Seborrheic dermatitis - Anogenital in
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Synopsis
Seborrheic dermatitis presents in infants as a self-limited eruption caused by persistent maternal androgens, or in adults, after adrenarche. The pathogenesis is not known with certainty, but in adolescents it may be related to an abnormal immune response to Pityrosporum (Malassezia) yeast, a common skin commensal. Severe seborrheic dermatitis in adolescence may be associated with immunosuppression; consider human immunodeficiency virus (HIV) in those at risk.
Infantile seborrheic dermatitis is a common disease affecting the diaper area. Onset is typically within the first few months of life, and it may be localized or disseminated. In addition to the diaper region, the most common sites are the face and scalp. Nonspecific erythema, scale, and poorly demarcated lesions make it very difficult to distinguish seborrheic dermatitis from irritant diaper dermatitis and atopic dermatitis. However, distinguishing characteristics of seborrheic dermatitis include yellowish scale and the involvement of intertriginous areas (spared in diaper dermatitis). Linear fissures in the interlabial cleft of the vulva are sometimes suggestive of seborrheic dermatitis. Genital seborrheic dermatitis may be complicated by a secondary bacterial or candidal infection.
Codes
ICD10CM:L21.9 – Seborrheic dermatitis, unspecified
SNOMEDCT:
50563003 – Seborrheic dermatitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The most difficult diagnoses to separate from infantile seborrheic dermatitis are contact dermatitis and atopic dermatitis. Atopic dermatitis more often involves the face and flexural areas and is associated with a family history of other atopic conditions (asthma, allergic rhinitis). Contact dermatitis (diaper dermatitis) caused by the irritant effects of urine and feces typically spares the deep body folds for lack of contact with the skin.Psoriasis is extremely uncommon in neonates and infants.
When localized in the diaper area, dermatoses to consider include the following:
- Candidiasis
- Psoriasis – Consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis.
- Allergic contact dermatitis
- Irritant contact dermatitis
- Tinea cruris
- Intertrigo
- Langerhans cell histiocytosis
- Scabies
- Kawasaki disease
- Sexual abuse
- Acrodermatitis enteropathica
- Lichen sclerosus
- Perianal streptococcal infection
- Congenital syphilis
- Psoriasis – Consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis.
- Atopic dermatitis
- Candidiasis
- Allergic contact dermatitis
- Irritant contact dermatitis
- Tinea cruris
- Intertrigo
- Lichen simplex chronicus
- Erythrasma
- Impetigo
- Darier disease
- Langerhans cell histiocytosis
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/13/2017
Last Updated:03/22/2017
Last Updated:03/22/2017
Seborrheic dermatitis - Anogenital in
See also in: Overview,Hair and Scalp