Differentiating Seborrheic Dermatitis From Other Conditions in Practice in a 22-Year-Old Patient With Multiple Treatment Failures

This case centers on a young man with severe, chronic facial seborrheic dermatitis marked by redness, burning, and persistent flaking. Despite trying numerous over-the-counter treatments, including antifungals, corticosteroids, and anecdotal remedies such as tea tree oil and apple cider vinegar, his symptoms remained uncontrolled. The physical symptoms were compounded by emotional distress, particularly around his appearance and its impact on personal relationships. Like many patients, he was initially misdiagnosed, highlighting the diagnostic challenges seborrheic dermatitis presents, especially when symptoms overlap with eczema, psoriasis, or contact dermatitis.

Recognizing hallmark features—such as involvement of the nose, eyebrows, and parietal scalp—can help distinguish seborrheic dermatitis from other inflammatory dermatoses. In cases such as this, where itch, burning, and emotional distress are prominent and treatment history is extensive, a more targeted and consistent therapy is needed. After beginning treatment with a PDE4 inhibitor foam applied daily, the patient achieved near-clearance by week 8. His itch was nearly resolved, and his skin significantly improved, validating clinical trial findings in a real-world setting. When treatment is successful, patients often ask about long-term plans. Some prefer continued daily use, while others explore intermittent use. While on-label treatment supports continuous use, regimens can be tailored to patient preferences and lifestyle.

Safety monitoring for this therapy is minimal, and long-term use tends to be well-tolerated without lab requirements. During follow-up, clinicians focus on symptoms such as itch, stinging, or recurrence rather than lab metrics or extensive exams. Importantly, while itch is a common and measurable symptom, patients may report variations such as burning, tingling, or discomfort. These nuances should not alter the treatment pathway but rather reinforce the need for therapies that address the full spectrum of symptom burden. Ultimately, this case illustrates how newer targeted treatments offer effective and manageable options for patients whose disease impacts both skin and quality of life.