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Key Features

  • An acute or chronic papulosquamous dermatitis that often coexists with psoriasis

  • The tendency is to lifelong recurrences, with outbreaks lasting weeks, months, or years

Clinical Findings

  • The scalp, face, chest, back, umbilicus, eyelid margins, genitalia, and body folds have dry scales (dandruff) or oily yellowish scurf

  • Pruritus is a variable finding

  • Patients with Parkinson disease, HIV infection, and patients who become acutely ill often have seborrheic dermatitis

  • Differential diagnosis

    • Psoriasis

    • Atopic dermatitis (eczema)

    • Tinea capitis

    • Contact dermatitis

    • Tinea versicolor

    • Pityriasis rosea

Diagnosis

  • Clinical

Treatment

Scalp

  • Shampoos that contain zinc pyrithione or selenium daily

  • These may be alternated with ketoconazole shampoo (1% or 2%) used twice weekly

  • Tar shampoos

  • Topical corticosteroid solutions or lotions twice daily

Facial

  • A mild corticosteroid (hydrocortisone 1% cream, alclometasone dipropionate 0.05% cream, desonide 0.05% cream) used intermittently and not near the eyes

  • Add ketoconazole (Nizoral) 2% cream applied twice daily if control is not obtained with intermittent topical corticosteroid use

  • Topical tacrolimus (Protopic) 0.03% and 0.1% ointment applied twice daily and pimecrolimus (Elidel) 1% cream applied twice daily are steroid-sparing alternatives

    • Only use when other agents are ineffective

    • Use in a limited area for a brief time

    • Avoid these agents for patients with known immunosuppression, HIV infection, bone marrow and organ transplantation, lymphoma, at high risk for lymphoma, and those with a prior history of lymphoma

Nonhairy/intertriginous areas

  • Hydrocortisone 1% or 2.5% cream, desonide 0.05% cream, or alclometasone dipropionate 0.05% cream applied twice weekly for maintenance

  • Selenium lotion, ketoconazole 2% cream, or clotrimazole 1% gel or cream may be added

  • Tacrolimus or pimecrolimus

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