Search

Seborrheic dermatitis (SD) is a common skin disease with signs and symptoms that may vary by skin color, associated medical conditions, environmental factors, and vehicle preference. Diagnosis of SD is based on presence of flaky, "greasy" patches, and/or thin plaques accompanied by erythema of the scalp, face, ears, chest, and groin and is associated with pruritus in many patients. The presentation may vary in different skin types and hyper- or hypopigmentation may occur, with or without erythema and minimal or no scaling. While the pathogenesis is not certain, 3 key factors generally agreed upon include lipid secretion by sebaceous glands, Malassezia spp. colonization, and some form of immunologic dysregulation that predisposes the patient to SD. Treatment involves reducing proliferation of, and inflammatory response to, Malassezia spp. Topical therapies, including antifungal agents and low potency corticosteroids, are the mainstay of treatment but may be limited by efficacy and side effects. Few novel treatments for SD are currently being studied; however, clinical trials assessing the use of topical phosphodiesterase-4 inhibitors have been completed. Improving outcomes in SD requires recognizing patient-specific manifestations/locations of the disease, including increased awareness of how it affects people of all skin types., Competing Interests: Conflicts of interest Dr Jackson received research, honoraria, consulting, and/or other support from the following companies over the last 12 months: AbbVie, Arcutis, BMS, Dermavant, Evommune, Janssen, Lilly, Novartis, Pfizer, Regeneron, Sanofi, and UCB. Dr Alexis received grants (funds to institution) from Leo, Novartis, Almirall, Bristol-Myers-Squibb, Amgen, Menlo, Galderma, Valeant (Bausch Health), Cara, Arcutis, Dermavant; Advisory board/Consulting: Leo, Galderma, Pfizer, Sanofi-Regeneron, Dermavant, Beiersdorf, Valeant, L'Oreal, BMS, Bausch Health, UCB, Vyne, Arcutis, Janssen, Allergan, Almirall, AbbVie, Sol-Gel , Amgen, VisualDx, Eli Lilly, Swiss American; Speaker: Regeneron, Sanofi-Genzyme, Pfizer, and BMS. Dr Zirwas received research, honoraria, consulting, and/or other support from the following companies: AbbVie, All Free Clear/Sun, Anaptys Bio, Arcutis, Asana, AsepticMD, Avillion, Bausch Health, Cara, Concert, Dermavant, Edessa Biotech, EPI Health, Fit Bit, Galderma, Genentech/Novartis, Incyte, Janssen, L'Oreal, Leo, Level-Ex, Lilly, LUUM, Oculus, Peloton, Pfizer, Regeneron/Sanofi, Sol-Gel, Trevi, UCB, and Vyne. Dr Taylor serves on the Board of Directors and receives honoraria from CannTec; serves on advisory boards, is a consultant, and/or speaker/faculty education and receives honoraria and/or stock options from AbbVie, Arcutis Biotherapeutics, Inc, Armis Scientific, Beiersdorf, Inc, Biorez, Inc, Cara Therapeutics, EPI Pharma, Evolus, Inc, Galderma Laboratories, L.P., GloGetter, Hugel America, Inc, Janssen, Johnson & Johnson Consumer Products Company, L'Oreal USA, Medscape/WebMD, Piction Health, Scientis U.S., UCB, and Vichy Laboratoires; is a speaker/faculty education with no compensation for Evolus, Inc, and L'Oreal USA; is on the editorial board and reports no compensation for Practical Dermatology, Cutis, and Archives in Dermatologic Research; is an author and receives book royalties from McGraw-Hill; is an investigator and reports no compensation for Concert Pharmaceuticals, Croma-Pharma, Eli Lilly, Pfizer Investigator; and reports a spouse is an employee of and receives a salary from CannTec., (Copyright © 2022 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: No long-term maintenance therapy has been tested in patients with seborrheic dermatitis (SD)., Objective: We sought to compare the efficacy and tolerance of tacrolimus 0.1% ointment versus ciclopiroxolamine 1% cream as maintenance therapy for severe SD., Methods: This double-blind randomized controlled study was conducted from 2014 to 2017 in 5 Dermatology Departments and 15 dermatology practices in France. Consecutive patients with severe and chronic facial SD were included. Patients were initially treated with desonide 0.05% cream twice daily for 7 days. Patients cleared after this open phase were randomized to receive tacrolimus 0.1% or ciclopiroxolamine 1% cream 2 times a week 24 weeks. The primary endpoint was disease-free-duration, defined as the time from randomization to first relapse., Results: One hundred fourteen patients were randomized (tacrolimus, n = 57; ciclopiroxolamine, n = 57). Twelve patients relapsed in the tacrolimus group after a median delay of 91.5 days (range 15-195 days) versus 23 patients in the ciclopiroxolamine group (median delay, 27 days [range 13-201 days]). Comparison of disease-free duration curves showed that patients in the tacrolimus group had a longer duration of complete remission than those in the ciclopiroxolamine group (P = .018), corresponding to a hazard ratio of relapse of 0.44 (95% confidence interval 0.22-0.89; P = .022)., Limitations: The theoretical sample size was not reached., Conclusion: Tacrolimus 0.1% is more effective than ciclopiroxolamine 1% as maintenance therapy for patients with facial SD., (Copyright © 2020. Published by Elsevier Inc.)

