eMedicine Specialties > Dermatology > Papulosquamous Diseases

Seborrheic Dermatitis: Differential Diagnoses & Workup

Author: Samuel Selden, MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School
Contributor Information and Disclosures

Updated: Mar 10, 2009

Differential Diagnoses

Asteatotic Eczema
Lichen Simplex Chronicus
Atopic Dermatitis
Lupus Erythematosus, Acute
Candidiasis, Cutaneous
Nummular Dermatitis
Contact Dermatitis, Allergic
Pemphigus Erythematosus
Contact Dermatitis, Irritant
Pemphigus Foliaceus
Dermatologic Manifestations of Gastrointestinal Disease
Perioral Dermatitis
Dermatomyositis
Pityriasis Rosea
Drug Eruptions
Rosacea
Drug-Induced Photosensitivity
Tinea Capitis
Erythrasma
Tinea Corporis
Extramammary Paget Disease
Tinea Cruris
Glucagonoma Syndrome
Tinea Versicolor
Impetigo
Intertrigo

Other Problems to Be Considered

Xerotic eczema
Chronic granulomatous disease
Exfoliative erythroderma
Facial chapping
Infectious eczematoid dermatitis
Letterer-Siwe disease
Scaling drug eruptions
Sebopsoriasis
Staphylococcal blepharitis
Tinea amiantacea
Tinea versicolor6
Vitamin B and/or zinc deficiency

Workup

Laboratory Studies

A clinical diagnosis of seborrheic dermatitis is usually made based on a history of waxing and waning severity and by the distribution of involvement upon examination.

Procedures

A skin biopsy may be needed in persons with exfoliative erythroderma, and a fungal culture can be used to rule out tinea capitis.

Histologic Findings

Dermatopathologic findings of seborrheic dermatitis are nonspecific. Hyperkeratosis, acanthosis, accentuated rete ridges, focal spongiosis, and parakeratosis are characteristic. Psoriasis is distinguished by regular acanthosis, thinned rete ridges, exocytosis, parakeratosis, and an absence of spongiosis. Neutrophils may be seen in both diseases.

More on Seborrheic Dermatitis

Overview: Seborrheic Dermatitis
Differential Diagnoses & Workup: Seborrheic Dermatitis
Treatment & Medication: Seborrheic Dermatitis
Follow-up: Seborrheic Dermatitis
Multimedia: Seborrheic Dermatitis
References

References

  1. Groisser D, Bottone EJ, Lebwohl M. Association of Pityrosporum orbiculare (Malassezia furfur) with seborrheic dermatitis in patients with acquired immunodeficiency syndrome (AIDS). J Am Acad Dermatol. May 1989;20(5 Pt 1):770-3. [Medline].

  2. Odom RB. Seborrheic dermatitis in AIDS. J Int Postgrad Med. 1990;2:18-20.

  3. Belew PW, Rosenberg EW, Jennings BR. Activation of the alternative pathway of complement by Malassezia ovalis (Pityrosporum ovale). Mycopathologia. Mar 31 1980;70(3):187-91. [Medline].

  4. Elish D, Silverberg NB. Infantile seborrheic dermatitis. Cutis. May 2006;77(5):297-300. [Medline].

  5. Tajima M, Sugita T, Nishikawa A, Tsuboi R. Molecular analysis of Malassezia microflora in seborrheic dermatitis patients: comparison with other diseases and healthy subjects. J Invest Dermatol. Feb 2008;128(2):345-51. [Medline].

  6. Pontasch MJ, Kyanko ME, Brodell RT. Tinea versicolor of the face in black children in a temperate region. Cutis. Jan 1989;43(1):81-4. [Medline].

  7. Ford GP, Farr PM, Ive FA, Shuster S. The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol. Nov 1984;111(5):603-7. [Medline].

  8. Green CA, Farr PM, Shuster S. Treatment of seborrhoeic dermatitis with ketoconazole: II. Response of seborrhoeic dermatitis of the face, scalp and trunk to topical ketoconazole. Br J Dermatol. Feb 1987;116(2):217-21. [Medline].

  9. Skinner RB Jr, Noah PW, Taylor RM, et al. Double-blind treatment of seborrheic dermatitis with 2% ketoconazole cream. J Am Acad Dermatol. May 1985;12(5 Pt 1):852-6. [Medline].

  10. Cunha PR. Pimecrolimus cream 1% is effective in seborrhoeic dermatitis refractory to treatment with topical corticosteroids. Acta Derm Venereol. 2006;86(1):69-70. [Medline].

  11. Firooz A, Solhpour A, Gorouhi F, et al. Pimecrolimus cream, 1%, vs hydrocortisone acetate cream, 1%, in the treatment of facial seborrheic dermatitis: a randomized, investigator-blind, clinical trial. Arch Dermatol. Aug 2006;142(8):1066-7. [Medline].

  12. High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. Jun 2006;54(6):1083-8. [Medline].

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  14. Cook BA, Warshaw EM. Role of topical calcineurin inhibitors in the treatment of seborrheic dermatitis: a review of pathophysiology, safety, and efficacy. Am J Clin Dermatol. 2009;10(2):103-18. [Medline].

  15. Zisova LG. Fluconazole and its place in the treatment of seborrheic dermatitis--new therapeutic possibilities. Folia Med (Plovdiv). 2006;48(1):39-45. [Medline].

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  17. Carr MM, Pryce DM, Ive FA. Treatment of seborrhoeic dermatitis with ketoconazole: I. Response of seborrhoeic dermatitis of the scalp to topical ketoconazole. Br J Dermatol. Feb 1987;116(2):213-6. [Medline].

  18. Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. Jul 2008;7(7):699-703. [Medline].

  19. Siadat AH, Iraji F, Shahmoradi Z, Enshaieh S, Taheri A. The efficacy of 1% metronidazole gel in facial seborrheic dermatitis: a double blind study. Indian J Dermatol Venereol Leprol. Jul-Aug 2006;72(4):266-9. [Medline].

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  21. Jacobs PH. Seborrheic dermatitis: causes and management. Cutis. 1988;41:182-6.

  22. Leyden JJ. Overview: Pityrosporum and scaling disorders of the scalp. J Int Postgrad Med. 1990;2:5-9.

  23. Leyden JJ, Kligman AM. Dandruff: cause and treatment. Cosmet Toilet. 1979;94:23-28.

  24. Leyden JJ, McGinley KJ, Kligman AM. Role of microorganisms in dandruff. Arch Dermatol. Mar 1976;112(3):333-8. [Medline].

  25. Litt JZ, Powlak WA. Drug Eruption Reference Manual. 5th ed. Cleveland, Ohio: Wal-Zac Enterprises; 1966:465.

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Further Reading

Keywords

seborrheic dermatitis, seborrhea, seborrheic blepharitis, dandruff, Pityrosporum ovale , P ovale, Malassezia, Malassezia ovalis, M ovalis, psoriasis, cradle cap, infantile napkin dermatitis, diaper dermatitis, fungal infection, drug-induced dermatitis, drug-induced seborrhea

Contributor Information and Disclosures

Author

Samuel Selden, MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School
Samuel Selden, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Astellas Pharma US, Inc. Honoraria Consulting; Galderma Laboratories, L.P. Honoraria Review panel membership

Medical Editor

Robin Travers, MD, Assistant Professor of Medicine (Dermatology), Dartmouth University School of Medicine; Staff Dermatologist, New England Baptist Hospital; Private Practice, SkinCare Physicians
Robin Travers, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Informatics Association, Massachusetts Medical Society, Medical Dermatology Society, and Women's Dermatologic Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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