Seborrhoeic dermatitis - Making a diagnosis

What else might it be?

 In adults or adolescents:

o Scalp:

o Psoriasis — presents with sharply demarcated scalp plaques. Other signs (e.g.

nail pitting and onycholysis) may help with diagnosis.

o Infected eczema.

o Tinea capitis (fungal infection of the scalp) — presents with variable scaling.

Inflammation, pruritus, and alopecia may be present.

o Face:

o Systemic lupus erythematosus — characteristic photosensitive maculopapular

eruption with fine scaling in a 'butterfly' distribution on the cheeks.

o Rosacea — tends to include facial erythema in a cruciform pattern.

o Body:

o Atopic eczema — typically affects the antecubital and popliteal fossae in

adults.

o Pityriasis rosea — unlike seborrhoeic dermatitis, there is often a herald patch

and lesions are less widely distributed.

o Pityriasis versicolor — flatter, extensive, less symmetrical than lesions of

petaloid seborrhoeic dermatitis. Often noticed after a holiday where the person has been

exposed to the sun.

o Lichen simplex of the nape of the neck — thickened plaques mimic seborrhoeic

dermatitis, but are intensely irritating.

o Psoriasis — typically well-defined 'salmon pink' lesions with variable scaling

which is often a characteristic silvery white colour.

o Candidiasis — may resemble seborrhoeic dermatitis of the groin.

[Goodfield et al, 2004; Griffiths et al, 2004; Holden and Berth-Jones,

2004; Schwartz et al, 2006; Grimalt, 2007]
 In infants:

o Atopic eczema — generally itchy, and may ooze or weep.

o Scabies — can resemble widespread seborrhoeic dermatitis.

o Psoriasis — similar appearance to seborrhoeic dermatitis, but less common.

o Irritant contact dermatitis — can occur in the nappy area.

o Langerhans cell histiocytosis — rare; can affect the scalp, trunk, and nappy area.

[Chu, 2004; Holden and Berth-Jones, 2004; Schwartz et al, 2006;O'Connor et al,

2008