Seborrheic Dermatitis

Seborrheic dermatitis is a common chronic, relapsing skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disorder that presents as erythematous plaques with greasy, yellow scales in susceptible areas (scalp, face, and trunk). Seborrheic dermatitis has a biphasic incidence, occurring in two peaks: first in infants, then in adolescence and early adulthood. Although the exact etiology is unknown, pathologic mechanisms have been observed involving the sebaceous glands and Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi on the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin. Topical medications are used for acute exacerbation or maintenance treatment. These options aim to inhibit skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin colonization (antifungal agents), reduce inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation (steroids, calcineurin inhibitors), and loosen scales and crusts (keratolytic agents). Severe and refractory seborrheic dermatitis may warrant the use of systemic antifungal medications.

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Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

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Epidemiology and Etiology

Seborrheic dermatitis is a common chronic skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disorder that is characterized by erythematous patches with greasy, yellowish scales that most often appear in areas with prominent sebaceous glands (scalp, face, upper trunk, and anogenital area).

Epidemiology

  • Prevalence: 3% of the general population
  • More common in men
  • Bimodal distribution: occurs in two peaks (first in infancy, then in adolescence and early adulthood)
  • Up to 70% of infants < 3 months of age are affected but improvement noted by 1 year
  • In adults, the disease peaks between the 3rd and 4th decades.

Etiology

Unclear, but may be affected by  the following:

  • Skin colonization of Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi and its interaction with lipids on skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin surface
  • Individual susceptibility: 
    • Increased sebaceous gland activity (seborrhea)
    • Stress
  • Immunodeficiency:
    • HIV infection
      • Seborrheic dermatitis affects up to 85% of patients with AIDS.
      • Severe seborrheic dermatitis in patients with low CD4 counts
    • Lymphoma
    • Renal transplantation
  • Neuropsychiatric conditions:
    • Parkinson’s disease 
      • Increased sebum production
      • Improvement of seborrheic dermatitis with use of levodopa
    • Alzheimer’s dementia, depression
  • Alcoholism
  • Climate changes (worse in cold temperatures, some improve with sun exposure)
  • Medications: lithium, haloperidol, chlorpromazine, immunosuppressants Immunosuppressants Immunosuppressants are a class of drugs widely used in the management of autoimmune conditions and organ transplant rejection. The general effect is dampening of the immune response. Immunosuppressants, psoralen, dopamine antagonists

Pathophysiology

  • The exact pathophysiologic mechanism remains unknown.
  • Findings involve sebaceous glands and Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi colonization. Association is strongly suggested because antifungal agents decrease Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi organisms and effectively treat the disease.
  • Seborrheic dermatitis is found in areas with abundant sebaceous glands.
  • Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi (lipophilic yeast) on the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin interacts with sebum. Yeast produce lipases and phosphatases which cleave fatty acids from sebum → release inflammatory free fatty acids → aberrant keratinocyte production →  abnormal stratum corneum  → inflammatory response stimulated → skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin eruption
  • Other factors include oxidative stress and cell-damaging oxygen radicals.

Clinical Presentation

General features

  • Pruritic, erythematous papules and plaques
  • Easily detachable greasy scales and yellow crusts
  • Remits and relapses

Seborrheic dermatitis in infants

  • Affected areas:
    • Head: 
      • Scalp (“cradle cap”)
      • Eyebrows, eyelids, nasolabial and retroauricular folds, and neck
    • Trunk: umbilicus and intertriginous areas (opposite of atopic dermatitis Atopic Dermatitis Atopic dermatitis, also known as eczema, is a chronic, relapsing, pruritic, inflammatory skin disease that occurs more frequently in children, although adults can also be affected. The condition is often associated with elevated serum levels of IgE and a personal or family history of atopy. Skin dryness, erythema, oozing, crusting, and lichenification are present. Atopic Dermatitis (Eczema), which spares the intertriginous areas)
  • Leiner disease:
    • Rare disease associated with complement (C5) deficiency
    • Generalized severe seborrheic dermatitis
    • Also with diarrhea Diarrhea Diarrhea is defined as ≥ 3 watery or loose stools in a 24-hour period. There are a multitude of etiologies, which can be classified based on the underlying mechanism of disease. The duration of symptoms (acute or chronic) and characteristics of the stools (e.g., watery, bloody, steatorrheic, mucoid) can help guide further diagnostic evaluation. Diarrhea and/or vomiting, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview, or failure to thrive Failure to Thrive Failure to thrive (FTT), or faltering growth, describes suboptimal weight gain and growth in children. The majority of cases are due to inadequate caloric intake; however, genetic, infectious, and oncological etiologies are also common. Failure to Thrive

