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, although tinea capitis in the adult is rare.
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.
Zisova LG. Malassezia species and seborrheic dermatitis. Folia Med (Plovdiv). Jan-Mar 2009;51(1):23-33. [Medline].
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].
Odom RB. Seborrheic dermatitis in AIDS. J Int Postgrad Med. 1990;2:18-20.
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].
Elish D, Silverberg NB. Infantile seborrheic dermatitis. Cutis. May 2006;77(5):297-300. [Medline].
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].
Prohic A, Kasumagic-Halilovic E. Identification of Malassezia species from immunocompetent and immunocompromised patients with seborrheic dermatitis. Eur Rev Med Pharmacol Science. Dec 2010;14(12):1019-23. [Medline].
Litt JZ, Powlak WA. Drug Eruption Reference Manual. 5th ed. Cleveland, Ohio: Wal-Zac Enterprises; 1966:465.
Brodell EE, Smith E, Brodell RT. Exacerbation of seborrheic dermatitis by topical fluorouracil. Arch Dermatol. Feb 2011;147(2):245-6. [Medline].
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].
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].
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].
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].
Tatlican S, Eren C, Eskioglu F. Insight into pimecrolimus experience in seborrheic dermatitis: close follow-up with exact mean cure and remission times and side-effect profile. J Dermatolog Treat. 2009;20(4):198-202. [Medline].
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].
Ozden MG, Tekin NS, Ilter N, Ankarali H. Topical pimecrolimus 1% cream for resistant seborrheic dermatitis of the face: an open-label study. Am J Clin Dermatol. 2010;11(1):51-4. [Medline].
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].
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].
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].
Schwartz RA, Janusz CA, Janniger CK. Seborrheic dermatitis: an overview. Am Fam Physician. Jul 1 2006;74(1):125-30. [Medline].
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].
Zisova LG. Fluconazole and its place in the treatment of seborrheic dermatitis--new therapeutic possibilities. Folia Med (Plovdiv). 2006;48(1):39-45. [Medline].
Shin H, Kwon OS, Won CH, et al. Clinical efficacies of topical agents for the treatment of seborrheic dermatitis of the scalp: a comparative study. J Dermatol. Mar 2009;36(3):131-7. [Medline].
Kligman AM, Marples RR, Lantis LR, McGinley KJ. Appraisal of efficacy of antidandruff formulations. J Soc Cosmet Chem. 1974;225:73-91.
Schwartz JR, Rocchetta H, Asawanonda P, Luo F, Thomas JH. Does tachyphylaxis occur in long-term management of scalp seborrheic dermatitis with pyrithione zinc-based treatments?. Int J Dermatol. Jan 2009;48(1):79-85. [Medline].
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].
Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. Jul 2008;7(7):699-703. [Medline].
Seite S, Rougier A, Talarico S. Randomized study comparing the efficacy and tolerance of a lipohydroxy acid shampoo to a ciclopiroxolamine shampoo in the treatment of scalp seborrheic dermatitis. J Cosmet Dermatol. Dec 2009;8(4):249-53. [Medline].
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].
Elewski B. An investigator-blind, randomized, 4-week, parallel-group, multicenter pilot study to compare the safety and efficacy of a nonsteroidal cream (Promiseb Topical Cream) and desonide cream 0.05% in the twice-daily treatment of mild to moderate seborrheic dermatitis of the face. Clin Dermatol. Nov-Dec 2009;27(6 Suppl):S48-53. [Medline].
Bikowski J. Facial seborrheic dermatitis: a report on current status and therapeutic horizons. J Drugs Dermatol. Feb 2009;8(2):125-33. [Medline].

