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Updated: Jun 27 2018

Seborrheic Dermatitis

  • Snapshot
    • A 1-week-old infant is brought to his pediatrician for a skin concern. His mom complains of a strange, scaly rash on his scalp. No matter how much she washes it, the flakes come back. She wants to know what she can do about it.
  • Introduction
    • Common, chronic, inflammatory skin disease
      • associated with Malassezia furfur (formerly Pityrosporum ovale)
    • Involves scalp and eyebrows
      • aka dandruff (adults), cradle cap (infants)
    • More severe in
      • patients with neurologic disease (traumatic brain injury, Parkinson’s disease, stroke)
      • HIV patients
  • Presentation
    • Symptoms
      • dandruff” in hair and face
      • burning, itchy, scaling
    • Physical exam
      • scaly, greasy, flaky (dandruff) skin on scalp margins and face
      • can be erythematous
  • 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 infections
    • Acne rosacea
  • Treatment
    • Medical management
      • low-potency topical steroids (e.g., hydrocortisone)
      • topical antifungals
      • selenium or zinc pyrithione or tar shampoo
  • 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 hygiene
    • Complications
      • can become secondarily infected with bacterial, fungal, or viral agents
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