Seborrheic dermatitis is reported to have distinct clinical and histologic presentations in patients with human immunodeficiency virus infection. Here we present 20 cases to further define some of these unique characteristics. Common features include erythematous, scaly papules, and plaques involving areas beyond the typical seborrheic distribution; thick, greasy scale on the scalp; and an increased frequency of erythroderma. Histologically, there is widespread parakeratosis, spongiosis, and necrotic keratinocytes. Treatment is often difficult, requiring prolonged use of oral and topical antifungals and corticosteroids as well as antibiotics for bacterial superinfection. Seborrheic dermatitis with these features represents a marker for human immunodeficiency virus infection and can aid in early diagnosis.
Diffuse HIV-associated seborrheic dermatitis – a case series.