This chapter discusses common infections and inflammations affecting the face and scalp; allergic dermatitis involving the face (including poison ivy); and photosensitivity reactions. Erysipelas and facial cellulitis are discussed in Chapter 152, “Soft Tissue Infections,” and impetigo and bullous impetigo are discussed in Chapter 142, “Rashes in Infants and Children.”
Seborrheic dermatitis has both infantile and adult forms. The infantile form is called “cradle cap” and peaks in the first 3 months of life (see Chapter 142, “Rashes in Infants and Children” for further discussion of infantile seborrheic dermatitis). Adult seborrheic dermatitis presents as white to yellow greasy scaling of the scalp (i.e., dandruff), eyebrows, nasolabial folds, ears, and postauricular skin associated with mild erythema and variable pruritus (Figure 250-1). Occasionally, the lesions may extend onto the upper central chest and intertriginous areas. Adults with acquired immunodeficiency syndrome and Parkinson’s disease are predisposed to severe disease. The typical distribution of seborrheic dermatitis is in areas with high concentrations of sebaceous glands. Malassezia yeasts residing on the skin may contribute to inflammation.1 This factor may explain why seborrheic dermatitis responds to both antifungal and anti-inflammatory agents. In adults, the condition is chronic and recurrent but without any systemic symptoms.
Adult seborrheic dermatosis. Erythema and scaling on face and facial skin folds. [Reproduced with permission from Wolff K, Johnson R, Suurmond R: Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, 5th ed. New York, McGraw Hill, Inc.; 2005:51.]
Treat adults with an antidandruff shampoo containing zinc pyrithione, selenium sulfide 2.5%, salicylic acid, or tar. Ketoconazole can also be used and is available over the counter as 1% shampoo and by prescription at 2% for shampoo and cream. Lather the shampoo into the scalp and leave on briefly before rinsing. For severe cases, a topical corticosteroid such as fluocinonide solution may be applied to the scalp daily. For the face, low-potency topical corticosteroids applied twice per day may be used (Table 250-1). The use of higher potency topical corticosteroids on the face for more than a few days can lead to the development of perioral dermatitis or steroid rosacea and should be avoided. Treatment continues until the dermatitis is cleared. Re-treat recurrences as needed.
TABLE 250-1Clinical Features and Treatment of Seborrheic Dermatitis of the Face, Tinea Barbae, Sycosis Barbae |Favorite Table|Download (.pdf) TABLE 250-1 Clinical Features and Treatment of Seborrheic Dermatitis of the Face, Tinea Barbae, Sycosis Barbae
|Condition ||Clinical Features ||Treatment ||Comments |
|Seborrheic dermatitis ||White to yellow scale involving scalp, eyebrows, nasolabial folds, and chest with variable erythema and pruritus || |
OTC antidandruff shampoo
Ketoconazole 2% shampoo
Ketoconazole 2% cream
Desonide 0.05% or hydrocortisone 2.5%
|Leave shampoos on for 3–5 ...|