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INTRODUCTION

KEY POINTS

  • Seborrheic dermatitis is a common concern among patients with skin of color.

  • The clinical features of seborrheic dermatitis depend on the age of the individual, his or her Fitzpatrick skin type, and the presence or absence of concurrent systemic illnesses.

  • In addition to the scaly appearance, lesions of seborrheic dermatitis in skin of color may be hypopigmented, hyperpigmented, or erythematous.

  • Treatment options are numerous but should be adjusted to the hair-grooming practices of the individual.

Seborrheic dermatitis is a chronic papulosquamous condition affecting the scalp, face, and trunk. It is a superficial inflammatory disease that can occur as an isolated condition in the sebum-rich areas of the scalp or in conjunction with other common disorders such as blepharitis, acne vulgaris, and rosacea. Certain systemic illnesses have been associated with seborrheic dermatitis, particularly acquired immunodeficiency syndrome (AIDS) and Parkinson disease.1,2,3,4 Seborrheic dermatitis may also be seen in patients who have received psoralen with ultraviolet A therapy.5

The exact etiology of seborrheic dermatitis is unknown; however, some of the theorized causative factors include production of sebum by the sebaceous glands, Malassezia globosa yeast species, and a genetic susceptibility for an inflammatory response.6 Clinically, seborrheic dermatitis is easily recognized. However, findings may differ based on the Fitzpatrick skin type of the affected individual. Treatment options are numerous but should be adjusted for individuals with a Fitzpatrick skin type of IV to VI, based on their hair grooming practices. Treatment is usually successful in controlling the symptoms and the clinical manifestations of the disease; however, a cure is rarely attained.

EPIDEMIOLOGY

The occurrence of seborrheic dermatitis in the general population is reported to be 3% to 5%.7 The condition can affect people of all ages. There are two age categories with distinct increases in the rate of occurrence: infancy and the fourth through fifth decades of life. Males are affected by seborrheic dermatitis more often than females [Figure 23-1], and African American populations are affected more frequently than fairer-skinned populations.8 An increased incidence is found in human immunodeficiency virus (HIV)-positive patients or those with AIDS, with estimates ranging from 20% to 83%.9,10,11 Higher rates of occurrence have also been found in individuals with Parkinson disease,3,4 familial amyloidosis with polyneuropathy,12 trisomy 21 genetic disorder,13 anorexia nervosa,14 increased stress levels,9 and chronic alcohol consumption [Table 23-1].15

TABLE 23-1Disorders commonly associated with seborrheic dermatitis
FIGURE 23-1.

A male patient with Fitzpatrick skin type V with annular ...

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