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Three Steps to Overcoming Scalp Itch an Emphasis on Accurate Diagnosis and Patient-Friendly Interventions Leads to Successful Management of This Common Complaint

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Three Steps to Overcoming Scalp Itch an Emphasis on Accurate Diagnosis and Patient-Friendly Interventions Leads to Successful Management of This Common Complaint Winter 2007 Vol. 3, No. 1 Editor’s Letter & Contributors. 3 More on Negotiations . 4 Professional Resolutions for 2007 . 4 Sun Protection Education. 7 Three Steps to Overcoming Scalp Itch An emphasis on accurate diagnosis and patient-friendly interventions leads to successful management of this common complaint. By Coyle S. Connolly, DO, and Gerard W. Stroup, PA-C hen a patient presents to the dermatology office complaining of scalp itch, he or she Wmay report frustration with the recurrent symptom, a history of failed at-home therapies, and concern about the appearance of associated lesions on the scalp. The clinician recognizes that several der- matoses may be associated with scalp itch in children and adults (Tables 1, 2). Successful management depends on accurate diagnosis and initiation of an effective, patient-friendly treatment regimen. Step 1.Visual Examination Evaluation of primary lesions will provide clues to the proper diagnosis. While thickened, silver, scaling plaques obviously indicate psoriasis, a diffuse, fine, white scale—with or without erythema—is a sign of seborrheic dermatitis. Scaling in tinea capitis tends to be well-demarcated and erythematous, with cen- tral clearing and fine peripheral scale, with or with- out associated hair loss. In African-American patients tinea capitis can resemble non-inflammato- ® 6 e Salary and Benefits: Negotiate from Strength c tions.” This is far below the American Academy of Physician i nyone seeking employment knows that the ideal posi- t tion may be elusive. Sometimes a candidate must set Assistants’ (AAPA) recently reported average national salary for c Aaside certain less important preferences in order to find full-time clinically practicing PAs of $84,396 (aapa.org). a Although this figure is a national average across a range of spe- t a job that meets critical criteria. But a fair salary is not a prior- r cialties, it is illustrative. h ity to set aside. According to Society of Dermatology Physician Physician assistants should earn a salary that reflects their P Assistants’ (SDPA) President Joe Monroe, PA-C in a statement g i on the association website, some newly employed dermatology level of training and experience. Most dermatology PAs earn a s A PAs are earning less than $30,000 annually in “apprentice posi- base salary with bonuses based on production (usually a per- n ® 4 P I Vol. 3 No. 1 • Winter 2007 Supported by an unrestricted educational grant from Coria Laboratories. Cloderm Ad (New) 1/24/06 4:08 PM Page 1 Safety that’s reassuring for everyone For children and adults, Cloderm® is the mid-potency topical steroid with proven safety in extensive clinical trials. • Uniquely formulated to be selectively absorbed where it’s needed1 • Designed to minimize the likelihood of local and systemic side effects • Proven efficacy as early as Day 41 • The most common adverse events with Cloderm include dryness, irritation, folliculitis, acneiform eruptions, and burning. Cloderm is contraindicated in patients who are hypersensitive to any of the ingredients of this product. As with all topical corticosteroids, systemic absorption can produce reversible HPA-axis suppression. Please see full prescribing information on reverse side of page. Reference: 1. Data on file, Healthpoint, Ltd. Cloderm is a registered trademark of Healthpoint, Ltd. ©2005 CORIA Laboratories, Ltd. A DFB Company. 137259-1105 www.corialabs.com DermPerspectives Copyright 2007 by Avondale Medical Publications, LLC 630 West Germantown Pike, Suite 123, Plymouth Meeting, PA 19462 Postmaster, please send address changes c/o Avondale Medical Publications, LLC. Cloderm PI Derm Times 12/13/05 3:23 PM Page 1 HPA axis suppression by using the urinary free Pediatric Use: Pediatric patients may demonstrate cortisol and ACTH stimulation tests. If HPA axis greater susceptibility to topical corticosteroid- Coyle S. Connolly, DO, Editor suppression is noted, an attempt should be made induced HPA axis suppression and Cushing’s to withdraw the drug, to reduce the frequency of syndrome than mature patients because of a Assistant Clinical Professor of For Topical Use Only application, or to substitute a less potent steroid. larger skin surface area body weight ratio. DESCRIPTION: Recovery of HPA axis function is generally Hypothalamic-pituitary-adrenal (HPA) axis sup- Dermatology, Philadelphia College Cloderm Cream 0.1% contains the medium potency prompt and complete upon discontinuation of pression, Cushing’s syndrome, and intracranial topical corticosteroid, clocortolone pivalate, in a the drug. Infrequently, signs and