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Seborrhoeic dermatitis - Management
How should I manage severe or widespread seborrhoeic dermatitis?

  • Consider whether the diagnosis of seborrhoeic dermatitis is correct (see Differential diagnosis) and whether the person may be immunocompromised (e.g. HIV infection):
    • Consider blood tests based on clinical judgement (e.g. full blood count, glucose measurement, viral serology).
  • Refer to a dermatologist and seek specialist advice as to whether treatment is needed while the person is waiting to be seen.
Basis for recommendation
  • The recommendation to refer if seborrhoeic dermatitis is severe or widespread is based on the concern that people with severe seborrhoeic dermatitis are more likely to have an underlying immunodeficiency than people with milder or localized rash:
    • Some authors believe that, in people with HIV, seborrhoeic dermatitis is more severe than usual [Gupta and Bluhm, 2004].
    • Generalized seborrhoeic dermatitis is uncommon in otherwise healthy children and usually is associated with immunodeficiency [Schwartz et al, 2006].
  • Several treatments have been suggested for widespread seborrhoeic dermatitis or cases that are refractory to topical treatments (e.g. oral antifungal drugs [Gupta and Bluhm, 2004; Plewig and Jansen, 2008]). Because of the potentially serious adverse effects of these treatments, CKS recommends seeking specialist advice in this situation to ensure that the diagnosis is correct and appropriate treatment is initiated.

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