A 30-Year-Old Man with Recurrent Scaling and Itching of the Scalp

Abstract

Seborrheic dermatitis is a chronic, inflammatory skin disorder. It has been suggested that the condition is caused by an altered response to Malassezia yeasts and their metabolites. Seborrheic dermatitis occurs mainly in infants (usually within the first three months of life), adolescents, young adults and in the elderly. Men are more commonly affected compared to women. The condition is more frequently reported in immunocompromised patients (organ transplant recipients, patients with HIV/AIDS or chronic alcoholic pancreatitis), patients with neurological and psychiatric diseases (Parkinson’s disease, depression, epilepsy) and patients with Down syndrome. Seborrheic dermatitis is characterized by the presence of erythematous plaques with greasy, yellowish scales with no hair loss. Usually, a mild itch is presented. Lesions are localized on the areas with a high concentration of sebaceous glands, such as the scalp (mainly the vertex and parietal areas), nasolabial folds, ears, eyebrows, chest, back, axilla and groin. Seborrheic dermatitis tends to intensify with stress and in winter months while improves in summertime. The diagnosis of seborrheic dermatitis is usually established clinically. In treatment of scalp seborrheic dermatitis, shampoos containing selenium sulfide, zinc pyrithione, coal tar or antifungal agents are commonly used. In the case of more severe inflammation, topical corticosteroids can be beneficial. If the seborrheic dermatitis is particularly widespread or refractory, an oral treatment with antifungal agents or isotretinoin may be added.