Updated: 12/13/2019

Seborrheic Dermatitis

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Snapshot
  • A 40-year-old man with history of HIV infection presents to the clinic with a red, flaky rash around his scalp, face, nose, and ears. He has tried low-dose topical steroids, which have not helped. He would like stronger therapy for his rash.
Introduction
  • Common, chronic, inflammatory skin disease that results from
    • oversecretion of sebaceous material
    • hypersensitivity to superficial fungi, Malassezia fufur (formerly Pityrosporum ovale)
  • Affects all ages
    • dandruff” in adults
    • cradle cap” in infants
  • More severe in
    • patients with neurologic disease (traumatic brain injury, Parkinson’s disease, stroke) 
    • HIV patients 
Presentation
  • Symptoms
    • most commonly “dandruff” in hair and face
    • burning, itchy, scaling
    • if severe, can become exfoliative erythroderma (as in those with immunodeficiencies)
  • Physical exam
    • scaly, greasy, flaky skin on scalp margins and face
    • erythematous
    • especially where sebaceous glands are numerous          
      • eyebrows
      • nasolabial folds
      • external ear canals
      • groin
Evaluation
  • Diagnosis is made by clinical history and exam
    • skin biopsy typically not necessary
  • KOH prep
    • to rule out fungal infection if resistant or suspicion for other fungal infections
Differential
  • Fungal infection
  • Cutaneous lupus
  • Acne rosacea
Treatment
  • Medical management 
    • topical therapies for mild disease
      • best initial therapy: emollients and non-medical shampoos (zinc containing) 
      • low-potency topical steroids (e.g., hydrocortisone)
      • topical antifungals (e.g., ketoconazole or selenium sulfide) 
      • selenium or zinc pyrithione or tar shampoo
    • systemic therapies for severe or resistant disease
      • oral antifungals (e.g., ketoconazole)
      • oral steroids
Prognosis, Prevention, and Complications
  • Prognosis
    • most infections respond well to therapy
    • may recur, especially in immunocompromised individuals
  • Prevention
    • shampoos mentioned above work well if used properly
    • good skin hygeine
  • Complications
    • can become secondarily infected with bacterial, fungal, or viral agents

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(M2.DM.13.10) A 58-year-old man presents to the office complaining of a rash on his forehead and scalp. He states he has had it for the past few months but noticed it has been worsening recently and is itchy. His temperature is 98.1°F (36.7°C), blood pressure is 142/92 mmHg, pulse is 83/min, respirations are 15/min, and oxygen saturation is 98% on room air. Inspection of the patient's scalp reveals the finding in Figure A. Which of the following conditions is most likely to be found in this patient's medical history?

QID: 104221
FIGURES:
1

Alzheimer disease

14%

(19/137)

2

Parkinson disease

42%

(58/137)

3

Rheumatoid arthritis

4%

(6/137)

4

Sjogren syndrome

21%

(29/137)

5

Systemic lupus erythematosus

16%

(22/137)

M 6 E

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