Seborrheic dermatitis in adults

  • Affected areas:
    • Scalp: dandruff/pityriasis sicca; fine, white, flaking scales on the scalp
    • Face:
      • Eyebrows, glabella, eyelids, sides of the nose Nose The nose is the human body's primary organ of smell and functions as part of the upper respiratory system. The nose may be best known for inhaling oxygen and exhaling carbon dioxide, but it also contributes to other important functions, such as tasting. The anatomy of the nose can be divided into the external nose and the nasal cavity. Anatomy of the Nose, nasolabial folds (opposite of lupus, which spares the nasolabial folds)
      • Mustache and beard areas; improves with shaving
    • Trunk:
      • Intertriginous areas ( axilla Axilla The axilla is a pyramid-shaped space located between the upper thorax and the arm. The axilla has a base, an apex, and 4 walls (anterior, medial, lateral, posterior). The base of the pyramid is made up of the axillary skin. The apex is the axillary inlet, located between the 1st rib, superior border of the scapula, and clavicle. Axilla and Brachial Plexus, inframammary folds, anogenital region) 
      • Upper chest and back

Seborrheic dermatitis in patients with HIV

  • In patients with CD4 counts < 400 cells/microL, lesions may be widespread and difficult to control.
  • Seborrheic dermatitis can be the initial clinical cutaneous marker for HIV/AIDS (sudden severe onset, atypical distribution of lesions or treatment resistance)
  • May improve with antiretroviral therapy Antiretroviral therapy Antiretroviral therapy (ART) targets the replication cycle of the human immunodeficiency virus (HIV) and is classified based on the viral enzyme or mechanism that is inhibited. The goal of therapy is to suppress viral replication to reach the outcome of undetected viral load. Anti-HIV Drugs

Diagnosis

  • Diagnosis is based on clinical findings.
  • Biopsy can be used if the diagnosis is uncertain. Findings on biopsy:
    • Superficial perivascular inflammatory infiltrate (neutrophils, lymphocytes Lymphocytes Lymphocytes are heterogeneous WBCs involved in immune response. Lymphocytes develop from the bone marrow, starting from hematopoietic stem cells (HSCs) and progressing to common lymphoid progenitors (CLPs). B and T lymphocytes and natural killer (NK) cells arise from the lineage. Lymphocytes)
    • Psoriasiform hyperplasia
    • Parakeratosis (retention of nuclei in the stratum corneum)
    • Focal spongiosis
    • Yeast species in the stratum corneum
  • In HIV: more parakeratosis, increased inflammatory infiltrate, and less spongiosis

Management

General approach

  • Avoid cold temperatures
  • Discontinue medications that can trigger flares
  • Treat associated comorbidities

Medical therapy

  • Topical agents containing:
    • Selenium sulfide: has antifungal properties
    • Tar: decreases inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation and has antifungal properties
    • Sulfur: keratolytic and has antifungal properties
    • Salicylic acid: keratolytic; softens thick scales
    • Zinc pyrithione: has fungistatic and antibacterial properties
  • Antifungals:
    • Topical: ketoconazole, naftifine, ciclopirox
    • Systemic ketoconazole, fluconazole, or itraconazole if refractory or with extensive disease 
  • Topical steroids:
    • Only used for acute flares
    • Long-term use not recommended due to dermal atrophy and increased risk of recurrence and dependence
  • Calcineurin inhibitors (tacrolimus, pimecrolimus) used as steroid alternatives, especially for delicate areas (e.g., face).
    • Suppress cytokine production
    • Do not have adverse effects of steroids

Differential Diagnosis

Differential diagnoses of seborrheic dermatitis include the following conditions:

