A 24 years male has eczematous dermatitis involving scalp and face with greasy yellow scales. He is also suffering from severe dandruff. He is having - (AIIMS Nov 2013)
i.e., Seborrheic dermatitis
Differential diagnosis of Dermatitis (eczemA. in children and adults
Atopic dermatitis (childhood and adolescent pattern)
a. Intensively pruritic lesions on flexural areas (poplitealfossa, antecubital fossa, axilla & groin)
b. Note - In infants face and extensor surface are involved
c. Scratching results in excoriation, Lichenification, hyperlinear palm.
d. Increased suceptibility to infection, espesially staphylococcus, molluscum contigiosum and warts
e. Denny Morgan folds à extrafold of skin beneath lower lids
f. Personal or family history of other atopic conditions àAsthma, Hay fever, Allergic rhinitis or conjuctivitis
g. Food allergies àexacerbatiorrof skin rashes may be seen following oral challange with certain foods.
h. Chronic urticaria and alopecia areata.
a. Mainly in adults (may be seen infrequently in infants, but not in children)
b. Follicular papules with greasy yellow scales
c. Scales over the erythmatous patch give stuck on appearance.
d. There is Itching or buring in lesions
e. Scalp and face are involved as a rule.
f. Overall distribution à scalp face (nasolabial folds, eyebrows, eyelashes), major flexures (axillae, groins, infra-mammary region), presternal and interscapular regions -t referred as seborrheic distribution.
g. Cradle cap and severe dandruff
h. Lesions may be infected à bacteral (scalp), candidal (flexures)
1). Irritant contact dermatitis
a. More common in house wives.
b. Mostly involves hands and forearms,
c. Acute cases àexudative lesions
d. Chronic cases àLichenifications, scaly àhouse wive dermatitis
e. History of contact with irritants -t strong irritants (in acutE., weak irritants (in chroniC.
2). Allergic contact dermatitis
a. History of contact of allergen at the site of lesions.
b. Wrist dermatitis à contact allergy to nickel in a metal wath strab
c. On forehead àdue to sticker in resin bindi
d. Foot àdue to rubber and leather footwear àfootwear dermatitis
e. Hand àdue to thiuram used in rubber gloves
3). Air borne contact dermatitis
a. Most commonly due to parthenium (congress grass)
b. Common in farmers, labourers, though can be seen in any person.
c. Sites involved are Face, neck fore arms, cubital fossae, eyelids, as pollen lands and accumulate increases of uncovered areas of body.
d. SeasonalàOccurs in July - August (with persistant exposure loses seasonal nature)
e. Like other two types of contact dermatitis history of exposure is very important.
Nummular (Discoid) eczema
a. Middle-aged, men
b. Multiple, itchy, scaly, coin-shaped (Jharkhand05) exudative plaques.
c. On extremities (arm or leg).
Coming to question
a. Information in this question are :-
i. Age of patient is 24 year (adult)
ii. Involvement of scalp & face
iii. ill) Greasy yellow scale
iv. Severe dandruff
b. Diagnosis is seborrheic dermatitis