SCALY DERMATOSIS

ASSIST ANT

SAR AH J. P AY NE, MS, P H AR MD, BCP S

P R O FESSO R , DEP AR T MENT O F P H AR MACO T H ER AP Y
OCTOBER 27,2015

LEARNING OBJECTIVES
1. State causes of the three types of scaly
dermatoses.
2. Recognize classification of treatment options.
3. Discuss triggers for scaly dermatoses.
4. Select appropriate treatment of scaly dermatoses.

INTRODUCTION
Types: dandruff, dermatits, psoriasis
Primary manifestation: scales
Dandruff is less inflammatory form with relatively fine
scaling confined to scalp
Seborrheic dermatitis involves scalp, face, and
chest with significant inflammation
Psoriasis is highly inflammatory skin condition with
raised plaques and adherent thick scales

PATHOPHYSIOLOGY OF DANDRUFF
Hyperproliferative epidermal disorder
Characterized by accelerated epidermal skin
turnover and irregular keratin breakup pattern
resulting in scales
Accelerated skin turnover rate is caused by
inflammatory effects of fatty acids and cytokines
produced by Malassezia species

TREATMENT OF DANDRUFF
Washing hair with general shampoo daily or every
other day is generally sufficient
Medicated shampoo (pyrithione zinc or selenium
sulfide, ketoconazole, coal tar, salicylic acid, sulfur)
Leave on hair for 3-5 minutes before rinsing
Rinse 2-3 more times
Use daily x 1 week, 2-3 x/wk x 2-3 wks, weekly thereafter

SEBORRHEIC DERMATITIS
Marked by accelerated epidermal proliferation in
areas with dense distribution of sebaceous glands
It is even faster than dandruff
Hallmark: greasy, yellow scales

SEBORRHEIC DERMATITIS TREATMENT

More aggressive than dandruff treatment
Treatment for control of disease, not cure
Infant
Massage baby oil into affected area, typically scalp
If do not respond, refer to pediatrician

Adults
Medicated shampoo
A regular shampoo or Dawn can loosen scales
Topical steroids can be used to help control inflammation
Hydrocortisone no more than BID
Do not use for more than 7 days
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PSORIASIS
Cause is unknown
Triggered by

Environmental factors
Infections
Prescription drug use

Beta blockers
Lithium
Antimalarials
Indomethacin
Quinidine

Withdrawal of systemic corticosteroids

Stress
Hormonal changes
Obesity
Use of alcohol or tobacco
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PSORIASIS TREATMENT
Only very mild cases can be treated OTC (<5%)
Use emollients and hydrocortisone cream
Avoid triggers

WHICH OF THE FOLLOWING CLASSES

DOES SELENIUM SULFIDE BELONG TO?
A. Anti-Malassezia agents
B. Cytostatic agents
C. Keratolytic agents

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AGENTS
Anti-Malassezia agents
Pyrithione zinc
Selenium sulfide
Ketoconazole

Cytostatic agents
Coal tar

Keratolytic agents
Salicylic acid
Sulfur

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TREATMENT ALGORITHM

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SCALY DERMATOSIS
ASSIST ANT

SAR AH J. P AY NE, MS, P H AR MD, BCP S

P R O FESSO R , DEP AR T MENT O F P H AR MACO T H ER AP Y
OCTOBER 27,2015