DermDx: Patchy Rash on Chest

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A 51-year-old man presents seeking consultation for a rash on his chest. The condition has been present for approximately 3 years, waxes and wanes in intensity, and is often worse in winter months. The rash is not itchy. The patient’s medical history is positive for hypertension controlled with chlorthalidone. Physical examination reveals discrete erythematous papules and patches on his central chest accompanied by a fine scale. Slight scaling of his scalp and external ear canal is also noted.

Seborrheic dermatitis is a chronic papulosquamous skin disorder that manifests as erythematous macules or plaques with varying degrees of scaling. The condition arises in sebum-endowed areas of the body, notably the central face including the nasolabial folds, eyebrows, scalp, and anterior chest.1...

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Seborrheic dermatitis is a chronic papulosquamous skin disorder that manifests as erythematous macules or plaques with varying degrees of scaling. The condition arises in sebum-endowed areas of the body, notably the central face including the nasolabial folds, eyebrows, scalp, and anterior chest.1

Prevalence is bimodal with 1 peak during early infancy and another peak after the fourth decade.2 All ethnic groups are affected. Patients complain of scaling and often pruritus. Scaling is usually most marked on the scalp and is commonly referred to as dandruff. The cause is unknown but improvement with antifungal medications suggests a key role for the fungi Malassezia.3,4 The density of this organism often correlates with disease severity. Conditions associated with seborrheic dermatitis include AIDS, Alzheimer disease, and Parkinson disease.

Interventions for infantile seborrheic dermatitis include moisturizers and topical steroids of varying potency.5 The majority of cases of seborrheic dermatitis resolve within several months. Topical antifungals, steroids, and calcineurin inhibitors are used to manage cases in adults, with the former preferred by some clinicians for long-term management.6 Ongoing maintenance therapy is often required.

Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Shi V, Leo M, Hassoun L, Chahal D, Maibach H, Sivamani R. Role of sebaceous glands in inflammatory dermatoses. J Am Acad Dermatol. 2015:73(5):856-863. doi:10.1016/j.jaad.2015.08.015

2. Tucker D, Masood S. Seborrheic dermatitis. In: StatPearls [Internet]. StatPearls Publishing; August 1 2022. https://www.ncbi.nlm.nih.gov/books/NBK551707/

3. Dessinioti C, Katsambas A. Seborrheic dermatitis: etiology, risk factors, and treatments: facts and controversies. Clin Dermatol. 2013;31(4):343-351. doi:10.1016/j.clindermatol.2013.01.001

4. Kamamoto C, Nishikaku A, Fernandez F, Sanudo A, Gomperto O, Melo A. Malassezia yeasts in seborrheic dermatitis and seborrhea. J Am Acad Dermatol. 2016:74(5):AB61. doi:10.1016/j.jaad.2016.02.24

5. Victoire A, Magin P, Coughlan J, van Driel ML. Interventions for infantile seborrhoeic dermatitis (including cradle cap). Cochrane Database Syst Rev. 2019;3(3):CD011380. doi:10.1002/14651858.CD011380.pub2.

6. Clark GW, Pope SM, Jaboori KA. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician. 2015;91(3):185-190.

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