Fast Five Quiz: Common Skin Conditions

William James, MD

Disclosures

May 20, 2019

Antifungal therapies are first-line therapies for seborrheic dermatitis. Ketoconazole, naftifine, or ciclopirox creams are effective therapies. Alternatives include calcineurin inhibitors (ie, pimecrolimus, tacrolimus), sulfur and sulfonamide combinations, and selenium sulfide. Early treatment of flares is encouraged. Behavior modification techniques in reducing excoriations are especially helpful with scalp involvement. Low-potency topical corticosteroids, such as hydrocortisone, desonide, and hydrocortisone valerate, have shown to be efficacious on the face. Topical steroids have been associated with the development of telangiectasias and thinning of the skin. Class IV or lower corticosteroid creams, lotions, or solutions can be used for acute flares. Tea tree oil has been reported to benefit the condition. Systemic fluconazole may help if seborrheic dermatitis is severe or unresponsive. Combination therapy has been recommended.

The usual onset of seborrheic dermatitis occurs with puberty. It peaks at age 40 years and is less severe, but present, among older populations. In infants, it occurs as cradle cap or, rarely, as a flexural eruption or erythroderma.

Intermittent, active phases of seborrheic dermatitis manifest with burning, scaling, and itching, alternating with inactive periods. Activity is increased in winter and early spring, with remissions commonly occurring in summer. Active phases of seborrheic dermatitis may be complicated by secondary infection in the intertriginous areas and on the eyelids.

Chronic seborrheic dermatitis may appear similar to psoriasis, but psoriasis is distinguished by regular acanthosis, thinned rete ridges, exocytosis, parakeratosis, and an absence of spongiosis. Neutrophils may be seen in both diseases.

Read more about seborrheic dermatitis.

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