  • Atopic dermatitis: chronic, relapsing, inflammatory skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disease that often precedes asthma Asthma Asthma is a chronic inflammatory respiratory condition characterized by bronchial hyperresponsiveness and airflow obstruction. The disease is believed to result from the complex interaction of host and environmental factors that increase disease predisposition, with inflammation causing symptoms and structural changes. Patients typically present with wheezing, cough, and dyspnea. Asthma and other allergic disorders. The main features of this skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin condition are intense pruritus and eczematous skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lesions.
  • Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis: a chronic, recurrent, relapsing skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin disorder characterized by inflammation Inflammation Inflammation is a complex set of responses to infection and injury involving leukocytes as the principal cellular mediators in the body's defense against pathogenic organisms. Inflammation is also seen as a response to tissue injury in the process of wound healing. The 5 cardinal signs of inflammation are pain, heat, redness, swelling, and loss of function. Inflammation and hyperproliferation of skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin cells of the epidermis. Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis presents with salmon-colored plaques with overlying silvery scales, which is why this disease is also called plaque psoriasis.
  • Impetigo Impetigo Impetigo is a highly contagious superficial bacterial infection typically caused by Staphylococcus aureus (most common) and Streptococcus pyogenes. Impetigo most commonly presents in children aged 2 to 5 years with lesions that evolve from papules to vesicles to pustules, which eventually break down to form characteristic "honey-colored" crusts. Impetigo: an infectious condition characterized by bacterial infection of the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin. Impetigo Impetigo Impetigo is a highly contagious superficial bacterial infection typically caused by Staphylococcus aureus (most common) and Streptococcus pyogenes. Impetigo most commonly presents in children aged 2 to 5 years with lesions that evolve from papules to vesicles to pustules, which eventually break down to form characteristic "honey-colored" crusts. Impetigo can present with bullous or nonbullous lesions. The crusts in nonbullous impetigo are honey-colored and located on the face and upper or lower extremities. Bullous impetigo, as the name implies, involves the formation of bullous skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin eruptions.
  • Tinea versicolor: Malassezia Malassezia Malassezia is a lipophilic yeast commonly found on the skin surfaces of many animals, including humans. In the presence of certain environments or triggers, this fungus can cause pathologic diseases ranging from superficial skin conditions (tinea versicolor and dermatitis) to invasive disease (e.g., Malassezia folliculitis, catheter-associated fungemia, meningitis, and urinary tract infections). Malassezia Fungi furfur is the causative pathogen for this superficial infection of the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin, which presents with hypopigmentation or hyperpigmentation of the infected area.
  • Tinea capitis: infection of the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin caused by the dermatophyte fungi Fungi Fungi belong to the eukaryote domain and, like plants, have cell walls and vacuoles, exhibit cytoplasmic streaming, and are immobile. Almost all fungi, however, have cell walls composed of chitin and not cellulose. Fungi do not carry out photosynthesis but obtain their substrates for metabolism as saprophytes (obtain their food from dead matter). Mycosis is an infection caused by fungi. Mycology: Overview. There are 3 types of dermatophytes Dermatophytes Tinea infections are a group of diseases caused by fungi infecting keratinized tissue (hair, nails, and skin). These infections are termed dermatomycoses and are caused by the dermatophyte fungi. There are approximately 40 dermatophyte fungi that are part of 3 genera, including Trichophyton, Epidermophyton, and Microsporum. These infections can affect any part of the body but occur most often in warm, moist regions like the groin and the feet. Dermatophytes/Tinea Infections: trichophyton, epidermophyton, and microsporum. 
  • Pityriasis rosea Pityriasis rosea Pityriasis rosea is an acute, self-limited skin disease. The etiology is not known, and it commonly occurs in young adults. Patients initially present with a single, ovoid "herald patch." This is followed by diffuse, pruritic, scaly, oval lesions over the trunk (often in a "Christmas tree" distribution on the back) and extremities. Pityriasis Rosea: a common skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin eruption that is characterized by a single skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin patch that usually evolves into a widespread exanthem after 1 week. The condition typically lasts 6 weeks and is self-limited, with an excellent prognosis. 
  • Candidiasis Candidiasis Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis). Candida/Candidiasis: an opportunistic fungal infection that can affect the gastrointestinal tract or skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin, or be systemic in immunocompromised patients. Clinical presentation varies and is dependent on the severity of immunosuppression and the anatomical site affected. 
  • Pemphigus vulgaris: a chronic, autoimmune, intraepithelial disease characterized by blister formation involving the skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin and mucous membranes. Caused by autoantibodies, which are directed against target antigens present on the cell surface of keratinocytes.
  • Secondary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis: untreated primary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis becomes secondary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis. Patients present with a generalized non-pruritic maculopapular rash, generally on the palms and soles, along with pustular lesions. Various skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin lesions include condylomata lata and white plaques.
  • Scabies Scabies Scabies is an infestation of the skin by the Sarcoptes scabiei mite, which presents most commonly with intense pruritus, characteristic linear burrows, and erythematous papules, particularly in the interdigital folds and the flexor aspects of the wrists. Scabies: highly contagious skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Structure and Function of the Skin infection caused by Sarcoptes scabiei mites that are transmitted via direct physical contact. Scabies Scabies Scabies is an infestation of the skin by the Sarcoptes scabiei mite, which presents most commonly with intense pruritus, characteristic linear burrows, and erythematous papules, particularly in the interdigital folds and the flexor aspects of the wrists. Scabies causes erythematous, pruritic papules, scattered vesicles, and thin, curvilinear burrow tracks.
Site Differential diagnosis
Scalp Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, dandruff, atopic dermatitis Atopic Dermatitis Atopic dermatitis, also known as eczema, is a chronic, relapsing, pruritic, inflammatory skin disease that occurs more frequently in children, although adults can also be affected. The condition is often associated with elevated serum levels of IgE and a personal or family history of atopy. Skin dryness, erythema, oozing, crusting, and lichenification are present. Atopic Dermatitis (Eczema), tinea capitis
Face Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, impetigo, contact dermatitis
Ear canal Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, contact dermatitis
Eyelids Atopic dermatitis, demodex folliculorum infestation
Chest and trunk Pityriasis rosea Pityriasis rosea Pityriasis rosea is an acute, self-limited skin disease. The etiology is not known, and it commonly occurs in young adults. Patients initially present with a single, ovoid "herald patch." This is followed by diffuse, pruritic, scaly, oval lesions over the trunk (often in a "Christmas tree" distribution on the back) and extremities. Pityriasis Rosea, tinea versicolor
Intertriginous areas Psoriasis Psoriasis Psoriasis is a common T-cell-mediated inflammatory skin condition. The etiology is unknown, but is thought to be due to genetic inheritance and environmental triggers. There are 4 major subtypes, with the most common form being chronic plaque psoriasis. Psoriasis, candidiasis
All sites, rule out Secondary syphilis Syphilis Syphilis is a bacterial infection caused by the spirochete Treponema pallidum pallidum (T. p. pallidum), which is usually spread through sexual contact. Syphilis has 4 clinical stages: primary, secondary, latent, and tertiary. Syphilis, pemphigus, scabies

