Dandruff, also known as pityriasis capitis, is a common condition that presents with a scaly and flaky scalp. If the scalp is also red and irritated, then the dandruff is caused by seborrheic dermatitis. The two conditions are interchangeable and treated similarly.

Diagnosis of dandruff

The diagnosis of dandruff is usually done with an examination, but if your doctor considers another diagnosis, such as tinea or psoriasis, you may require a swab or skin biopsy.

Treatment options for dandruff and seborrheic dermatitis

Dandruff is hard to cure but can be manageable. Treatment for dandruff and seborrheic dermatitis overlap, with common recommended therapies including:

• Zinc pyrithione shampoo, which has antibacterial and antifungal effects
• Selenium sulfide shampoo, which is an antifungal that controls how much the skin sheds
• Piroctone olamine shampoo (antifungal)
• Ketoconazole shampoo (antifungal)
• Tar shampoo, which has antimicrobial, anti-itch, and skin shedding effects
• Salicylic acid shampoo, which loosens the top layer of shedded skin
• Topical corticosteroid lotions, which can provide symptomatic relief of itch

Each shampoo or lotion has its own directions on how often they should be used. Dandruff is not always able to be cured, but it can come and go depending on many factors, and often a mix of these shampoos or lotions is necessary to get the desired result.

When to seek medical advice

If your dandruff is hard to control or is leading to distress, speak to your doctor. You may need expert advice from a dermatologist.

Scrotal angiokeratomas are small, raised, red or purple bumps that are noncancerous and quite common. Although angiokeratomas can appear anywhere on the body, this article focuses on those found on the scrotum, known as angiokeratomas of Fordyce. These lesions are particularly common, with their prevalence increasing with age. About 6% of men in their 30s have scrotal angiokeratomas, and this figure rises to 16% for men over 70.

In most cases, the exact cause is unclear. However, in rare instances, scrotal angiokeratomas may be linked to genetic conditions or certain medications.

For individuals with lighter skin tones, scrotal angiokeratomas are more noticeable, while those with darker skin may find the lesions less visible. In rare cases, the lesions may bleed, especially if they are large, located in areas where skin rubs together, or if you are taking blood-thinning medications.

How is it diagnosed?

Your doctor will usually diagnose scrotal angiokeratomas via a clinical examination.

If there is some uncertainty about skin lesions on your scrotum, your doctor may perform a skin biopsy to exclude conditions like melanoma or pyogenic granuloma.

If you choose to pursue treatment for scrotal angiokeratoma, they are usually provided by a dermatologist.

There are two main types of non-melanoma skin cancers, called basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs). Melanoma skin cancers act very differently to non-melanoma skin cancers and will be addressed in another article.

Treatment options of non-melanoma skin cancers

Often, if the biopsy has cut the whole lesion out then the skin cancer has been cured. This means you may be diagnosed with a BCC or SCC and have it cured on the same day. Other treatments for BCCs and SCCs may involve:

-Liquid nitrogen, which causes a chemical burn to the skin cancer.

-Topical medications such as imiquimoid and 5-fluorouracil. These creams or gels attack or kill cancerous cells and are a type of chemotherapy.

-Radiotherapy, which uses x-rays to kill cancer cells. This method is usually for skin cancers that are in tricky areas, such as near eyes.

-Surgery involves cutting the whole skin cancer out. This is often done under local anaesthetic as part of the biopsy procedure, so you are awake. If it is a large lesion or if it requires complex plastic surgery due to being on tricky areas in the body, you may need to return for more surgery and/or it can be done under general anaesthetic (asleep).

Impact and prevention of non-melanoma skin cancers

Although most BCCs and SCCs will not cause death, they can cause stress and physical deformity. Some can affect surrounding tissue and so if they grow near your eyes, lips, or nose, they can affect those senses. Treatments may also lead to scars and pain, particularly if the skin cancers are large or complex.

