Can seborrheic dermatitis occur on the neck?

Seborrheic Dermatitis Can Occur on the Neck

Yes, seborrheic dermatitis can definitely occur on the neck, particularly in the retroauricular area (behind the ears) and other areas of the neck that contain sebaceous glands. 1, 2

Distribution Pattern of Seborrheic Dermatitis

Seborrheic dermatitis commonly affects sebum-rich areas of the body, including:

• Scalp (most common location)
• Face (particularly central face)
• Ears and retroauricular area
• Neck
• Chest (often in a V-shaped distribution)
• Upper back
• Axillary (armpit) folds
• Inframammary folds
• Inguinal (groin) folds 1, 3, 4

Clinical Presentation on the Neck

When seborrheic dermatitis appears on the neck, it typically presents as:

• Greasy yellowish scaling
• Erythema (redness)
• Itching
• Sometimes mild burning sensation
• In darker skin types, hyper- or hypopigmentation may occur with or without visible erythema 4

The condition may be misdiagnosed as other dermatological conditions such as:

• Contact dermatitis (irritant or allergic)
• Atopic dermatitis (eczema)
• Psoriasis
• Tinea (fungal infection) 2

Pathophysiology

Seborrheic dermatitis on the neck follows the same pathophysiological mechanisms as in other locations, involving three key factors:

1. Malassezia yeast colonization - These lipophilic yeasts thrive in sebum-rich areas
2. Sebaceous gland activity - Areas with more sebaceous glands are more susceptible
3. Inflammatory immune response - An abnormal immune reaction to the Malassezia yeasts 5, 4

Treatment Approach for Neck Involvement

First-line treatments:

• Topical antifungal agents (primary treatment):

  • Ketoconazole cream or shampoo (1-2%)
  • Ciclopirox
  • Bifonazole
  • Selenium sulfide 3, 5

• Anti-inflammatory agents (for short-term use only):

  • Low-potency topical corticosteroids (for brief periods)
  • Topical calcineurin inhibitors (tacrolimus, pimecrolimus) 2, 3

Maintenance therapy:

• Regular use of antifungal products
• Gentle cleansing with pH-neutral formulations
• Avoiding irritants and potential allergens 2

Special Considerations

• In cases of severe or refractory seborrheic dermatitis on the neck, consider evaluating for associated conditions like HIV or Parkinson's disease 2
• Avoid prolonged use of potent topical corticosteroids as they can cause skin atrophy and other adverse effects 2, 3
• For persistent cases, short courses of systemic antifungals like ketoconazole, itraconazole, or terbinafine may be considered 5, 6
• Newer treatments like topical roflumilast foam may be considered for recalcitrant cases 7

Clinical Pearls

• Look for the characteristic greasy scaling and distribution pattern to differentiate seborrheic dermatitis from other dermatoses
• The condition tends to be chronic and recurrent, requiring maintenance therapy
• Treatment should focus on both reducing Malassezia yeast burden and controlling inflammation
• Patients should be educated about the chronic nature of the condition and the importance of maintenance therapy