Our topic here is
I want you to take a look at
our patient right off the bat.
You’ll notice that, oh my goodness, do
not confuse this with malar rash of SLE.
Do not confuse this with
rhinophyma of rosacea,
or maybe even perhaps acne, but the
patient looks a little bit older.
So, the things that you want to keep in
mind, as soon as you see this picture,
is that, well, could it be rosacea?
Could it be acne vulgaris?
Could it be the malar rash of SLE, right?
Let’s talk about seborrheic
dermatitis, dermatitis, dermatitis.
Why do I repeat that?
Because I don’t want you to get this
confused with seborrheic keratosis.
You’ve heard of seborrheic keratosis
in reference to Leser-Trélat sign.
It has nothing to do with this.
Could I be any more emphatic?
Description for seborrheic dermatitis
by reflex, greasy, yellow scale.
Look at that forehead there.
Doesn’t it look greasy?
Maybe yellowish in terms of scale.
Sure, there is erythema as well.
May involve the nasolabial area.
Give me a condition where the
nasolabial fold was not involved?
Was it SLE?
Or was it rosacea?
SLE is not going to involve
the nasolabial fold.
Because we will talk about
photo type of sensitivity.
So, it may involve the nasolabial
area, eyebrows, scalp and chest.
These are big areas.
So, if you have an infant that is going
to present with seborrheic dermatitis,
may present like dandruff, huh?
It may present like dandruff.
And therefore, we call this a cradle cap
because the involvement in an infant
would be exactly
that on the scalp.
The management here,
creams or washes
or mild topical steroids
tend to be quite effective.
With seborrheic dermatitis,
what’s the etiology?
And here, we have a particular yeast,
and we call this pityrosporum.
Hence, the management
we talked about earlier
could be something like antifungal
or steroid, topical steroid.
Ranges from simple “dandruff,”
especially in that infant that we talked about
cradle cap, which is yellow and greasy.
And with this type of dermatitis,
you have flaking on the scalp.
So therefore, it would
appear as dandruff,
and hopefully, in that infant,
that is as far as it goes.
well, if 80% of your dermatologic
conditions was acne vulgaris,
then all the rest will
comprise the 10% to 15%.
And that’s where we have
Increases with age, the demographics.
The differential diagnoses here:
So here, we’ll take
a look at psoriasis
as being a differential for
Keep in mind that picture.
With psoriasis, when I show you
a picture quite dramatically,
you will see that you’ll
be able to clearly see
that it cannot be
With psoriasis, you’re going to
find this salmon-colored plaque.
And with plaque, obviously,
it’s going to be an elevation
and it’s a flat-like elevation.
Generally, more scale, less waxy.
Where is it if it’s
What is the description that
you give it automatically?
Greasy, yellow, waxy
type of appearance.
With psoriasis, often involves skin
outside of the seborrheic areas.
So, what have we talked
about seborrheic areas?
We talked about the
talked about the scalp, and
maybe perhaps the chest.
At some point in time, we’ll talk
about superficial dermatomycosis.
In other words, the superficial
fungal infections of the skin.
Tinea is a huge deal in the U.S.
You’ve heard of one of the most common,
which includes your, let’s
say, tinea jock itch.
You’ve heard it before.
So, that would be inguinal.
Or underneath the
nail, tinea unguium.
And elsewhere there, we’ll
talk about with tineas.
Here, maybe tinea capitis.
The cap means what you
put on top of your head.
So therefore, this fungal infection
will be taken place off the scalp.
So, how could you rule it out?
Not usually so diffuse in
involvement with tinea capitis.
Pretty much restricted
to the scalp.
Tinea often with bogginess or
significant scalp inflammation,
and keep in mind that when you’re dealing
with such superficial dermatomycosis,
is that we will be investigating
the actual fungi further.
Differential diagnosis with dermatitis:
acute, acute systemic lupus.
Now, with acute systemic lupus,
which I’ll show you a picture of,
tends to involve
the maxillary skin
Spares the actual,
once again where?
The opposite of
I’ve mentioned that
a few times now.
Please don’t miss this
That is a huge clinical pearl.
And what about rosacea?
What’s my triggers?
Stress, spicy food,
maybe sun, maybe wind, maybe
hot temperatures, right?
And if it’s a male, most likely
affecting the nose, rhinophyma.
And you must find
Don’t forget that because it,
actually, is going to be
a point of management, isn’t it?
Usually limited to the central face
with a background of telangiectasia.
These are differential diagnoses
for seborrheic dermatitis.
Isn’t it nice now that just with a few
conditions that we’ve walked through,
in which I’m giving you a
list of differentials,
your knowledge of dermatology is
already increasing by leaps and bounds?
You keep doing this
over and over again,
you’ll be in fantastic shape for
dermatology, and actually, any pathology.