Addressing Patient Needs in Seborrheic Dermatitis with Novel Therapies - Episode 2
Dermatologists discuss differentiating seborrheic dermatitis from conditions like psoriasis, eczema, and lupus, highlighting similarities and differences with other skin conditions.
Linda Stein Gold, MD: A lot of us know it when we see it, but it can be sometimes a little bit challenging. So, Neal, what are the other conditions that we have to make sure we differentiate?
Neal Bhatia, MD: Well, in this internet world, everyone’s looking at pictures, and they tell us what they have. But I think the No. 1 differentiator is simple: dry skin. You have a lot of patients who just say my skin is dry. It’s itchy here, it’s a little flaky. The real key is again, like James just talked about, [to] look at the distribution. We’re dealing with just scalp, chest, face, anywhere in between, and especially in patients with beards and heavy eyebrows. You really have to get into the nuts and bolts of what is their distribution, as well as the morphology. The first question that I asked is, does your skin feel like snowflakes, or does it feel like plates that won’t come off? And that’s the way we can get the conversation about psoriasis versus seborrheic dermatitis out of the way. Most of the time with eczema, you’re not thinking so much about scalp as you are with seborrheic dermatitis. So that also helps the conversation a little bit. But the other component is also, what have they tried? What have they experienced in terms of symptoms? Seborrheic dermatitis doesn’t itch as much as, say, eczema does, for example, in different parts, but a heavy-centered facial involvement that has a lot of native labial folds, a lot of eyebrows, that can be very itchy for some. Then you really just have to broaden the differential if you’re really not getting into any kind of response rates, thinking, obviously, about malar [rash] forms of lupus, discoid changes in rheumatoid myositis can look very familiar, PMLE [polymorphous light eruption]. But some of those don’t have the epidermal change that seborrheic dermatitis does. And Shawn described it well with the “papillose squamous nature” of seborrheic dermatitis. It’s much more of a Th1 disease than Th2, and there are a lot of neutrophils in the stratum corneum, which, again, might change the response rate to some of the topicals that patients have had. So if they approach it like that, someone who used Th2-driven therapies that may not respond as well as maybe some kind of combination or direct anti-inflammatory approach.
Linda Stein Gold, MD: So do you find the differentiators between atopic dermatitis and seborrheic dermatitis, is it more the way it presents? Is it more the scale or the erythema? Is there something that people can kind of hang on to?
Neal Bhatia, MD: I would definitely say the scale pattern would give a lot of it away. The snowflake pattern, the loose scale. If it’s built up in the nasolabial folds, for example, that’s a real giveaway for many. Again, exanimis change tends to be a little more crusted, a little more fissured, and again, on the head and neck, maybe it presents a little bit more heavy plaque formation than seborrheic dermatitis does. That being said, if you’re dealing with the scalp, you tend to see a lot of females looking at that posterior aspect above the neck, and in men you tend to see kind of broad [area]. But again, if it’s not really heavy plate-like, you can get into the discussion. This is probably more seborrheic dermatitis. The other thing James mentioned too is about rosacea. You have to see the overlap with rosacea quite a bit. And [it’s the] same with a lot of acne patients, you’ll see their forehead. If you don’t check their scalp for bad seborrheic dermatitis, we’re kind of missing the treatment algorithm for taking care of their forehead and the comedones up top.
Transcript was AI-generated and edited for clarity and accuracy.