51-Year-Old With Asymptomatic Rash

Differential Diagnosis

• Erythrasma
• Granuloma annulare
• Nummular dermatitis
• Seborrheic dermatitis

Diagnosis

This patient was diagnosed with seborrheic dermatitis. Seborrheic dermatitis is a common inflammatory papulosquamous condition that affects the sebum-rich areas of the body, including the face, scalp, neck, upper chest, and back. Up to 5% of adults are affected by seborrheic dermatitis, and the condition is particularly common after the fifth or sixth decades. Clinical presentations of seborrheic dermatitis vary, ranging from simple dandruff to fulminant rash.

What to Look For

• Lesions may look pink or red, ashy gray, or darker than normal skin depending on a person’s skin color
• Lesions may also have dryness, pruritus, and fine, greasy scaling
• Characteristic sites include the scalp, eyebrows, glabella, nasolabial folds, the beard area, upper chest, external ear canal, posterior ears, eyelid margins, and intertriginous areas

Pearls for Urgent Care Management

• Treatment may include corticosteroids (low potency for the face), anti-fungals, or a combination of both
• Seborrheic dermatitis tends to be a chronic condition, and remissions and exacerbations are expected
• Intermittent treatment may be helpful for chronic state
• Seborrheic dermatitis is often better in summer months and worse in the winter

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