Table 1.
Clinical presentations of seborrheic dermatitis (SD) and dandruff.
| Features | ||
|---|---|---|
| Dandruff | Light, white to yellow and dispersed flaking on the scalp and hair without erythema. Absent to mild pruritus. Can spread to hairline, retro-auricular area and eyebrows. | |
| SD in Infants | Scalp | Cradle Cap: Most Common. Red-yellow plaques coated by thick, greasy scales on vertex, appearing within 3 months of age. |
| Face/Retro-auricular area | Erythematous, flaky, salmon-colored plaques on forehead, eyebrows, eyelids, nasolabial folds, or retro-auricular areas. | |
| Body folds | Lesions have moist, shiny, non-scaly aspects that tend to coalesce on neck, axillae or inguinal area. | |
| Trunk | More extensive form: Sharply limited plaques of erythema and scaling that cover lower abdomen. | |
| Generalized | Leiner’s Disease: Unusual, associated with immunodeficiency. Absent to mild pruritus. Concurrent diarrhea and failure to thrive. Spontaneous clearing within weeks to few months. | |
| SD in Adults | Scalp | From mild desquamation to honey-colored crusts attached to scalp and hair leading to alopecia. May reach into forehead as scaly erythematous border known as “corona seborrheica”. |
| Face/Retro-auricular area | Forehead, eyebrows, glabella or nasolabial folds. May spread to malar regions and cheeks in butterfly distribution. | |
| Eyelids: Yellowish scaling between eye lashes. Can lead to blepharitis with honey-colored crusts on free margin. | ||
| Retro-auricular area: Crusting, oozing and fissures. May expand to external canal, with marked itching on occasionally secondary infection (otitis externa). | ||
| Upper Chest | Petaloid type (common): small, reddish follicular and peri-follicular papules with oily scales at onset that become patches resembling a medallion (flower petals). | |
| Pityriasiform type: Widespread 5–15 mm oval-shaped, scaly macules and patches. Distributed along the skin tension lines (similar to extensive pityriasis rosea). New eruptions can continue for >3 months. Commonly on face and intertriginous areas. | ||
| Body Folds | Moist, macerated appearance with erythema at the base and periphery on axillae, umbilicus, breast fold, genital or inguinal area. May progress to fissures and secondary infection. | |
| SD with immune-suppression* | Extensive, severe and refractory to treatment. In both children and adults with AIDS†. Unusual sites involved such as extremities. More widespread with CD4 counts <200 cells/mm3. Associated with rosacea, psoriasis and acne. | |
*
Human Immune-deficiency Virus (HIV), lymphoma and organ transplant recipients.
†
AIDS: Acquired Immune-Deficiency Syndrome.