for Health Care Providers

Seborrheic Dermatitis

Etiology	Findings/ Distribution	Diagnostic Clues	Management
See photo in DermAtlas.
May be related to skin-surface yeasts (Malassezia furfur) and environmental factors	Erythematous scaly plaques on the central face, scalp, behind ears Can be pruritic Can affect sternum, axillae, and genital region	More severe, atypical, and diffuse in patients with low CD4 count nadirs Common in patients who are not on ART: up to 40% of HIV-infected patients and 80% of AIDS patients have seborrheic dermatitis Should improve with immune reconstitution on ART	Hydrocortisone 1% ointment mixed with ketoconazole or econazole applied BID to affected area If very itchy: triamcinolone 0.5% ointment in nonfacial areas Scalp: ketoconazole, tar (T-Gel), selenium sulfide (Selsun), or zinc pyrithione (eg, Head & Shoulders) shampoo twice weekly; leave lather on for 5 minutes before rinsing

From Dermatologic Conditions
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009