Scaly Dermatoses

Dandruff, seborrheic dermatitis, and psoriasis are chronic scaly dermatosis

Dandruffinflammatory form and it has a substantial cosmetic concern LessOccurs in 1 to 3% of the populationUncommon 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 unknownCould be due to elevated microorganism level

Pathophysiology of Dandruff

Hyperproliferative epidermal conditionAccelerated epidermal cell turnover and irregular keratin breakup patternShedding of large non adherent white scalesKeratinezed 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 goalsReduce epidermal turnover rate of the scalpMinimize the cosmetic embarrassmentMinimize itch

Mild to moderate cases: frequent hair washing is sufficientOtherwise, medicated shampoos can be used

Medicated shampoos

Cytostatic agents: pyrithione zinc, selenium sulfide: reduce scaling by decreasing epidermal growth rateKeratolytic shampoos: salicylic acid, sulphurContact 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 washingUsed only 2 to 3 times weekly for 2 to 3 weeksKetoconazole can be used (non OTC)

Seborrheic dermatitisSubacute of chronic inflammatory disorder that occurs predominantly in the areas of greatest sebaceous gland activity (scalp, face, trunk).

Scaly itchy rashTwo age peaks of occurrence: one in the first 3 months of life and the second around the fourth to seventh decade of lifeCommon in infants and more common in adult men

Unknown cause, fungus could be involved in some cases

Clinical presentationScalp, eyebrows, eyelid margins, beard area, central back, retroauricular creasesTypically: dull, yellowish, oily scales on red skinPruritis is commonEarly in life: cradle cap: greasy scales and scale crust on bright erythematous base and affect the scalpIn adults: greasy scales on the scalp that extends to the middle third of the face and eyes. Erythema and accumulation of thick crust .

TreatmentSeborrhoeic 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 advisedRegular 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 ointmentsSeborrheic dermatitis of the scalp could be treated.

with hydrocortisone lotions