Both BCCs and SCCs can be prevented by avoiding intense sunshine and UV light. This can include using sunscreen, staying in shade, avoiding peak UV exposure times, wearing long sleeves and pants, and sunglasses. You can also have a regular skin check through your regular doctor to pick up any early lesions and discuss skin care.

References

• Patient Info on Basal Cell Carcinoma
• Cancer Council Australia on Non-Melanoma Skin Cancer
• Patient Info on Non-Melanoma Skin Cancer
• Cancer Council on Skin Cancer
• Cancer Council Australia on Skin Cancer
• Skin Cancer Foundation

Herpes zoster, known as shingles, is caused by the reactivation of the varicella-zoster virus, the same virus responsible for chickenpox. In Australia, significant strides have been made in preventing this painful condition through effective vaccination strategies.

Understanding shingles

Shingles typically presents as a painful rash that may blister and can appear anywhere on the body but often forms a single stripe on either side of the torso. It is caused by the reactivation of the varicella-zoster virus in individuals who have recovered from chickenpox. Risk factors for developing shingles include age, weakened immunity, and physical or emotional stress.

In response to the increased risk of shingles and its complications among older adults and immunocompromised individuals, the Australian National Immunisation Program (NIP) recommends vaccination in certain groups of people:

Shingrix Vaccine:

• For Immunocompetent Adults: Adults aged 50 years and older are recommended to receive two doses of Shingrix, 2 to 6 months apart.
• For Immunocompromised Adults: Those aged 18 years and above should receive two doses at a 1 to 2-month interval.
• Shingrix is provided free under the NIP for all adults aged 65 years, Aboriginal and Torres Strait Islander people aged 50 years and above, and selected groups aged 18 years and above with severe immunocompromise.

Zostavax Vaccine:

• A single dose is recommended for immunocompetent adults aged 50 years and over.
• Zostavax is contraindicated for individuals with severe immunocompromise and is no longer used under the NIP due to its live attenuated nature and the availability of Shingrix.

Precautions and contraindications

• Individuals who have experienced anaphylaxis due to vaccine components or a previous dose of Shingrix or Zostavax should not receive these vaccines.
• Zostavax is not recommended for people who are immunocompromised or shortly expected to be due to the risk of disseminated VZV infection.

Supporting Resources

• HealthDirect Australia – Shingles
• The Australian Immunisation Handbook – Zoster (Shingles)

Shingles vaccination is a critical health measure for eligible Australians, particularly given the severe potential complications of the disease. With the availability of effective vaccines like Shingrix, individuals can significantly reduce their risk of developing shingles and experiencing long-term pain. Australians are encouraged to discuss their vaccination options with healthcare providers to ensure optimal protection against this painful condition.

Food allergies are on the rise in Australia, affecting 5-10% of children. Understanding allergies, recognising the symptoms, and knowing how to respond can help parents to feel less stressed about their child’s condition, and manage the risks more effectively.

Living with food allergies

Living with food allergies involves more than just avoiding allergens. It requires educating those around the child—teachers, family members, and caregivers—about the allergies and how to respond in an emergency. This includes understanding how to use an adrenaline auto-injector and recognizing the signs of an allergic reaction.

Special care should be taken when travelling, particularly checking out the policies of airlines regarding food served on board. Carry your auto-injector and keep it with you (don’t stow it in overhead bins when flying).

While food allergies in children can be daunting, with the right knowledge and tools, they are manageable. By educating themselves and others, parents can create a safer environment that keeps their children safe and allows them to thrive, despite their allergies.

Resources and support

Several helpful resources are available to help families manage food allergies:

• Allergy & Anaphylaxis Australia (Allergy Facts): Provides education, support, and resources for allergy management.
• The Australasian Society of Clinical Immunology and Allergy (Allergy.org.au): Offers up-to-date information and guidelines for managing allergies.
• Travelling with allergies – Allergy Facts

What are anogenital warts?

Anogenital warts are caused by Human Papilloma Virus (HPV) and can affect the anus and the genitals.