Background: Eyelid dermatitis is a common dermatologic complaint., Objective: To characterize patients with eyelid dermatitis., Methods: Retrospective analysis (1994-2016) of North American Contact Dermatitis Group data., Results: Of 50,795 patients, 2332 (4.6%) had eyelid dermatitis only, whereas 1623 (3.2%) also had dermatitis of the eyelids and head or neck. Compared with patients without eyelid involvement (n = 26,130), groups with eyelid dermatitis only and dermatitis of the eyelid and head or neck were significantly more likely to be female, white, and older than 40 years, and to have a history of hay fever, atopic dermatitis, or both (P < .01). Final primary diagnoses included allergic contact dermatitis (eyelid dermatitis only: 43.4%; dermatitis of the eyelid and head or neck: 53.5%), irritant contact dermatitis (eyelid dermatitis only: 17.0%; dermatitis of the eyelid and head or neck: 9.8%), and atopic dermatitis (eyelid dermatitis only: 13.1%; dermatitis of the eyelid and head or neck: 13.8%). Top 5 currently relevant allergens included nickel sulfate (eyelid dermatitis only: 18.6%; dermatitis of the eyelid and head or neck: 22.5%), fragrance mix I (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 18.3%), methylisothiazolinone (eyelid dermatitis only: 16.5%; dermatitis of the eyelid and head or neck: 17.7%), gold sodium thiosulfate (eyelid dermatitis only: 14.7%; dermatitis of the eyelid and head or neck: 11.4%), and balsam of Peru (eyelid dermatitis only: 11.9%; dermatitis of the eyelid and head or neck: 12.6%). Both eyelid-involvement groups were significantly more likely to react to gold sodium thiosulfate, carmine, shellac, dimethylaminopropylamine, oleamidopropyl dimethylamine, and thimerosal (P < .05) compared with the no eyelid involvement group., Limitations: Lack of specific distribution patterns of eyelid dermatitis and no long-term follow-up data., Conclusion: Patch testing remains a critical tool in evaluating patients with eyelid dermatitis., (Published by Elsevier Inc.)

Background: Hand eczema (HE) is a heterogeneous and burdensome disorder., Objective: To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing., Methods: Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113)., Results: Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ 2 , P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators., Limitations: No data on HE phenotype., Conclusion: HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2020 American Academy of Dermatology, Inc. All rights reserved.)

Dermatoscopy is a noninvasive diagnostic tool that allows the recognition of morphologic structures not visible by the naked eye. Trichoscopy (scalp dermatoscopy and videodermatoscopy) is useful for the diagnosis and follow-up of hair and scalp disorders. However, it is not widely used in the management of hair disorders. This review provides updated information from the literature and our experience on the dermoscopic features of the most common hair and scalp disorders. This will enable dermatologists to make fast diagnoses of tinea capitis and alopecia areata, distinguish early androgenetic alopecia from telogen effluvium, and differentiate scarring from nonscarring alopecia., (Copyright © 2012 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

The use of medicinal tar for dermatologic disorders dates back to the ancient times. Although coal tar is utilized more frequently in modern dermatology, wood tars have also been widely employed. Tar is used mainly in the treatment of chronic stable plaque psoriasis, scalp psoriasis, atopic dermatitis, and seborrheic dermatitis, either alone or in combination therapy with other medications, phototherapy, or both. Many modifications have been made to tar preparations to increase their acceptability, as some dislike its odor, messy application, and staining of clothing. One should consider a tried and true treatment with tar that has led to clearing of lesions and prolonged remission times. Occupational studies have demonstrated the carcinogenicity of tar; however, epidemiologic studies do not confirm similar outcomes when used topically. This article will review the pharmacology, formulations, efficacy, and adverse effects of crude coal tar and other tars in the treatment of selected dermatologic conditions.

Background: Dandruff appears to be related to the yeast Pityrosporum ovale. Tea tree oil has antifungal properties with activity against P ovale and may be useful in the treatment of dandruff., Objective: We conducted a randomized, single-blind, parallel-group study to investigate the efficacy and tolerability of 5% tea tree oil and placebo in patients with mild to moderate dandruff., Methods: One hundred twenty-six male and female patients, aged 14 years and older, were randomly assigned to receive either 5% tea tree oil shampoo or placebo, which was used daily for 4 weeks. The dandruff was scored on a quadrant-area-severity scale and by patient self-assessment scores of scaliness, itchiness, and greasiness., Results: The 5% tea tree oil shampoo group showed a 41% improvement in the quadrant-area-severity score compared with 11% in the placebo group (P <.001). Statistically significant improvements were also observed in the total area of involvement score, the total severity score, and the itchiness and greasiness components of the patients' self-assessments. The scaliness component of patient self-assessment improved but was not statistically significant. There were no adverse effects., Conclusion: Five percent tea tree oil appears to effective and well tolerated in the treatment of dandruff.

