Papulosquamous scalp dermatoses: key aspects of differential diagnosis and treatment
https://doi.org/10.21518/ms2024-288
Abstract
Psoriasis and seborrheic dermatitis are common papulosquamous dermatoses. When localized only on the scalp, they often have very similar clinical manifestations and require a comprehensive differential diagnostic approach. The article presents the main comparative clinical and diagnostic characteristics of psoriasis and seborrheic dermatitis of the scalp, including trichoscopy features and pathomorphological markers. Topical therapy with glucocorticosteroids, keratolytics and agents with antifungal activity is of key importance in the treatment of papulosquamous diseases. Modern topical drugs with a fixed combination of active ingredients provide an effect on several pathogenetic mechanisms at once, are stable, compatible, and convenient for use by patients. One of the main drugs for the treatment of psoriasis and seborrheic dermatitis is a solution of betamethasone dipropionate and salicylic acid (trade name – Akriderm SK), which in terms of anti-inflammatory activity is comparable to the highest strength topical corticosteroids, while providing a faster response to therapy and effectively relieving symptoms of itching and peeling. This is confirmed by the authors’ own clinical experience and demonstrated in the clinical cases described in the article.
About the Authors
G. P. Tereshchenko
Peoples’ Friendship University of Russia named after Patrice Lumumba;
Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology
Russian Federation
Russian Federation
Galina P. Tereshchenko, Cand. Sci. (Med.), Associate Professor of the Department of Dermatovenereology, Allergology and Cosmetology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba; Dermatovenerologist, Allergist-Immunologist, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology
6, Miklukho-Maklai St., Moscow, 117198,
17, Leninsky Ave., Moscow, 119071
O. V. Zhukova
Peoples’ Friendship University of Russia named after Patrice Lumumba;
Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology
Russian Federation
Russian Federation
Olga V. Zhukova, Dr. Sci. (Med.), Professor, Head of the Department of Dermatovenereology, Allergology and Cosmetology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba; Chief Physician, Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology
6, Miklukho-Maklai St., Moscow, 117198,
17, Leninsky Ave., Moscow, 119071
M. N. Ostretsova
Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Maria N. Ostretsova, Cand. Sci. (Med.), Associate Professor of the Department of Dermatovenereology, Allergology and Cosmetology
6, Miklukho-Maklai St., Moscow, 117198
M. A. Bobrov
Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology
Russian Federation
Russian Federation
Maksim A. Bobrov, Cand. Sci. (Med.), Pathomorphologist
17, Leninsky Ave., Moscow, 119071
S. Alhaffar
Peoples’ Friendship University of Russia named after Patrice Lumumba
Russian Federation
Russian Federation
Suzanne Alhaffar, Postgraduate Student of the Department of Dermatovenereology, Allergology and Cosmetology, Medical Institute
6, Miklukho-Maklai St., Moscow, 117198
References
1. Varma K, Kumar U, Kumar V. Clinical pattern of papulosquamous dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India. Int J Res Dermatol. 2020;6(2):230–236. https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20200602.
2. Polonskaya AS, Shatokhina EA, Kruglova LS. Seborrheic dermatitis: current ideas of the etiology, pathogenesis, and treatment approaches. Russian Journal of Clinical Dermatology and Venereology. 2020;19(4):451–458. (In Russ.) https://doi.org/10.17116/klinderma202019041451.
3. Borda LJ, Wikramanayake TC. Seborrheic Dermatitis and Dandruff: A Comprehensive Review. J Clin Investig Dermatol. 2015;3(2):10. https://doi.org/10.13188/2373-1044.1000019.
4. Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020;323(19):1945–1960. https://doi.org/10.1001/jama.2020.4006.
5. Wozel G, Klein E, Mrowietz U, Reich K, Sebastian M, Streit V. Scalp psoriasis. J Dtsch Dermatol Ges. 2011;9(1):70–74. https://doi.org/10.1111/j.1610-0387.2010.07412.x.
6. Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61(2):233–239. https://doi.org/10.1002/art.24172.
7. Ruiz-Arriaga LF, Arenas R, Vega-Sánchez DC, Asz-Sigall D, Martínez-Velazco MA. Seborrheic Dermatitis: Three Novel Trichoscopic Signs and Its Correlation to Malassezia sp. Colonization. Skin Appendage Disord. 2019;5(5):288–292. https://doi.org/10.1159/000497782.
8. Rudnicka L, Sicinska J, Rakowska A, Warszawik-Hendzel O. Seborrheic Dermatitis. In: Rudnicka L, Olszewska M, Rakowska A (eds.). Atlas of Trichoscopy. London: Springer; 2012, pp. 371–378. https://doi.org/10.1007/978-1-4471-4486-1_30.
