Skip to content

Content

Home
Patient case
Patient Case: Seborrheic dermatitis

Patient Case: Seborrheic dermatitis

Discussion

A 30-year-old office worker presents with a six-month history of a recurrent, itchy rash affecting his scalp, eyebrows, and sides of the nose. He describes the rash as flaky and sometimes greasy, with occasional redness and mild burning. The symptoms worsen during periods of stress and cold weather. Over-the-counter dandruff shampoos provide only temporary relief.

He has no significant history of allergies or chronic skin conditions. There is no history of recent illness, but he mentions that his skin tends to be oily.

On examination, there are yellowish, greasy scales and mild erythema on the scalp, eyebrows, and nasolabial folds. No pustules or deep cracks are observed. A clinical diagnosis of seborrheic dermatitis is made.

He is advised to use an antifungal shampoo containing ketoconazole or sulphur schampoo and a mild topical steroid for flare-ups. He is also counseled on stress management and regular washing with gentle cleansers to help control symptoms.

Questions
1. What is the most likely diagnosis in this patient?

a) Psoriasis
b) Seborrheic dermatitis
c) Contact dermatitis
d) Atopic dermatitis

2. Which of the following best describes the characteristic appearance of seborrheic dermatitis?

a) Thick, silvery plaques on the extensor surfaces
b) Vesicular rash with clear fluid-filled blisters
c) Yellow, greasy scales with mild erythema in oily areas
d) Dry, scaly patches in the flexural folds with intense itching

3. What is the most appropriate initial treatment for this condition?

a) Antifungal or sulphur shampoo and mild topical corticosteroids
b) Oral antibiotics and antihistamines
c) Long-term systemic corticosteroids
d) Moisturizers and avoidance of all hair products

4. Which of the following factors is known to worsen seborrheic dermatitis?

a) Frequent scalp washing with antifungal shampoo
b) Stress and cold weather
c) A diet rich in omega-3 fatty acids
d) Regular application of lightweight, non-comedogenic moisturizers

Reveal answers

Answers

  1. (b) Seborrheic dermatitis
    • The presence of yellow, greasy scales with mild erythema in seborrheic (oily) areas like the scalp, eyebrows, and nasolabial folds strongly suggests seborrheic dermatitis. Psoriasis (a) usually presents with silvery plaques, contact dermatitis (c) is linked to irritant exposure, and atopic dermatitis (d) typically affects flexural areas with a history of atopy.
  2. (c) Yellow, greasy scales with mild erythema in oily areas
    • Seborrheic dermatitis is characterized by scaly, greasy lesions in areas rich in sebaceous glands, such as the scalp, eyebrows, and nasolabial folds. Silvery plaques (a) suggest psoriasis, vesicular blisters (b) are seen in allergic or irritant contact dermatitis, and dry, scaly patches in flexural areas (d) are more typical of atopic dermatitis.
  3. (a) Antifungal shampoo and mild topical corticosteroids
    • Ketoconazole-containing antifungal shampoos help reduce Malassezia yeast, a key factor in seborrheic dermatitis, while mild topical corticosteroids help control inflammation. Oral antibiotics (b) are not necessary, systemic corticosteroids (c) are too aggressive for this condition, and complete avoidance of hair products (d) is not required—only irritants should be minimized.
  4. (b) Stress and cold weather
    • Stress and cold weather are common triggers for seborrheic dermatitis, leading to flare-ups. Regular scalp washing with antifungal shampoo (a) helps reduce symptoms, omega-3 fatty acids (c) may have anti-inflammatory effects but do not directly trigger the condition, and using non-comedogenic moisturizers (d) can help manage irritation without worsening symptoms.

Are you a Medical Doctor?

Yes, I'm a Doctor
No, I'm not