Seborrhea

A 27-year-old woman asks about slightly itchy and scaly “white spots” on her face. She has rather severe dandruff, which requires shampooing every other day for control.

Key point: Seborrhea usually presents as a scaling erythema on the face, behind the ears, in the scalp, and occasionally on the body. However, the morphology in this patient is a rather distinct appearance of seborrhea on skin of color. Involvement of the face may or may not be concurrent with scalp involvement.

Treatment: Use of an antifungal azole cream, particularly ketoconazole, is the first therapeutic option. Low-potency corticosteroid preparations may also be useful. If scalp disease is present, control via ketoconazole, selenium sulfide, or low-potency corticosteroid-containing shampoos is indicated.

Note: A potassium hydroxide preparation of the scale is a good idea, since tinea versicolor can exactly mimic seborrhea on the face, especially in African American patients.