Seborrheic Dermatitis

Skin Lesion: Erythematous plaques covered with greasy, yellowish scales. In chronic cases, it may present as ill-defined red patches with fine branny desquamation.

Classic Distribution (Seborrheic Areas):

• Face: Favors the eyebrows, glabella, and nasolabial folds (T-zone).
• Scalp: Presents as dandruff (Pityriasis sicca) or thick, adherent crusts.
• Trunk: Presternal area and intertriginous folds (axilla, inframammary).
• Infants: Known as "Cradle Cap" (thick, yellow, crusty scales on the scalp).

Pityriasis Versicolor

• The Clue: Hypopigmented, hyperpigmented, or erythematous macules with fine scale (best seen on stretching the skin).
• Vs Seborrheic: Versicolor scales are dry and fine, not greasy. It favors the upper trunk and back rather than the facial nasolabial folds.

Psoriasis (Sebopsoriasis)

• The Clue: Well-demarcated plaques with thick silvery-white scales.
• Vs Seborrheic: Psoriasis scales are dry, silvery, and much thicker. Psoriasis typically involves the extensor surfaces (elbows/knees) and has a more defined border than Seborrheic Dermatitis.

Scalp Treatment

• Ketoconazole 2% Shampoo: Apply 2-3 times weekly for 2-4 weeks. Leave on for 5 minutes before rinsing.
• Tar-based Shampoos: For thick scaling.

Face & Body Treatment

• Antifungal: Ketoconazole 2% cream or Miconazole 2% cream BD.
• Mild Steroid: Hydrocortisone 1% cream BD for 1-2 weeks (for acute inflammation).

Symptomatic Treatment:

• Cetirizine 10mg OD.
  [Child: 0.25mg/kg OD]
• Piriton 4mg ON/TDS.
  [Child: 0.1mg/kg ON/TDS]
• Desloratadine 5mg OD
  [Child: 0.1mg/kg OD] (non-drowsy)

⚠️ Clinical Pearl: Seborrheic Dermatitis is a chronic condition with frequent relapses. Maintenance therapy with intermittent antifungal shampoo (e.g., once weekly) is often required.

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