Seborrheic Dermatitis

Pediatric (Cradle Cap)

6 month old female with no history of immunodeficiency disorders presents with chronic greasy scaling of the scalp. Lesions to not appear to irritate infant. Yellow-brown scaling on well-demarcated erythematous plaques covering scalp on exam.

• Recommend physical removal of plaques and regular hair washing

• Parents advised that condition generally resolves by 1 year of age

Adults (Dandruff)

55 year old male with history of parkinsonism and HIV presents with chronic greasy scaling of the skin. Reports mild, intermittent pruritus in affected regions. Patient has noted dermatitis improvement since starting L-dopa therapy and antiretrovirals. Greasy yellow scales present on scalp, central face, chest, ear canal, and groin.

• Head: Start ketoconazole 2% shampoo

  • Apply twice weekly and leave in place for 5 to 10 minutes before rinsing

  • Continue for 4 weeks and then transition to once weekly use to prevent relapse

• Face/Body

  • Apply ketoconazole 2% cream BID to affected areas x 4 weeks and then stop for 4 weeks before restarting

  • Corticosteroid: Apply BID x 2 weeks and then discontinue for 2 weeks before restarting

    • Face: Hydrocortisone cream 2.5% (Group 7)

    • Body: Triamcinolone acetonide cream 0.1%

• Seborrhea refractory to initial treatment and no history of elevated AST, ALT: Start itraconazole 200 mg qd x 7 days

Notes

• Pathophysiology (suspected): Abnormal immune response to Malassezia yeast

• Epidemiology

  • Most common in children < 1 year and adults > 40 years old

  • Risk factors in adults: Parkinsonism, untreated HIV

• Most commonly occurs in regions with high concentrations of sebaceous glands, e.g. head/face

• Differential in adults includes

  • Common: Psoriasis, rosacea, tinea capitis, tinea corporis, tinea versicolor

  • Less common: Lupus erythematosus, pemphigus foliaceus, secondary syphilis