seborrhoeic dermatitis and dandruff

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seborrhoeic dermatitis and dandruff

• Done by Eliama Abed , Anwar Maalawani.
• Presented to Dr. Adham Abu Taha

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Seborrhoeic Dermatitis

• is an inflammatory skin disorder affecting the
  scalp, face, and torso.
• It is results from accelerated epidermal
  proliferation and sebaceous gland activity on the
  scalp, face and trunk.

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Causes

1. Fungal As in dandruff, growth of Pityrosporum
   ovale is increased in the scaly epidermis and may
   be a causative agent, or fungus called
   Malassezia.
2. Change of season Episodes are often worse in
   winter.
3. Neurological conditions Seborrheic dermatitis
   may occur more frequently in people who have
   Parkinson's disease and certain other
   neurological disorders.
4. Stress and fatigue Stressful life events and
   situations may help trigger an episode or make it
   worse through mechanisms that aren't yet
   understood. The role of neurological disorders
   and stress may be related through effects on the
   nervous system.
5. HIV/AIDS Seborrheic dermatitis may occur more
   commonly and tend to be more severe in those with
   HIV/AIDS.

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• On the scalp, the condition may be difficult to
  distinguish from more severe forms of dandruff,
  as characteristic features
• are the presence
• of greasy scales
• and often pruritus.

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• Seborrhoeic dermatitis is common in infants, when
  it is known
• as cradle cap.

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• Relatively rare in children and occurs again
  from puberty, the incidence peaking between the
  ages of 18 and 40 years.
• The condition may also involve the area in and
  around the ears, the eyebrows and eyelashes.

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Diagnosis

• Steps to diagnosis include
• Medical history by asking about the symptoms
  that the patient suffer from, and all the
  prescription and over the counter drugs and other
  health condition.
• Physical examination examine the scalp and areas
  of patient face or body where he has symptoms.

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Dandruff

• Dandruff is seen as excessive shedding of the
  cornified cells of the scalp in the form of
  scales.
• Dandruff (pityriasis capitis) is a chronic,
  non-inflammatory scalp condition characterised by
  excessive shedding of the cornified cells of the
  scalp in
• the form of scales, which is
• sometimes accompanied
• by itching and redness
• of the scalp.

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• Dandruff is rare in young children, but incidence
  increases rapidly with age, peaking in the second
  decade of life and declining gradually
  thereafter.
• Estimates of prevalence vary, but it has been
  claimed that 75 of the population is affected by
  dandruff at some time in their lives.
• It appears to affect both sexes equally.

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Causes?

• increases in the production of horny substance
• cell turnover on the scalp.
• raised androgen levels.
• Too much sebum,.which may be abreeding ground for
  yeast or fungus.
• Not drinking enough water or being exposed to a
  lot of dry air can cause skin to dry out of
  flake, which can look like dandruff.

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The fungus Malassezia.
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Treatment

• Topical treatments for dandruff and mild forms of
  seborrhoeic dermatitis are the same and are
  available without prescription.

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• Seborrheic dermatitis tends to be chronic, and
  there's usually no strategy that stops it
  permanently.
• But treatments including many can try at home
  may control the signs and symptoms during a
  flare-up.
• The best approach depends on the skin type, the
  severity of the condition, and whether the
  symptoms affect the scalp or other areas of the
  body.

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• A wide range of medicated treatments is
  available, containing ingredients
• such as
• pyrithione zinc
• selenium sulphide
• ketoconazole
• coal tar
• keratolytic agents
• antimicrobial detergents.

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Pyrithione zinc and selenium sulphide

• MOA Both of these compounds are cytostatic
  agents, which act by reducing the rate
• of epidermal cell turnover.

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Administration

• pyrithione zinc
• Early formulations required contact times of
• 510 minutes, but for current products 23
  minutes two or three times weekly is sufficient.
• Selenium sulphide
• is used twice a week for 2 weeks, and then once
  a week as necessary to control the conditionand
  left for 2-3 minutes.

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Contraindications, cautions and side-effects

• Pyrithione zinc
• Does not penetrate into the dermis long-term use
  has not been associated with toxicity.
• Selenium sulphide
• It is highly toxic if ingested.
• Regular use shampoo tends to leave a residual
  odour of hydrogen sulphide and makes the scalp
  oily.
• Not recommended for children under 5 years of
  age.
• Not use in the first trimester of pregnancy.

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Products

• Pyrithione zinc
• Polytar AF shampoo (contains 1 pyrithione zinc
  with coal tar
• extracts and cade oil it is the only licensed
  medicine to contain
• pyrithione zinc)
• Pyrithione zinc is included in several
• medicated shampoos that are
• not licensed as medicines, including
• Head and Shoulders
• Procter Gamble (HBC)

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• Selenium sulphide
• Selsun shampoo (2.5)
• - Sebosel

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Ketoconazole

• MOA It is an azole antifungal that inhibits
  replication of yeast cells by interfering with
  the synthesis of ergosterol.
• Administrationthe shampoo is used twice a week
  for 24 weeks it should be left on the hair for
  35 minutes on each application.
• Ketoconazole shampoo appears to be extremely safe
  to use.

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• Products
• Nizoral
• Ketoral
• Dandrex
• Orazole

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Coal tar and other tar products

• MOA prevent the formation of squames or flakes
  of dandruff by interfering with the formation of
  intracellular cement. It also appears to impede
  the formation of sebum and to have antipruritic
  properties.
• Concerns have arisen over possible
  carcinogenicity and mutagenicity of coal tar, and
  the raw material is now subject to Control of
  Substances Hazardous to Health (COSHH)
  regulations so far, however, no restrictions
  have been placed on the use of manufactured
  products.

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• Some examples of preparations that contain coal
  tar are
• Alphosyl 2 in 1 shampoo
• Cocois Coconut Oil Compound ointment
• Pentrax shampoo
• Polytar liquid

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Keratolytic agents

• MOA break up dandruff squames and loosen them
  from the scalp.
• Administration Three proprietary shampoos
  containing salicylic acid (in combination with
  other constituents), at concentrations varying
  from 0.5 to 3, are licensed for the treatment
  of dandruff, seborrhoeic dermatitis and other
  scaly conditions of the scalp, but a prolonged
  contact time is needed and the effect takes up to
  10 days to develop.

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Product

• Capasal therapeutic shampoo
• Meted shampoo
• Cocois Coconut Oil Compound ointment

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Antimicrobial detergents

• Ceanel Concentrate (Ferndale) contains cetrimide,
  a quaternary ammonium antiseptic and cationic
  surfactant, together with an antifungal agent,
  undecenoic
• acid, at very low concentration.

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