Follicular skin diseases
Facial rash case challenge 2
Select the term(s) which best describe this rash.
* Erythematous papules
*! Scaly plaques
Explanation: This patient has scaly plaques on his nose, medial cheeks. Upper and lower eyelid margins are erythematous (they are frequently scaly, but this was not obvious when the photograph was taken).
Choose the best diagnosis from the following options:
* Acne vulgaris
*! Seborrhoeic dermatitis
* Periorificial dermatitis
The name for the reddened eyelid margins is:
* Irritant dermatitis
Explanation: The patient has chronic seborrhoeic dermatitis, and blepharitis. Unlike rosacea and perioral dermatitis, there are no papules.
Which would be the most suitable twice-daily medication for the next six weeks?
* Metronidazole gel
* Minocycline 50mg
*! Ketoconazole cream
* Hydrocortisone cream
Explanation: Metronidazole is not helpful for seborrhoeic dermatitis. Minocycline can reduce facial redness in some cases, but is rarely indicated as most respond to topical agents. Although hydrocortisone may improve the appearance rapidly, it is undesirable long term because of tachyphylaxis (stronger steroid creams could also cause skin atrophy and telangiectasia). Ketoconazole is the best choice from the list provided. In most patients it can be applied twice daily for a couple of weeks then two or three times weekly to maintain control. Hydrocortisone cream can be used for flare-ups for a few days.
What non-facial sites commonly develop seborrhoeic dermatitis?
#! Anterior chest
# Antecubital fossae
# Extensor aspect of the elbow joints
Explanation: Seborrhoeic dermatitis is most likely to affect the scalp, but many patients also develop salmon pink smooth or flaky plaques on the lower sternum. In adults, it rarely affects the antecubital fossae, unlike atopic dermatitis, or the extensor aspects of the elbow joints. However, seborrhoeic dermatitis may be difficult to distinguish from psoriasis, which commonly affects the elbows.