At a glance - Seborrhoeic dermatitis versus scalppsoriasis

Seborrhoeic dermatitis

Discriminatory signs

- Scaling rash affecting face and scalp.

- Affects any age after puberty, fluctuates in severity and may persist for years.

- Ill-defined dry pink or skin-coloured patches with yellowish or white bran-like scale.

- May spread to affect the entire scalp, eyebrows, edges of the eyelids, inside and behind the ears and creases beside the nose.

- Skin-folds of the armpits and groin, the middle of the chest or upper back can be affected.

Management

- Shampoos containing ketoconazole, selenium sulphide, zinc pyrithione, coal tar, salicylic acid.

- Steroid scalp applications.

- Anti-yeast tablet such as itraconazole.

Scalp psoriasis

Discriminatory signs

- Back of the head is a common site; multiple discrete areas of the scalp or the whole scalp may be affected. May extend beyond hairline.

- Thick silvery white scale on red skin. Scales not shed easily.

- Asymptomatic or itchy.

- Permanent balding is rare.

Management

- Coal tar shampoos.

- Topical steroid and calcipotriol.

- Salicylic acid and coal tar creams.

- Coconut compound ointment.

Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.

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