Pityriasis capitis

By Daphne Gima
2nd September 2009
Outline
 Introduction

 ClinicalFeatures
 Etiology

 Treatment

 Evidence for Use

 Prevention

 Summary

 References
Introduction
 Chronic relapsing non-inflammatory
hyperproliferative skin condition.
 Affects both sexes

 Affects all age groups; though unusual in

prepubescent children.
 Otherwise known as dandruff
Clinical Features
 White or gray scaling or flaking
 Mild pruritus (possible)
 No inflammation
 No alopecia
Differential Diagnoses:
i) Inflammatory changes such as erythema & pruritus
are present  seborrheic dermatitis
ii) Alopecia present  psoriasis
Etiology
 Abnormal cell turnover:
- Normal cell turnover: 25 -30 days
- In dandruff: 13 -15 days
- In seborrhoeic dermatitis: 9 -10 days
 Fungal etiology:
- Malassezia spp (previously known as Pityrosporum
sp )
- Lipophilic yeast, inhabits follicles
- Cannot synthesize fatty acids ≥ C12
- Metabolize fatty acid from surrounding → irritation
Treatment Strategies
3 main classes according to mechanisms:
- Keratolytic

- Antimicrobial

- Antiproliferative

 All antidandruff shampoos can cause local scalp

irritation.
 Generally safe in pregnancy,

 No drug interactions.
Selenium Sulfide 1%
 Proven cytostatic agent, highly inhibits growth of
P. ovale
 Studies shown significantly better than placebo
and non-medicated shampoos
 Only used in patients > 5 years.

 E.g. Selsun
Zinc Pyrithione
 Exhibitantifungal properties and reduce cell
turnover rate
 Can be used by all patients at any age

 Use on daily basis until dandruff clears

 E.g. Head and Shoulders

Ketoconazole 1%
 Antifungal activity controls flaking, scaling
and itching of dandruff.
 Studies shown it to be effective and better
tolerated than selenium sulphide
 Also has been shown as prophylactic agent
in preventing relapse
 Use every 3-4 days for up to 8 weeks, then
PRN
Coal Tar
 Affects DNA synthesis and antimitotic effect
 Effective, but not best choice

 Disadvantages:

- Unpleasant odour

- Stain skin and hair

- Folliculitis, allergic dermatitis

- Photosensitivity
Various Treatment
 Sulfur 2-5%
- Keratolytic action

- May also be combined with salicylic acid.

 Tea tree oil (Melaleuca oil)

- Trial of tea tree oil 5% vs placebo (n=126

patients)
- Tea tree significantly better, however only 1 case
complete response.
Evidence for Use
 RCT comparing 4 anti-dandruff shampoos (n= 199
patients):
- Selsun Blue (selenium sulfide 1%)
- Head & Shoulders (zinc pyrithione 1%)
- Tegrin (coal tar)
- Flex
 Results: Selsun Blue showed
- greatest improvement in loose & adherent dandruff
- greatest rate of improvement
P < 0.05
Prevention
 Brush hair daily.
 Use hypoallergenic shampoo daily to control
mild symptoms.
 Wash hair at least 3 times a week.

 Use anti-dandruff or anti-fungal shampoo

once a week to prevent recurrence.
 Nutrition: Include plenty of vitamin B in diet.
Summary
 Pityriasis capitis or dandruff is a common skin
condition.
 Etiology: increased cell turnover rate and
yeast inhabitation
 Treatment includes selenium sulphide, zinc
pyrithione, ketoconazole and coal tar.
 Patient education on prevention methods
may be beneficial.
References
1. Rutter P. Community Pharmacy: Symptoms, Diagnosis and Treatment.Churchill Livingstone
2004.
2. NHS Choices. Dandruff. Retrieved on 26th Aug 2009 from
http://www.nhs.uk/Conditions/Dandruff/Pages/Introduction.aspx
3. Pray WS. Dandruff and seborrheic dermatitis. Retrieved on 26th Aug 2009 from
http://www.medscape.com/viewarticle/407641
4. Grimalt R. A practical guide to scalp disorders. Journal of Investigative Dermatology
Symposium Proceedings (2007) 12, 10–14. doi:10.1038/sj.jidsymp.5650048
5. Rapaport M. A randomized, controlled clinical trial of four anti-dandruff shampoos. J. Int. Med.
Res. 9 (2): 152–6