References

  1. Berk, T.; Scheinfeld, N. (2010). Seborrheic dermatitis. P T., 35(6), 348–352. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888552/
  2. Borda, L.; Wikramanayake, T. (2015). Seborrheic dermatitis and dandruff: a comprehensive review. J Clin Investig Dermatol, 3(2), 10.13188/2373–1044.1000019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852869/
  3. Clark, G.; Pope, S.; Jaboori, K. (2015). Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician, 91(3), 185–190. https://www.aafp.org/afp/2015/0201/p185.html
  4. Johnson, B.; Nunley, J. (2000). Treatment of seborrheic dermatitis. Am Fam Physician, 61(9), 2703–2710.
  5. Sasseville, D.; Fowler, J. & Corona, R. (Eds.). (2020). Seborrheic dermatitis in adolescents and adults. UpToDate. Retrieved 25 Aug 2020, from https://www.uptodate.com/contents/seborrheic-dermatitis-in-adolescents-and-adults
  6. Scheinfeld, N. (n.d.). Seborrheic dermatitis. Medscape. Retrieved 26 Aug 2020, from https://www.medscape.com/viewarticle/499706
  7. Tucker, D.; Masood, S. (2020). Seborrheic dermatitis. https://www.ncbi.nlm.nih.gov/books/NBK551707/

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