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INTRODUCTION

KEY POINTS

  • Seborrheic dermatitis can present with various presentations across skin colors including differences among those with darker skin.

  • In individual with lighter skin, this condition typically presents with pink to bright-pink patches with overlying greasy scale in a seborrheic distribution that can include face, scalp, and trunk.

  • Individuals with olive to light-brown skin can also have marked erythema signified by pink scaly hyperkeratotic patches. In darker brown skin, this may appear more hyperpigmented, brown to black, and scaly.

  • Individuals with darker skin can also present with hypopigmented patches and plaques that lack significant scale in a seborrheic distribution, which can also signify active disease and can be misdiagnosed as vitiligo or postinflammatory hypopigmentation.

image

FIGURE 7-1.

Brown scaly erythematous patches on glabella, mid-forehead, nasolabial folds, perioral area, and chin. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 157-4. Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 7-2.

Bright-pink scaly patch seen along the left nasal ala, with scattered pink macules along the left cheek, chin, and upper cutaneous lip. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 26-2B.)

FIGURE 7-3.

Generalized facial seborrheic dermatitis seen as pink patches with faint overlying scale involving the forehead, nose, cheeks, perioral skin, chin, and neck. Note the visible pink hue along eyelid margins. (From Usatine RP, Smith MA, Mayeaux EJ Jr, et al. The Color Atlas and Synopsis of Family Medicine, 3rd ed. New York, NY: McGraw Hill; 2019, Figure 157-1. Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 7-4.

Marked hypopigmented patches along the nasal ala, nasolabial folds, cheeks, eyebrows, and forehead. Note the lack of significant overlying scale. (Reproduced with permission from Taylor SC, Kelly AP, Lim HW, et al. Taylor and Kelly’s Dermatology for Skin of Color, 2nd ed. New York, NY: McGraw Hill; 2016, Figure 48-9.)

FIGURE 7-5.

Diffuse scattered pink papules and macules overlying pink-brown patches on the chest, signifying postinflammatory change with minimal visible scale. (Reproduced with permission from Kang S, Amagai M, Bruckner AL, et al. Fitzpatrick’s Dermatology, 9th ed. New York, NY: McGraw Hill; 2019, Figure 26-5.)

FIGURE 7-6.

Multiple scattered, hypopigmented pink macules, patches, and plaques on the trunk. (Reproduced with permission from Burgin S. Guidebook to Dermatologic Diagnosis. New York, NY: McGraw Hill; 2021, Figure 12-12.)

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