Confusable diagnoses · PANCE / PANRE

Seborrheic Dermatitis vs Psoriasis

Seborrheic Dermatitis and Psoriasis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.

Seborrheic Dermatitis vs Psoriasis at a glance

  • Seborrheic Dermatitis: Chronic relapsing dermatitis of sebum-rich areas associated with Malassezia overgrowth; manifests as cradle cap (infants) and dandruff (adults).
  • Psoriasis: Chronic immune-mediated inflammatory disorder with well-demarcated erythematous plaques and silvery scale; systemic comorbidities.
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Side-by-side comparison

FeatureSeborrheic DermatitisPsoriasis
At a glanceChronic relapsing dermatitis of sebum-rich areas associated with Malassezia overgrowth; manifests as cradle cap (infants) and dandruff (adults).Chronic immune-mediated inflammatory disorder with well-demarcated erythematous plaques and silvery scale; systemic comorbidities.
Classic presentationGreasy yellow scale on erythematous base in sebaceous distribution; nasolabial fold involvement; postauricular fissures.; Mild pruritus or burning, especially scalp; Visible scaling and erythema, often worse in winter; Cosmetic concern, embarrassment; Scalp: fine flaky to thick greasy yellow scale; diffuse or patchy; erythema; Face:…Auspitz sign (pinpoint bleeding after scale removal); Koebner phenomenon (plaques at sites of trauma); silvery micaceous scale.; Pruritus (often less intense than eczema), burning, soreness; Joint pain, stiffness (PsA) — morning stiffness, dactylitis, enthesitis; Psychosocial impact, depression, sexual dysfunction; Plaque psoriasis…
Workup / key labsClinical: scaling and erythema in characteristic sebaceous distribution with chronic relapsing course.; Clinical diagnosis; Consider HIV testing if sudden, severe, or refractory disease, especially in young adults; KOH preparation if tinea or pityriasis versicolor cannot be excluded; Skin biopsy rarely needed; shows spongiosis with…Clinical diagnosis based on lesion morphology and distribution; severity by BSA, PASI, and impact (DLQI). Mild: BSA <3%; moderate: 3-10%; severe: >10% OR involvement of face, palms/soles, genitals, or nails with disability.; Clinical diagnosis; Skin biopsy if diagnosis uncertain: parakeratosis, Munro microabscesses, regular acanthosis,…
ImagingNot indicatedNot routinely indicated for skin disease; Joint X-rays/MRI for suspected PsA: 'pencil-in-cup' deformity, periostitis, ankylosis
First-line treatmentAdult scalp (dandruff/mild-moderate): ketoconazole 2% shampoo, selenium sulfide 2.5% shampoo, zinc pyrithione 1-2% shampoo, ciclopirox 1% shampoo, or coal tar shampoo — 2-3x/week, lather and leave on 5 min before rinsing; Adult scalp (severe/plaque): high-potency topical corticosteroid solution/foam — clobetasol 0.05%, fluocinonide —…Mild-moderate (limited BSA): topical corticosteroid potency by site — clobetasol 0.05% (high; trunk/extremities, 2 wks then taper), triamcinolone 0.1% (mid), hydrocortisone 1-2.5% (face/folds); Topical vitamin D analogues — calcipotriene/calcipotriol, calcitriol — often combined with steroid (calcipotriene/betamethasone foam, ointment);…

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Educational use only. This outline is a study aid for PA students and is not medical advice or a substitute for clinical judgment. FirstPassPA is an independent study tool and is not affiliated with, endorsed by, or sponsored by NCCPA or PAEA. PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants; End of Rotation™ is a program of the Physician Assistant Education Association.