9. Rudnicka L, Rakowska A, Olszewska M, Sicinska J, Maj M, Majsterek M et al. Psoriasis. In: Rudnicka L, Olszewska M, Rakowska A (eds.). Atlas of Trichoscopy. London: Springer; 2012, pp. 379–389. https://doi.org/10.1007/978-1-4471-4486-1_31.
10. Park JH, Park YJ, Kim SK, Kwon JE, Kang HY, Lee ES et al. Histopathological Differential Diagnosis of Psoriasis and Seborrheic Dermatitis of the Scalp. Ann Dermatol. 2016;28(4):427–432. https://doi.org/10.5021/ad.2016.28.4.427.
11. Almeida MC, Romiti R, Doche I, Valente NY, Donati A. Psoriatic scarring alopecia. An Bras Dermatol. 2013;88(6 Suppl. 1):29–31. https://doi.org/10.1590/abd1806-4841.20132241.
12. George SM, Taylor MR, Farrant PB. Psoriatic alopecia. Clin Exp Dermatol. 2015;40(7):717–721. https://doi.org/10.1111/ced.12715.
13. Kibar M, Aktan Ş, Bilgin M. Dermoscopic findings in scalp psoriasis and seborrheic dermatitis; two new signs; signet ring vessel and hidden hair. Indian J Dermatol. 2015;60(1):41–45. https://doi.org/10.4103/0019-5154.147786.
14. Gupta LK, Khare AK, Masatkar V, Mittal A. Pityriasis amiantacea. Indian Dermatol Online J. 2014;5(1 Suppl.):S63–64. https://doi.org/10.4103/2229-5178.144550.
15. Murakhovskaya EK, Sysoeva TA, Larionova YuYu. Pityriasis amiantacea. Lechaschi Vrach. 2024;(5):24–28. (In Russ.) https://doi.org/10.51793/OS.2024.27.5.004.
16. Guenther LC. Fixed-dose combination therapy for psoriasis. Am J Clin Dermatol. 2004;5(2):71–77. https://doi.org/10.2165/00128071-200405020-00001.
17. Ostretsova MN, Kasikhina EI, Zhukova OV, Al-Hawatmi A. The efficiency of the combination of topical and biological therapy in the treatment of nails psoriasis: a prospective study. Meditsinskiy Sovet. 2023;17(13):32–37. (In Russ.) https://doi.org/10.21518/ms2023-113.
18. Hillström L, Pettersson L, Svensson L. Comparison of betamethasone dipropionate lotion with salicylic acid (Diprosalic) and clobetasol propionate lotion (Dermovate) in the treatment of psoriasis of the scalp. J Int Med Res. 1982;10(6):419–422. https://doi.org/10.1177/030006058201000606.
19. Elie R, Durocher LP, Kavalec EC. Effect of salicylic acid on the activity of betamethasone-17,21-dipropionate in the treatment of erythematous squamous dermatoses. J Int Med Res. 1983;11(2):108–112. https://doi.org/10.1177/030006058301100208.
20. Chuslyaeva AA. Modern approaches to external therapy of atopic dermatitis in children. RMJ. 2014;(8):626–630. (n Russ.) Available at: https://www.rmj.ru/articles/allergologiya/Sovremennye_podhody_k_narughnoy_terapii_atopicheskogo_dermatita_u_detey/
21. Segaert S, Calzavara-Pinton P, de la Cueva P, Jalili A, Lons Danic D, Pink AE et al. Long-term topical management of psoriasis: the road ahead. J Dermatolog Treat. 2022;33(1):111–120. https://doi.org/10.1080/09546634.2020.1729335.
22. Papp KA, Dhadwal G, Gooderham M, Guenther L, Turchin I, Wiseman M, Yeung J. Emerging paradigm shift toward proactive topical treatment of psoriasis: A narrative review. Dermatol Ther. 2021;34(6):e15104. https://doi.org/10.1111/dth.15104.
23. Jackson JM, Alexis A, Zirwas M, Taylor S. Unmet needs for patients with seborrheic dermatitis. J Am Acad Dermatol. 2024;90(3):597–604. https://doi.org/10.1016/j.jaad.2022.12.017.
Review
For citations:
Tereshchenko GP, Zhukova OV, Ostretsova MN, Bobrov MA, Alhaffar S. Papulosquamous scalp dermatoses: key aspects of differential diagnosis and treatment. Meditsinskiy sovet = Medical Council. 2024;(14):124-132. (In Russ.) https://doi.org/10.21518/ms2024-288
Views:
330
Email this article 