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Updated: Dec 16 2021

Seborrheic Dermatitis

  • 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
  • Prevention and Complications
    • Prevention
      • shampoos mentioned above work well if used properly
      • good skin hygeine
    • Complications
      • can become secondarily infected with bacterial, fungal, or viral agents
  • Prognosis
    • Most infections respond well to therapy
    • May recur, especially in immunocompromised individuals
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