Definition
A.Chronic inflammatory superficial disease that mainly affects body oil baring surfaces such as scalp, brows, nasolabial folds, ears, chest, and groin.
Incidence
A.3% to 5% of general population.
B.40% to 80% of HIV population.
Pathogenesis
A.Caused by Malassezia furfur, lipophilic yeast that can overgrow in oily areas of the body.
Predisposing Factors
A.Stress.
B.Neurological disease (Parkinson’s disease, stroke).
C.Rosacea or other oily skin.
D.Hormonal imbalance (diabetes, polycystic ovarian syndrome [PCOS]).
E.Immunosuppression (HIV common in diffuse and treatment-resistant forms).
Subjective Data
A.Common complaints/symptoms.
1.Itch.
2.Scale/flakes.
3.Greasy hair.
B.Common/typical scenario.
1.Chronic itchy flaky scalp for years.
2.Better with more frequent hair washing.
3.Worse in summer.
C.Family and social history.
1.Typically negative.
2.May have other family members with seborrheic dermatitis.
D.Review of systems.
1.Typically negative.
Physical Examination
A.Yellow greasy scale on erythematous plaques; can be annular or polycyclic.
B.Mostly found on scalp (see Figure 15.3), brows, nasolabial folds, nasal alae, conchal bowls, and postauricular, sometimes on neck, chest, axillae, or groin folds.
Diagnostic Tests
A.KOH preparation should demonstrate hyphae.
B.Fungal culture—especially if suspicion for tinea is in differential diagnosis.
C.Skin biopsy—helpful for odd presentations that overlap with other dermatoses.
Differential Diagnosis
A.Tinea (capitis, corporis, cruris, versicolor).
B.Pityriasis rosacea.
C.Psoriasis.
D.Contact dermatitis.
E.Drug eruption.
F.Lupus erythematous.
Evaluation and Management Plan
A.General plan.
1.Decrease oils on scalp and other affected areas.
2.Decrease scale and itch.
B.Patient/family teaching points: Wash scalp more frequently, focus on scalp more than hair.
C.Pharmacotherapy.
1.Topical antifungals.
a.For face and body.
i.Ketoconazole 2% cream once daily to affected areas for 2 weeks.
ii.Ciclopirox 0.77% cream twice daily to affected areas for 2 to 4 weeks.
b.For scalp.
i.Ketoconazole 1% to 2% shampoo twice weekly; leave on damp scalp for 5 minutes, then rinse; repeat for 4 to 8 weeks.
ii.Ciclopirox 1% shampoo twice weekly; leave on scalp damp for 5 minutes, then rinse; repeat for 2 to 4 weeks.
iii.Selenium sulfide 1% to 2.5% shampoo or lotion twice weekly; leave on damp scalp for 5 minutes, then rinse; repeat for 2 to 4 weeks.
2.Topical steroids for itch and irritation only.
a.For face: Hydrocortisone 1% to 2.5% cream twice daily for 5 days.
b.For scalp: Mometasone 0.1% solution nightly on affected areas of scalp after showers for 3 weeks.
D.Discharge instructions.
FIGURE 15.3 Seborrheic dermatitis.
Source: Lyons, F., & Ousley, L. (2015). Dermatology for the advanced practice nurse. New York, NY: Springer Publishing Company.
1.Discuss risks of prolonged topical steroid use: Atrophy of skin, hypopigmentation of skin, risk for glaucoma if use is near eyes or hands are not washed after use.
2.May take a few weeks to improve.
Follow-Up
A.Dermatology in next 1 to 3 months.
Consultation/Referral
A.If persists or worsens, consult/refer to dermatology.
Special/Geriatric Considerations
A.Nursing home patients may have a hard time adhering to washing regimen.
Bibliography
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2013). Primary care—E-book (4th ed.). St. Louis, MO: Elsevier.
Fitzpatrick, J., & Morelli, J. (2011). Dermatology secrets plus (4th ed.). Philadelphia, PA: Elsevier.
Habif, T. (2011). Skin disease. Edinburgh, Scotland: Saunders/Elsevier.
Lyons, F., & Ousley, L. (2015). Dermatology for the advanced practice nurse. New York, NY: Springer Publishing Company.
Mameri, A., Carneiro, S., Mameri, L., Telles da Cunha, J., & Ramos-E-Silva, M. (2017). History of seborrheic dermatitis: Conceptual and clinico-pathologic evolution. Skinmed, 15(3), 187–194.
Yalçin, B., Tamer, E., Toy, G. G., Oztaş, P., Hayran, M., & Alli, N. (2006). The prevalence of skin diseases in the elderly: Analysis of 4099 geriatric patients. International Journal of Dermatology, 45(6), 672–676. doi:10.1111/j.1365-4632.2005.02607.x