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This review discusses the pathophysiology, presentation, diagnosis, and treatment options for seborrheic dermatitis (SD). SD is one of the five most common dermatologic disorders among African American individuals. Erythema is less detectable in patients with higher Fitzpatrick skin type classification, and hypopigmentation is more common among patients with skin of color. The risk factors associated with SD include warm climate, HIV-positive status, immunosuppression, Parkinson’s disease, and male sex. Topical antifungals, low-potency topical corticosteroids, and calcineurin inhibitors are often used for the treatment of SD. Recent studies have shown that topical and oral PDE-4 inhibitors are also effective treatments.
SD is a common condition, with various factors affecting its presentation and severity. PDE-4 inhibitors are among emerging treatments.
Seborrheic dermatitis (SD) is a common skin disease with signs and symptoms that may vary by skin color, associated medical conditions, environmental factors, and vehicle preference. Diagnosis of SD is based on presence of flaky, "greasy" patches, and/or thin plaques accompanied by erythema of the scalp, face, ears, chest, and groin and is associated with pruritus in many patients. The presentation may vary in different skin types and hyper- or hypopigmentation may occur, with or without erythema and minimal or no scaling. While the pathogenesis is not certain, 3 key factors generally agreed upon include lipid secretion by sebaceous glands, Malassezia spp. colonization, and some form of immunologic dysregulation that predisposes the patient to SD. Treatment involves reducing proliferation of, and inflammatory response to, Malassezia spp. Topical therapies, including antifungal agents and low potency corticosteroids, are the mainstay of treatment but may be limited by efficacy and side effects. Few novel treatments for SD are currently being studied; however, clinical trials assessing the use of topical phosphodiesterase-4 inhibitors have been completed. Improving outcomes in SD requires recognizing patient-specific manifestations/locations of the disease, including increased awareness of how it affects people of all skin types.