Clinical Reference / Therapeutic Strategies / Seborrheic Dermatitis

Seborrheic Dermatitis


Key Points

  • Seborrheic dermatitis is a chronic intermittent rash typically affecting the face, ears, scalp, and trunk.
  • It is marked by an erythematous papular or macular eruption often with greasy yellow scale, sometimes accompanied by pruritus.
  • This condition is believed to result from seborrhea and from an inflammatory response to the commensal skin organism, Malassezia fungi.
  • Thus, the mainstay of treatment includes topical anti-fungal agents alone or in combination with topical steroids.
  • Seborrheic dermatitis can be severe in immunocompromised individuals or persons with neurologic disease.

Clinical overview

Seborrheic dermatitis is a chronic intermittent rash affecting areas rich in sebaceous glands, and is marked by an erythematous papular or macular eruption often with greasy yellow scale, sometimes accompanied by pruritus. It can be limited to the scalp (a.k.a. dandruff), but it also can involve the face, the external auditory canal, any hairy or intertriginous area such as the chest or genitalia, and in rare cases can progress to a generalized erythroderma. On the face, it classically affects the nasolabial folds, eyebrows, glabella, and beard area; blepharoconjunctivitis may also occur. The mainstay of treatment includes anti-fungal agents alone or in combination with topical steroids.

Seborrheic dermatitis can be severe in patients with HIV (especially in persons with CD4 count below 400) and persons with neurologic disease. It may be exacerbated by stress, and patients sometimes report improvement with sun exposure. Seborrheic dermatitis frequently coexists or is overlapping with other skin diseases such as rosacea or psoriasis (sebopsoriasis).

In children, seborrheic dermatitis can present as “cradle cap” (frontal and parietal scalp regions and/or external auditory canal involvement only) or in conjunction with similar eruptions on the face, neck, chest and diaper area. On the face, the nasolabial folds, medial cheeks, glabella, eyebrows, and forehead are typical affected areas – similar to disease seen in adults.

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