A retrospective review of all eyelid dermatitis patients seen over an 18-year period revealed a large subgroup of patients who had, as the basis for their ongoing problem, an addiction to the use of topical or systemic corticosteroids. This group of 100 patients often sought many consultations with various physicians. Unrelenting eyelid or facial dermatitis often resulted in the use of increasing amounts of corticosteroids for longer periods of time. Soon the skin became addicted. Once the work-up ruled out other causes, the remedy for the problem was absolute total cessation of corticosteroid usage. This article describes the typical history of the problem, the evaluation of these patients, and the distinctive pattern of flaring erythema that ensued when the corticosteroids were ceased. We stress the absolute necessity of total cessation of corticosteroid use as the only treatment for corticosteroid addiction. We also demonstrate that no additional therapy or further consultations were necessary once remission was obtained after topical corticosteroid abuse was halted.

Scaly scalp is a common problem in the pediatric and adolescent population. The possible causes range from the commonly seen tinea capitis and seborrheic dermatitis to rare systemic diseases such as dermatomyositis and Letterer-Siwe disease. In all cases a thorough history and physical examination are important first steps to successful diagnosis and treatment.

Background: The clinical features attributed to atypical (formerly ¿dysplastic") nevi and to the atypical multiple mole melanoma syndrome have been used in clinical practice, as well as experimentally, to assign melanoma risk. Little information is available, however, on the interobserver reliability in assessing those features., Objective: Our purposes were to quantify interobserver and intraobserver concordances in recognizing certain atypical characteristics of nevi and to correlate the clinical assessments with the histologic characteristics., Methods: Three observers evaluated clinical photographs of 100 pigmented lesions (predominantly melanocytic nevi, with some lentigines and seborrheic keratoses) from 95 subjects, of whom 85 were family members of four multiple melanoma kindreds and 10 were spouses. Each lesion was rated for border irregularity, color variegation, surface contour irregularity, pigment diffusion, and macularity versus papularity. Predictions were made as to the histologic diagnoses and presence of melanocytic atypia for those lesions judged to be nevi., Results: The pair-wise concordances before agreement on specific criteria were quantified by kappa statistics, which indicated slight to fair agreement in judging the atypical clinical characteristics; concordances increased to moderate levels after consensus development of criteria for color variegation and assessment of macularity, but agreement on the other features remained limited. Whereas macularity and color variegation did correlate somewhat with higher grades of histologic atypia, correlations were generally low between the clinical and histologic diagnoses., Conclusion: There is limited interobserver reliability in the clinical assessment of nevus atypia, although correlations do exist between some atypical characteristics and grades of histologic atypia. Because of the low concordances, the clinical discrimination of the melanoma-associated atypical nevus phenotype should rely more on quantitative aspects of the trait, such as total numbers or maximal sizes of nevi, rather than on the subjective determinations of atypia.

Of 191 children who had had infantile seborrheic dermatitis, 88 were reexamined after 10 years. One child had psoriasis, four had atopic dermatitis, and seven had seborrheic dermatitis, which suggests a link with adult seborrheic dermatitis. A familial tendency toward infantile seborrheic dermatitis was noted, as was an increased incidence of allergy within the family.

HIV-positive patients and those persons immunosuppressed as a result of other diseases or chemotherapy are especially susceptible to mycotic infections. The superficial fungal infections seen most often in patients with HIV infection include seborrheic dermatitis, various dermatophyte infections, candidiasis, and onychomycosis. Uncommonly, systemic fungal infections, such as candidiasis, histoplasmosis, cryptococcosis, and coccidioidomycosis, may disseminate to the skin, producing a wide variety of cutaneous lesions. All cutaneous lesions in these patients should be biopsied and cultured if any question exists regarding the diagnosis. The diagnosis of superficial and deep mycotic infections in HIV-positive patients can be particularly difficult because the clinical presentation varies greatly and is often atypical.

Cutaneous involvement with disseminated histoplasmosis occasionally occurs in patients infected with the human immunodeficiency virus. We describe a profoundly immunocompromised patient with acquired immunodeficiency syndrome who had concomitant psoriasis, seborrheic dermatitis, and disseminated histoplasmosis, each with similar features. Findings of a skin biopsy specimen from a lesion on the forehead showed an infiltrate of histiocytes filled with Histoplasma capsulatum. In disseminated histoplasmosis involving the skin, lesions may have features more characteristic of a papulosquamous dermatosis than an infectious disease. In patients infected with human immunodeficiency virus, especially those with low numbers of CD4+ cells, serious infectious diseases may have unusual features and may assume the appearance of concomitant inflammatory diseases.

Papulosquamous diseases are a heterogeneous group of disorders whose etiology primarily is unknown. The nosology of these disorders is based on a descriptive morphology of clinical lesions characterized by scaly papules and plaques. The major entities in this group include psoriasis, parapsoriasis (including pityriasis lichenoides et varioliformis acuta), lichen planus, lichen nitidus, lichen striatus, pityriasis rosea, pityriasis rubra pilaris, seborrheic dermatitis, and the Gianotti-Crosti syndrome. Many other conditions may become papulosquamous and should be considered in the differential diagnosis.