An adolescent with thick yellow greasy scales on the forehead and behind the ears; what will you recommend?

An adolescent with thick yellow greasy scales on the forehead and behind the ears; what will you recommend?

• A. Daily application of ketoconazole 2% topical cream
• B. High-potency topical corticosteroids applied daily
• C. Mineral oil and shampoo on the affected areas
• D. Selenium sulfide shampoo twice weekly to the face

Answer: (A)

This presentation fits seborrheic dermatitis: greasy, thick yellow scales on areas rich in sebaceous glands such as the scalp, forehead, and behind the ears, common in adolescents due to overgrowth of Malassezia yeast and a reactive skin response. The most effective and appropriate treatment is a topical antifungal applied to the affected skin. Ketoconazole 2% cream directly targets the yeast, helping to reduce both the scaling and the inflammation when used regularly, and it is suitable for facial use in teens. Other options have drawbacks. A high-potency topical corticosteroid used daily on the face can thin the skin and cause other side effects with long-term use, making it less desirable for facial lesions. Mineral oil with shampoo on the affected areas won’t address the underlying yeast-driven inflammation. Selenium sulfide shampoo is helpful for scalp flaking but applying it to the face is not ideal and it’s not the standard facial treatment; it doesn’t reliably treat facial seborrhea and scalp-only regimens don’t address all involved areas.

This presentation fits seborrheic dermatitis: greasy, thick yellow scales on areas rich in sebaceous glands such as the scalp, forehead, and behind the ears, common in adolescents due to overgrowth of Malassezia yeast and a reactive skin response. The most effective and appropriate treatment is a topical antifungal applied to the affected skin. Ketoconazole 2% cream directly targets the yeast, helping to reduce both the scaling and the inflammation when used regularly, and it is suitable for facial use in teens.

Other options have drawbacks. A high-potency topical corticosteroid used daily on the face can thin the skin and cause other side effects with long-term use, making it less desirable for facial lesions. Mineral oil with shampoo on the affected areas won’t address the underlying yeast-driven inflammation. Selenium sulfide shampoo is helpful for scalp flaking but applying it to the face is not ideal and it’s not the standard facial treatment; it doesn’t reliably treat facial seborrhea and scalp-only regimens don’t address all involved areas.