Scaly Dermatoses
Dandruff, seborrheic dermatitis, and psoriasis are chronic scaly
dermatosis
Dandruff
Less inflammatory form and it has a substantial cosmetic concern
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
treated. Seborrheic dermatitis of the scalp could be
with hydrocortisone lotions