There are over 150 types of HPV and if you’ve ever had sex, you’ve been exposed to HPV. Most types of HPV don’t cause any symptoms but some can cause anogenital warts and a small number can also cause cancers of the cervix, penis, throat and rectum.

In-clinic or hospital treatments include:

• Cryotherapy: this is liquid nitrogen that is applied to the warts with a spray or cotton bud. Treatments are usually spaced into fortnightly treatments so the skin can recover between each session. The treated area can react with blistering, dull ache and ulceration.
• Trichloracetic acid (TCA): this causes a burn on the wart and is sometimes used by hospital specialists.
• Ablative treatments: cauterisation and laser can be used to remove warts, particularly when there is a large area of them that isn’t responding to other treatments.
• Surgery: some persistent warts can be removed surgically in hospital.

All treatments may take weeks to months to see complete resolution. The response to treatment depends on the amount of warts, how large they are and your overall general health.

Can warts lead to cancer?

The HPV strains that cause anogenital warts do not increase your risk of cancer. The two strains that are at highest risk of causing cancer are HPV-16 and HPV-18.

The strains most likely to cause anogenital warts are HPV-6 and HPV-11.

Prevention

Condoms can partially prevent HPV. Condoms cover the penis but if there is HPV in the scrotum, pelvis or anus then condoms won’t prevent transmission.

Since 2007, there has been a vaccine in Australia for preventing HPV infection. Initially, Gardasil contained 4 strains of HPV. In recent years, there is Gardasil9, which protects against nine strains of HPV (6, 11, 16, 18, 31, 33, 45, 52, and 58).

It is given for free to high-school aged children, but anyone can be vaccinated with Gardasil9 through their regular GP. The vaccine protects against HPV strains that cause anogenital warts and cancers.

Further resources & patient information about anogenital warts

Genital warts & HPV – Victorian Sexual Health Network

Anogenital Warts: Causes, Symptoms, Treatment, Prevention – Patient.info

Genital Warts – Patient.info

Anogenital Wart – DermNet

What is Jock Itch?

Jock Itch is a common name for the medical condition also known as “Tinea Cruris”. Jock Itch is caused by a fungus which naturally lives on the skin, but under certain conditions overgrows and leads to an itchy rash in the groin, either side of the penis and scrotum. 

Generally, the skin on both sides of the genitals becomes itchy and then appears dry and scaly. It can get red and spread, becoming more intensely itchy. Scratching can lead to nicks and bleeds in the irritated skin. 

Tinea can also affect the skin elsewhere, e.g. between the toes (Tinea Pedis) and beard (Tinea Barbae), so if you have Tinea on one part of the body it’s possible to “seed it” elsewhere.  If you are wondering how to get rid of jock itch, there are some steps you can take to prevent and treat it.

What is Psoriasis? 

Psoriasis is a chronic (long term) skin condition that causes areas of the skin to become thickened, red, and scaly (described as “plaques”). It affects men and women, across all ethnicities, occurring more commonly in adults than children. The peak ages of onset are 15-25 years and 50-60 years.

Psoriasis can fluctuate, flaring up and settling down over time. Though it does not have a permanent cure, treatments are available to help manage the symptoms and reduce the chance of flares.

What causes Psoriasis? 

The cause of psoriasis is somewhat unclear, but involves an abnormal response of the immune system, resulting in excessive skin turnover and the formation of plaques. It has several subtypes and can affect different parts of the body. The commonest subtype, “chronic plaque psoriasis”, affects the elbows, knees, lower back and scalp.

What are Head Lice?

Head Lice are small insects that live in human hair and feed on blood from the scalp. Outbreaks are very common in childcare centres, schools and residential facilities.

How do Head Lice spread?

Head Lice are spread by close head-to-head contact. Less commonly they can spread by sharing items such as a hairbrushes, combs or pillows. The types of lice that live on other animals do not infect humans. Head Lice do not have wings, so they crawl from place to place- they cannot fly or jump from one person to another.