Dandruff, seborrheic dermatitis, psoriasis assessment

Recommendation: Require medical referral

Recommendation: Require medical referral

Recommendation: Pharmacological and non-pharmacological therapy

• • decreasing epidermal turnover rate by reducing Malassezia fungi on skin
  • minimizing cosmetic embarassment
  • relieve itching
  • prevent flareups

• • Patient should shampoo with non-medicated, nonresidue shampoo to remove dirt, oil and scales form scalp and hair before medicated shampoo. Non -medicated shampoo if not rinsed well can aggravate the condition
  • Shampoos with harsh surfactants (e.g., sodium lauryl sulfate, sodium laureth sulfate) should be avoided due to damaging effect of stratum corneum
  • The treatment goal is to control the condition and hence require ongoing therapy
  • Emotional, physical and environmental factors aggravates the symptoms. Best avoided
  • Gentle rubbing during bathing to remove scales.
  • Frequent use of emollients and lubricating bath products.

• Application of medicated shampoo:  Massage onto the scalp with a scalp scrubber, if possible, and left on the hair for 3-5 minutes. Contact time is essential for these products to slow replication of the fungi.
• Use daily for 1 week, then 2-3 times weekly, then once weekly or every other week for dandruff
  • For scalp conditions, wash hair with nonmedicated shampoo containing pyrithione zinc or coal tar (or derivatives). Switch agents if first product is unsuccessful.
  • Cytostatic medicated shampoos (Pyrithione zinc, selenium sulfide)
    • Indication:
      • first line for dandruff, seborrheic dermatitis
      • Can add non-medicated shampoo to reduce odor
    • Adverse effect:
      • Generally well tolerated
      • Repeat rinsing (2-3) times to avoid leftover residue that can cause discoloration
      • avoid contact with eyes to prevent stinging
  • Antifungal medicated shampoo (Ketconazole)
    • Indication:
      • Alternative treatment for dandruff
      • first-line for seborrheic dermatitis
    • Adverse effect:
      • skin irritation, hair loss, abnormal hair texture, and dry skin
      • avoid contact with eyes to prevent stinging)
  • General-purpose non-medicated shampoo
    • Indication:
      • sufficient for mild-moderate dandruff
    • Adverse effect:
      • Harsh surfactants (e.g., Sodium Lauryl Sulfate,) in shampoos may damage skin layers.
  • Keratolytic medicated shampoo (salicylic acid, sulfur)
    • Indication:
      • 2nd line for dandruff
      • limited benefit and require longer duration of treatment
    • Adverse effect:
      • Application over extensive areas has the potential for percutaneous absorption of salicylic acid

Recommendation: Pharmacological and non-pharmacological therapy

• • decreasing epidermal turnover rate by reducing Malassezia fungi on skin
  • minimizing cosmetic embarassment
  • relieve itching
  • prevent flareups

• • Patient should shampoo with non-medicated, nonresidue shampoo to remove dirt, oil and scales form scalp and hair before medicated shampoo. Non -medicated shampoo if not rinsed well can aggravate the condition
  • Shampoos with harsh surfactants (e.g., sodium lauryl sulfate, sodium laureth sulfate) should be avoided due to damaging effect of stratum corneum
  • The treatment goal is to control the condition and hence require ongoing therapy
  • Emotional, physical and environmental factors aggravates the symptoms. Best avoided
  • Gentle rubbing during bathing to remove scales.
  • Frequent use of emollients and lubricating bath products.
  • If seborrheic dermatitis scales are difficult to remove, dishwashing liquid or olive oil may be beneficial to help remove

• Application of medicated shampoo:  Massage onto the scalp with a scalp scrubber, if possible, and left on the hair for 3-5 minutes. Contact time is essential for these products to slow replication of the fungi.
• Use daily for 1-2 weeks, then 2-3 times weekly for 4 weeks. Once the condition is controlled, the shampoo should be applied once weekly to prevent relapse
  • For scalp conditions, wash hair with nonmedicated shampoo containing pyrithione zinc or coal tar (or derivatives). Switch agents if first product is unsuccessful.
  • Cytostatic medicated shampoos (Pyrithione zinc, selenium sulfide)
    • Indication:
      • first line for dandruff, seborrheic dermatitis
      • Can add non-medicated shampoo to reduce odor
    • Adverse effect:
      • Generally well tolerated
      • Repeat rinsing (2-3) times to avoid leftover residue that can cause discoloration
      • avoid contact with eyes to prevent stinging
  • Antifungal medicated shampoo (Ketconazole)
    • Indication:
      • Alternative treatment for dandruff
      • first-line for seborrheic dermatitis
    • Adverse effect:
      • skin irritation, hair loss, abnormal hair texture, and dry skin
      • avoid contact with eyes to prevent stinging)
  • General-purpose non-medicated shampoo
    • Indication:
      • sufficient for mild-moderate dandruff
    • Adverse effect:
      • Harsh surfactants (e.g., Sodium Lauryl Sulfate,) in shampoos may damage skin layers.
  • Keratolytic medicated shampoo (salicylic acid, sulfur)
    • Indication:
      • 2nd line for dandruff
      • limited benefit and require longer duration of treatment
    • Adverse effect:
      • Application over extensive areas has the potential for percutaneous absorption of salicylic acid
• For other body areas, hydrocortisone (usually ointment) for pruritic
  • Topical hydrocortisone (1%): apply as a thin layer not more than twice daily for not more than 7 days. Prolonged (>7days) is associated with flare-ups when discontinues.
  • Indication:
    • drug of choice in psoriasis bright red lesion
    • Used for itching and inflammation for seborrheic dermatitis
    • used when erythema persists after medicated shampoo use
    • efficacy enhanced by covering the area 30 minutes after hydrocortisone application via occlusion with a greasy emollient (e.g., petrolatum)