Dermatitis, Seborrheic

KEY FEATURES

• An acute or chronic 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 0.03% and 0.1% ointment applied twice daily and pimecrolimus 1% cream applied twice daily are steroid-sparing alternatives

  • Only use when other agents are ineffective

  • May be more effective than antifungal therapy

  • 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