Chronic Itchy Rash on Scalp and Beard: Managing Seborrheic Dermatitis in a 38-Year-Old Male
At Village Dermatology, we often see patients dealing with persistent skin conditions that come and go over time. One common example is seborrheic dermatitis, a chronic inflammatory condition that typically affects areas of the body with high oil production—such as the scalp, face, and neck. In this case, we evaluated and treated a 38-year-old male from the Katy and Houston, Texas area who had been struggling with flares of a scaly, itchy rash for years.
Patient Case Overview
This new patient presented with a rash affecting multiple areas:
Right side of the lip
Left lip
Neck
Scalp
He described the rash as moderately severe, itchy, and flaky, and reported that the symptoms would flare periodically. Despite washing his hair daily and trying over-the-counter shampoos, the condition persisted.
Clinical Examination
During the comprehensive skin examination—including use of a dermatoscope—we noted pink to orange, scaly plaques on the:
Left superior parietal scalp
Philtrum (area between the nose and upper lip)
Right chin and beard area
The patient was alert, oriented, and in no acute distress, with otherwise healthy appearance. Based on clinical findings, we diagnosed him with seborrheic dermatitis.
Understanding Seborrheic Dermatitis
Seborrheic dermatitis is a chronic skin condition characterized by inflammation in areas with abundant oil glands. While the exact cause is unknown, it is believed to involve a combination of genetic, environmental, and yeast (Malassezia) factors. Stress and weather changes can also trigger flare-ups.
Treatment Plan and Counseling
Because the patient had already tried non-prescription shampoos without relief, we developed a customized prescription-based treatment plan:
Medications Prescribed:
Ketoconazole 2% Shampoo: To be used 3 times per week, left on for at least 3 minutes before rinsing. This antifungal helps reduce yeast on the scalp that contributes to seborrheic dermatitis.
Fluocinonide 0.05% Topical Solution: Applied twice daily for up to 2 weeks during flares. This high-potency corticosteroid helps reduce inflammation and itching.
Additional Counseling:
We educated the patient on key skin care strategies:
Use of gentle emollients
Shampoos with tar, selenium sulfide, or zinc pyrithione
Avoiding triggers like stress and harsh detergents
We also discussed potential side effects of long-term steroid use, such as skin thinning, hypopigmentation, and telangiectasia, especially when used on sensitive areas like the face.
Follow-Up Plan
The patient was advised to follow up annually, unless symptoms worsen or fail to respond to treatment. Ongoing management will include recognizing early signs of flares and adjusting treatment as needed.
Why This Matters for Katy and Houston Residents
Chronic skin conditions like seborrheic dermatitis are highly manageable with the right guidance. If you or a loved one in Katy or Houston, Texas experiences persistent scalp or facial rashes that come and go, Village Dermatology offers expert care tailored to your needs. With an emphasis on evidence-based treatment and patient education, we help our patients take control of their skin health—one flare at a time.
