A red rash on the face

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A red rash on the face

J Fam Pract. 2003 September;52(9):697-699

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References

1. Danby FW, Maddin WS, Margesson LJ, Rosenthal D. A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff. J Am Acad Dermatol 1993;29:1008-1012.

2. Peter RU, Richarz-Barthauer U. Successful treatment and prophylaxis of scalp seborrhoeic dermatitis and dandruff with 2% ketoconazole shampoo: results of a multicentre, double-blind, placebo-controlled trial. Br J Dermatol 1995;132:441-445.

3. Parsad D, Pandhi R, Negi KS, Kumar B. Topical metronidazole in seborrheic dermatitis—a double-blind study. Dermatology 2001;202:35-37.

4. Smith SA, Baker AE, Williams JH. Effective treatment of seborrheic dermatitis using a low dose, oral homeopathic medication consisting of potassium bromide, sodium bromide, nickel sulfate, and sodium chloride in a double-blind, placebo-controlled study. Altern Med Rev 2002;7:59-67.

5. Scaparro E, Quadri G, Virno G, Orifici C, Milani M. Evaluation of the efficacy and tolerability of oral terbinafine (Daskil) in patients with seborrhoeic dermatitis. A multicentre, randomized, investigator-blinded, placebo-controlled trial. Br J Dermatol 2001;144:854-857.

DIAGNOSIS

This young man has seborrhea (seborrheic dermatitis), a superficial inflammatory dermatitis. It is a common condition characterized by patches of erythema and scaling, usually on the scalp (ie, dandruff), eyebrows, nasolabial creases, forehead, cheeks, around the nose, behind the ears, and under facial hair. Seborrhea can also occur over the sternum and in the axillae, submammary folds, umbilicus, groin, and gluteal creases. These areas are regions with a greater number of pilosebaceous units, which produce sebum.

Seborrhea is thought to be caused by an inflammatory hypersensitivity to epidermal, bacterial, or yeast antigens. Persons with seborrhea have a profusion of Pityrosporum yeast on the skin. This yeast can be a normal part of skin flora; seborrhea is an inflammatory reaction to its presence. Seborrhea is characterized by remissions and exacerbations. The most common precipitating factors are stress, immuno suppression, and cold weather. The treatment of seborrhea should be directed at the inflammation and the Pityrosporum.

Epidemiology

Seborrhea is most commonly seen in patients aged 20 and 50 years, and mostly in males. The prevalence of seborrhea is approximately 3% to 5% in young adults who are HIV-negative. The prevalence of seborrhea is as high as 36% in HIV-positive persons, although the vast majority of persons with seborrhea have a normal immune system. No lab tests are required to make the diagnosis.

Treatment: antifungals and topical steroids

Treat seborrhea with a 2-pronged plan: antifungal agents for the yeast and topical corticosteroids for the inflammation. The antifungals can also be used to prevent exacerbations; steroids should only be applied to active areas of inflammation.

Fortunately, seborrhea on the face responds well to low-potency topical corticosteroids, such as 1% hydrocortisone cream or lotion. Still, corticosteroids should not be used on the face for prolonged periods to avoid skin atrophy and other side effects. The lotion is better for hair-covered areas as it is less messy to apply than a cream.

A red rash on the face

References

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