The patient you are evaluating has had the rash on her face gradually grow over the last 6 weeks. She complains of only slight pruritus but is mostly concerned about her appearance. The lesions are not painful. Her past medical history is unremarkable and on review of systems she has dandruff. (AIPG 2009)
All of the following historic features are likely except (LQ)
|A||Difficulty rising from a seated position|
|C||Improvement with antidandruff shampoo|
|D||Lesions worsen with emotional stress|
|E||Serum antibodies to Malassezia furfur|
Difficulty rising from a seated position
1). Seborrheic dermatitis is a common skin disorder, for which the majority of patients lack any predisposing conditions.
2). It is characterized by greasy scales overlying erythematous plaques or patches.
3). Induration and scale are less prominent than in psoriasis.
4). The lesions are variably pruritic and may either improve or worsen with sunlight exposure.
5). Pruritus is also variable.
6). The most common location is the scalp, where it may manifest as severe dandruff.
7). On the face, the most common locations are the eyebrows, eyelids, glabella, and nasolabial folds.
8). Lesions typically worsen in the winter, and emotional stress also seems to exacerbate the rash.
9). Seborrheic dermatitis is commonly seen in patients with Parkinson’s disease, facial nerve palsies, and HIV infection.
10). The pathogenesis remains unclear but the yeast Malassezia furfur appears to play a role.
11). Successful treatment with topical ketoconazole and the prevalence of the disease in immunocompromised patients suggests that the yeast is pathogenic.
12). Patients with dermatomyositis may exhibit a heliotrope rash (violaceous rash around the eyelids) and may complain of proximal muscle weakness.