symptoms hypertension have been reported in children of Osteopathic Medicine. President, specially formulated water-washable emollient of steroid withdrawal may occur, requiring receiving topical corticosteroids. Manifestations cream base consisting of purified water, white supplemental systemic corticosteroids. of adrenal suppression in children include linear Coyle S. Connolly, DO petrolatum, mineral oil, stearyl alcohol, polyoxyl Children may absorb proportionally larger growth retardation, delayed weight gain, low 40 stearate, carbomer 934P, edetate disodium, amounts of topical corticosteroids and thus plasma cortisol levels, and absence of response sodium hydroxide, with methylparaben and be more susceptible to systemic toxicity. (See to ACTH stimulation. Manifestations of intracranial Dermatology and Dermatologic propylparaben as preservatives. PRECAUTIONS-Pediatric Use). hypertension include bulging fontanelles, headaches, and bilateral papilledema. Chemically, clocortolone pivalate is If irritation develops, topical corticosteroids Surgery, Linwood, NJ 9-chloro-6α-fluoro-11β, should be discontinued and appropriate Administration of topical corticosteroids to 21-dihydroxy-16α methylpregna-1, therapy instituted. children should be limited to the least amount 4-diene-3, 20-dione 21-pivalate. compatible with an effective therapeutic regimen. Its structure is as follows: In the presence of dermatological infections, the Chronic corticosteroid therapy may interfere with use of an appropriate antifungal or antibacterial the growth and development of children. agent should be instituted. If a favorable response does not occur promptly, the ADVERSE REACTIONS: corticosteroid should be discontinued until the The following local adverse reactions are reported Terry Arnold, MA, PA-C infection has been adequately controlled. infrequently with topical corticosteroids, but may CLINICAL PHARMACOLOGY: occur more frequently with the use of occlusive Information for the Patient: Patients using topical Topical corticosteroids share anti-inflammatory, dressings. These reactions are listed in an is a graduate of the US Air Force corticosteroids should receive the following antipruritic and vasoconstrictive actions. approximate decreasing order of occurrence: information and instructions: The mechanism of anti-inflammatory activity Burning Academy and completed PA school 1. This medication is to be used as directed of the topical corticosteroids is unclear. Various Itching by the physician. It is for external use only. laboratory methods, including vasoconstrictor Irritation at St. Louis University. He is Avoid contact with the eyes. Dryness assays, are used to compare and predict potencies 2. Patients should be advised not to use this Folliculitis and/or clinical efficacies of the topical corticos- Hypertrichosis employed by Dr. Jeff Alexander in teroids. There is some evidence to suggest that a medication for any disorder other than for Acneform eruptions recognizable correlation exists between vasocon- which it was prescribed. Hypopigmentation Tulsa, OK. strictor potency and therapeutic efficacy in man. 3. The treated skin area should not be bandaged Perioral dermatitis Pharmacokinetics: The extent of percutaneous or otherwise covered or wrapped as to be Allergic contact dermatitis absorption of topical corticosteroids is determined occlusive unless directed by the physician. Maceration of the skin by many factors including the vehicle, the Secondary infection 4. Patients should report any signs of local Skin atrophy integrity of the epidermal barrier, and the use adverse reactions especially under occlusive of occlusive dressings. Striae dressing. Miliaria Topical corticosteroids can be absorbed from 5. Parents of pediatric patients should be advised normal intact skin. Inflammation and/or other OVERDOSAGE: not to use tight-fitting diapers or plastic pants Topically applied corticosteroids can be absorbed disease processes in the skin increase percuta- on a child being treated in the diaper area, as neous absorption. Occlusive dressings substan- in sufficient amounts to produce systemic effects these garments may constitute occlusive (see PRECAUTIONS). tially increase the percutaneous absorption of dressings. topical corticosteroids. Thus, occlusive dressings DOSAGE AND ADMINISTRATION: may be a valuable therapeutic adjunct for Laboratory Tests: The following tests may be Apply Cloderm (clocortolone pivalate) Cream treatment of resistant dermatoses. (See helpful in evaluating the HPA axis suppression: 0.1% sparingly to the affected areas three times DOSAGE AND ADMINISTRATION). Urinary free cortisol test a day and rub in gently. ACTH stimulation test Once absorbed through the skin, topical Occlusive dressings may be used for the man- corticosteroids are handled through pharmacokinetic Carcinogenesis, Mutagenesis, and Impairment of agement of psoriasis or recalcitrant conditions. Fertility: Long-term animal studies
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