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December 2007
By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
An 85-year-old man arrives at your emergency department with an erythematous, mildly pruritic, slightly scaling rash affecting his eyebrows, nasolabial folds and ear canals. It tends to worsen during the colder months and times of stress. His medical history is negative for Parkinson disease and AIDS. He has tried several nonprescription creams that produced no significant improvement.
WHAT IS YOUR DIAGNOSIS? |
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This patient has seborrheic dermatitis, a common chronic inflammatory disease characterized by erythema and scale. The condition, seen more often in male patients, peaks within the first three months of infancy and once more after the fourth decade. Classic sites for involvement include the scalp, eyebrows, nasolabial folds, ear canals, posterior auricular regions, and chest. While the etiology is unknown, many cases have been linked to colonization with the yeast Malassezia ovalis. Severe seborrheic dermatitis may occur in association with Parkinson disease or HIV infection. The condition is treated topically with an antifungal medication (such as ketoconazole), selenium sulfide foam, or low-potency steroids. |
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 39(12):47-48, 2007
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