Rosh Emergency Medicine Practice Test

What is the best next step in managing a patient diagnosed with seborrheic dermatitis?

1. Phototherapy

2. Selenium sulfide shampoo

3. Topical ketoconazole 2% cream

4. Topical permethrin cream

The correct answer is: Selenium sulfide shampoo

The best next step in managing a patient diagnosed with seborrheic dermatitis is the use of selenium sulfide shampoo. Seborrheic dermatitis is a common, chronic inflammatory skin condition often affecting areas with a high density of sebaceous glands, such as the scalp, face, and upper back. It is characterized by red, flaky, greasy patches on the skin. Selenium sulfide is effective because it has antifungal properties that can reduce the overgrowth of Malassezia yeast, which is associated with seborrheic dermatitis. The shampoo form allows for direct application on the scalp, which is a typical area affected by this condition. Regular use can help control the scaling and itching associated with seborrheic dermatitis. In contrast, while topical ketoconazole 2% cream is also an effective antifungal treatment and can be used for seborrheic dermatitis, it is generally prescribed in cream or lotion form for affected areas other than the scalp. Phototherapy is often reserved for more severe dermatitis or resistant cases and may not be the most immediate or practical option. Topical permethrin cream is primarily used for scabies and lice treatment and is not appropriate for seborrheic dermatitis management. Thus, selenium sulfide shampoo