Answer

The image shows severe seborrheic dermatitis. The next best step in treatment is to prescribe topical agents (Table) and refer the patient to a dermatologist.

Discussion

Seborrhea, which is thought to be caused by excess discharge of sebum from the sebaceous glands, is characterized by red, greasy, scaly patches that primarily affect the scalp (in the form of dandruff), eyebrows, area behind the ears, nasolabial folds, chest, groin, and axillae. The condition occurs in approximately 2% to 20% of the population; those with HIV are at increased risk of developing seborrhea.  

Treatment of seborrhea is with topical agents such as selenium shampoo for the scalp, and zinc and/or topical steroids in other areas of the body.  Antifungal agents may also be useful.  Complications resulting from seborrhea are rare; this particular case was more severe than most. 

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Case Conclusion

The patient’s dermatologist was contacted.  The dermatologist assessed the patient in the ED and discharged him with topical steroids and antifungal agents. The patient reported significant improvement after 5 days of treatment.  

Reference

Pregerson DB. Emergency Medicine 1-Minute Consult Pocketbook. Emresource.org; 2017;5.