Presentations of Cutaneous Disease in Various Skin Pigmentations: Seborrheic Dermatitis

Abstract

Description Seborrheic dermatitis is a common dermatologic disease affecting patients of all ages, ethnicities, and skin pigmentations. The rash often affects the scalp, ears, and central face. The underlying skin pigmentation of the individual may affect how this disease presents. We present several cases of seborrheic dermatitis in individuals of varying ages, genders, and skin pigmentations.

Keywords: cutaneous disease; demographics in dermatology; ethnicity; seborrheic dermatitis; skin and connective tissue diseases; skin of color; skin pigmentation.

Figure 1

The Fitzpatrick scale provides a classification system for an individual’s skin type based on the ability to burn and/or tan when exposed to ultraviolet light. It is used to approximate the degree of skin pigmentation.

Figure 2

Fitzpatrick skin type II (mostly burns, rarely tans) shows seborrheic dermatitis on the central face without sparing the nasolabial folds in an older male. Pink to orangish plaques (>1 cm, raised) with scale are present. The medial eyebrows and chin are involved, while the perioral area is spared.

Figure 3

(A) Fitzpatrick skin type II (mostly burns, rarely tans) shows seborrheic dermatitis on the left retro-auricular skin. The erythematous plaques (>1 cm, raised) exhibit maceration and longitudinal fissures. These lesions also have a layer of scale on top. (B) The chest and anterior neck exhibit pink scaly papules (<1 cm, raised).

Figure 4

(A) Fitzpatrick skin type IV (rarely burns, mostly tans) shows seborrheic dermatitis on the central face and forehead of a young adult male. There is a faint erythema and a fine scale. (B) On closer examination, one can better appreciate the scale in the bilateral nasolabial folds (orange arrows) and the involvement of the mustache and beard on the upper lip, cheeks, and chin.

Figure 5

(A) Fitzpatrick skin type V (almost never burns, always tans) shows seborrheic dermatitis on the scalp. There is a fine, white scale. (B) On the right perinasal ala, there is a faint erythema and fine white scale (orange arrow) extending inferiorly onto the cheek and superiorly onto the nasal dorsum.

Figure 6

(A) Fitzpatrick skin type V (almost never burns, always tans) with faint erythematous plaques (>1 cm, raised) with a fine, white scale involving the bilateral eyebrows, central forehead, and bilateral nasolabial folds. (B) The scale coalesces in the nasolabial folds and on the nasal root, giving the skin a whitish hue (orange arrows).

Figure 7

(A and B) Fitzpatrick skin type III (sometimes burns, often tans) in a middle-aged female, involving the sun-exposed face. There are erythematous, hypertrophic plaques (>1 cm, raised) involving the bilateral malar cheeks and sparing the nasolabial folds (black arrow).

Figure 8

(A–C) Fitzpatrick skin type V (almost never burns, always tans) presents here in a young adult male. Pink, well-defined plaques (> 1 cm, raised) densely cover the central face, nasolabial folds, forehead, and scalp. The scale is adherent to the plaques. A biopsy of a scalp plaque (>1 cm, raised) showed psoriasis. This patient also had other lesions on his bilateral axillae and his lower extremities.