A 67-year-old man with Parkinson disease has macular areas of erythema with a greasy scale behind the ears and on the scalp, eyebrows, glabella, nasolabial folds, and central chest. Which of the following is true?
The patient has the typical areas of involvement of seborrheic dermatitis. This common dermatitis appears to be worse in many neurological diseases. It is also very common and severe in patients with AIDS. In general, symptoms are worse in the winter. UV radiation improves the condition. Pityrosporum ovale appears to play a role in seborrheic dermatitis and dandruff, and the symptoms improve with the use of certain antifungal preparations (e.g., ketoconazole) that decrease this yeast. Mild topical steroids also produce an excellent clinical response. High-dose topical steroids are rarely necessary; when used on the face for long periods of time, they can cause irreversible atrophy and thinning of the skin. Oral fluconazole is used in refractory Candida infections, which usually affect the oral mucosa (thrush), the vaginal mucosa or moist intertriginous areas. Psoriasis (which can cause destructive arthritis) should be easily distinguishable by the pattern of involvement (psoriasis does not usually affect the face) and by its characteristic thick micaceous scale.
A high-dose topical steroid is the best long-term treatment.
Oral fluconazole is usually necessary to eradicate the problem
This condition flares with sun exposure.
Topical ketoconazole or 1% hydrocortisone cream (low potency) is good initial therapy.
Skin