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dandruff cell turnover rate
13-15 days (2x normal)
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non-pharm for dandruff tx
wash hair & scalp w/ general purpose nonmedicated shampoo every day or daily
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seborrheic dermatitis cell turnover rate
9-10 days
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differentiating factors of seborrheic dermatitis
oily, yellow scales on red, itchy skin of the head, trunk (back, intertriginous areas in children)
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cause of seborrheic dermatitis
elevated levels of Malassezia
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tx of seborrheic dermatitis
medicated shampoo followed by emollient & hydrocortisone cream (0.5-1%)
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how long should tx w/ non-rx hydrocortisone NOT exceed
7 days
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onset of psoriasis can be triggered by...
- environmental factors
- infections
- rx drug use
- psychological stress
- hormonal changes
- obesity
- EtOH, tobacco
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psoriatic plaque cell turnover rate
4 days
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differentiating factors of psoriasis
- red, scaly plaques
- on elbows, lower extremities, knees
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non-pharm tx of psoriasis
- avoid psychological stress, & physical, UC, chemical injury of skin
- lose weight if obese
- cessation of tobacco, EtOH use
- apply emollients w/in 3min of bathing
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MOA of anti-Malassezia agents (eg: pyrithione zinc, selenium sulfide, ketoconazole)
reduce yeast count in scalp & skin
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MOA of coal tar
cross-links DNA & arrests excessive skin cell proliferation
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directions for use of medicated shampoo for seborrheic dermatitis
- use shampoo 2-3x/week x 4 weeks, w/ at least 3 days between each tx
- once controlled, apply once per week to prevent relapse
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directions for use of medicated shampoo for treatment of dandruff
use 2-3x/week for 2-3 weeks & thereafter once weekly or every other week
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MOA of keratolytic agents
dissolve the cement that holds epidermal cells together to loosen & lyse keratin aggregates, facilitating removal from the scalp in smaller particles
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MOA of salicylic acid in tx of scaly dermatoses
decreases skin pH leading to increased hydration of keratin & facilitating loosening & removal
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MOA of sulfur in tx of scaly dermatoses
causes increased sloughing of cells & reduces corneocyte counts
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MOA of hydrocortisone in tx of scaly dermatoses
anti-inflammatory, vasoconstrictive, immunosuppressive properties decrease redness & itching
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exacerbating factors of acne
- local irritation
- cosmetics
- occupation
- medications
- stress/emotional extremes
- high humidity/sweating
- hormonal changes
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EXCLUSIONS for self-tx of acne
- mod-severe acne (>10 comedomes)
- pustules
- meds that cause acne
- 6 weeks of tx w/o improvement
- acne mechanica
- possible rosacea
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non-pharm tx of acne
- eliminate exacerbating factors
- cleanse skin w/ mild/nonsoap cleanser BID
- stay well hydrated
- consider dietary changes (cut down on HGL)
- oil sheets
- pore strips
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MOA of benzoyl peroxide (BPO)
- generates free radicals that attack & inhibit growth of P. acnes
- bacteriocidal, keratolytic, comedolytic
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counseling point for use of BPO
- may experience mild erythema, scaling & acne may get worse in first few days -> but subsides w/in 1-2 weeks
- contact w/ hair, clothes may cause bleaching
- can cause sun sensitivity
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MOA of BHA's (eg: salicylic acid) in tx of acne
lipid soluble keratolytic agent
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role of sulfur in acne tx
included in acne products as a keratolytic & antibacterial agen
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MOA of sulfur/resorcinol combo products
- fcn primarily as keratolytics fostering cell turnover & desquamation
- also antibacterial & comedolytic
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why gel formulations are best in acne tx
astringent + remains on skin longest
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how to treat neonatal acne
use clean fingertips or washcloth to wash baby's skin w/ mild soap & water
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MOA of tea tree oil in tx of acne
disturbs cytoplasmic membranes of S. aureas & weakens cells' ability to fight of other cytocidal agents
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MOA of oral zinc in tx of acne
bacteriostatic against P. acnes, inhibits chemotaxis
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sx of rosacea
acne lesions persist beyond mid-20s, or develop in mid-20s
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MOA of light-based tx
porphyrin from p.acnes absorbs light & becomes excited -> produced oxygen & free radicals damage P. acnes cell wall lipids
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when to refer for dandruff
resistant to 4-8 weeks of appropriate use/tx
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season seborrheic derm is exacerbated in
winter, colder months
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age non-rx steroid cream can be used for seborrhea tx
 2yo
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types of scaly dermatoses topical steroids can be indicated for
seborrhea, psoriasis
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when to refer for seborrhea
conditions worsen or sx persist longer than 7 days after tx
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initial tx of seborrhea for infants/children
gently massage scalp w/ baby oil, followed by nonmedicated shampoo to remove scales
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