Seborrheic Dermatitis
A discolored, flaky patch on a female's face is most commonly seborrheic dermatitis, which presents as erythematous patches with yellow, oily scales and fine superficial flaking in areas rich in sebaceous glands such as the nasolabial folds, glabella, and eyebrows. 1, 2
Clinical Presentation
Key diagnostic features to identify:
- Classic appearance: Symmetric, poorly defined erythematous patches with yellow, oily scales and fine desquamation (flaking) 1
- Typical facial locations: Nasolabial folds, glabella (between eyebrows), eyebrows, beard area, and ears 3, 2
- In darker skin tones: Erythema may be less apparent, and the condition often presents as hypopigmented, scaly macules and patches rather than the classic red appearance 3, 1
- Associated symptoms: Scaling, itching, and in some cases postinflammatory pigmentary changes 2, 4
Pathophysiology
- The condition results from an inflammatory response to Malassezia yeast (particularly M. globosa), a common skin organism that proliferates in sebaceous-rich areas 2, 5
- Increased sebaceous activity and individual susceptibility to irritant metabolites of Malassezia contribute to disease development 5
Differential Diagnosis Considerations
Other conditions to exclude based on specific features:
- Atopic dermatitis: Look for marked facial/eyelid involvement, flexural neck involvement, and vesicular lesions on hands—these patterns suggest allergic contact dermatitis rather than seborrheic dermatitis 6
- Rosacea: Presents with telangiectasia, papules, pustules, and facial flushing, more common in middle-aged women with fair skin 6
- Psoriasis: Can be associated with blepharitis and has thicker, more well-demarcated plaques 6
- Vitiligo: Presents as depigmented (not hypopigmented) patches without scaling, often symmetrical 6, 7
Treatment Algorithm
First-line therapy for facial seborrheic dermatitis:
- Topical antifungal agents are the mainstay of treatment, with ketoconazole being most commonly used 2, 4
- Short-term topical corticosteroids (limited duration due to risk of skin atrophy) for anti-inflammatory effect 2, 4
- Calcineurin inhibitors (tacrolimus or pimecrolimus) as steroid-sparing alternatives for longer-term management 5, 4
Second-line and adjunctive options:
- Azelaic acid 15% gel has demonstrated efficacy and possesses antifungal, antikeratinizing, and anti-inflammatory properties 5
- Lithium gluconate/succinate, salicylic acid, or selenium sulfide for refractory cases 4
Important Clinical Pitfalls
- Do not use topical corticosteroids long-term on facial skin due to high risk of skin atrophy and other adverse effects—reserve for short-duration use only 2, 4
- In darker-skinned patients, recognize that hypopigmentation may be the primary presenting sign rather than erythema, and this can be mistaken for other conditions like vitiligo 3, 1
- Seborrheic dermatitis is chronic and relapsing—patients require long-term maintenance therapy with antifungal agents to prevent recurrence 3, 4
- In women with facial seborrheic dermatitis, consider screening for associated conditions like blepharitis (95% of seborrheic blepharitis patients also have seborrheic dermatitis) 6