Seborrheic Dermatitis

A 58-year-old man presents for evaluation of a facial rash. He is convinced, from internet research, that he has systemic lupus erythematosus.

Key point: The eruption does not actually follow the malar area (across the zygoma), but instead goes down the nasolabial folds and also involves the moustache area. There is abundant thick, greasy scale present. This is a classic picture of seborrheic dermatitis, albeit fairly severe.

Treatment: The rash resolved completely following 3 weeks of twice daily application of ketoconazole cream.

Note: This chronic disorder may require periodic application of an azole antifungal or low potency corticosteroid cream to prevent recurrence.