Bilateral Auricular Seborrheic Dermatitis in a Young Adult Male

Case at a Glance

A 23-year-old male presents with a 3-month history of bilateral scaling and pruritic lesions in the retroauricular areas, clinically consistent with seborrheic dermatitis. Patient reports social embarrassment affecting grooming habits and seeks over-the-counter treatment options.

Patient's Story

The patient developed progressive scaling and itching behind both ears over approximately 3 months. He describes daily pruritus that has significantly impacted his quality of life, causing him to avoid professional grooming services due to embarrassment about the visible skin condition. The patient has been using ketoconazole 1% shampoo (Nizoral) without significant improvement. He recently purchased hydrocortisone 1% cream specifically marketed for seborrheic dermatitis and seeks guidance on proper application and routine.

Initial Assessment

Physical examination reveals bilateral retroauricular scaling and erythematous patches consistent with seborrheic dermatitis. The lesions are localized to the area behind both ears without extension to other typical seborrheic zones. Patient reports no systemic symptoms and denies similar lesions elsewhere on the body.

The Diagnostic Journey

Based on the characteristic appearance of scaling, erythematous patches in the retroauricular distribution, along with the patient's symptom description and response pattern, the clinical presentation is most consistent with localized seborrheic dermatitis. The bilateral nature and typical location support this diagnosis.

Final Diagnosis

Bilateral retroauricular seborrheic dermatitis

Treatment Plan

Current regimen includes ketoconazole 1% shampoo with limited efficacy. Patient has initiated hydrocortisone 1% cream therapy. Recommended approach includes gentle cleansing of affected areas, application of topical antifungal agents, and short-term use of mild topical corticosteroids. Patient education on proper application technique and treatment expectations provided.

Outcome and Follow-up

Patient advised to continue current treatment regimen with proper application technique. Follow-up recommended if symptoms persist or worsen after 2-3 weeks of consistent therapy. Patient counseled on the chronic nature of seborrheic dermatitis and the importance of maintenance therapy to prevent recurrence.