas of greatest sebaceous gland activity (scalp, face, trunk). Scaly itchy rash Two age peaks of occurrence: one in the first 3 months of life and the second around the fourth to seventh decade of life Common in infants and more common in adult men Unknown cause, fungus could be involved in some cases Clinical presentation Scalp, eyebrows, eyelid margins, beard area, central back, retroauricular creases Typically: dull, yellowish, oily scales on red skin Pruritis is common Early in life: cradle cap: greasy scales and scale crust on bright erythematous base and affect the scalp In adults: greasy scales on the scalp that extends to the middle third of the face and eyes. Erythema and accumulation of thick crust.

Treatment Seborrhoeic dermatitis in infancy is a benign, self-limiting condition and often the most appropriate management is reassurance for the parents that the condition is not serious and will disappear. Simple measures should be advised Regular washing of the scalp with baby shampoo, followed by brushing with a soft brush to loosen scale. Prior to shampooing, the scales may be softened with baby oil. An emollient such as emulsifying ointment may also be helpful. Olive oil! Hydrocortisone

In adults, shampooing is the foundation of treatment. Wash scalp with shampoos containing pyrithione zinc, selenium sulfide, sulfur of salicylic acid. On the back of the ears, shampoos could be used as well followed by and emollient and hydrocortisone cream. Adults should avoid greasy ointments Seborrheic dermatitis of the scalp could be treated. with hydrocortisone lotions