Understanding Sebopsoriasis: Navigating the Clinical Overlap of Dermatoses

Announcer Introduction
You’re listening to DermConsult on ReachMD. On this episode, we’ll hear from Dr. Raj Chovatiya, who’s a Clinical Associate Professor at the Rosalind Franklin University Chicago Medical School and Founder and Director of the Center for Medical Dermatology and Immunology Research. He’ll be discussing overlapping seborrheic dermatitis and psoriasis. Here’s Dr. Chovatiya now.

Dr. Chovatiya:
So there's always been this concept and idea in dermatology that some patients have sebopsoriasis—or co-occurrence of seborrheic dermatitis and psoriasis—putting these conditions on a similar immunologic but also overlapping plane for someone who has scaling, flaking, and itch on the scalp, on the ears, and on the face. And there's increasing evidence of this co-occurrence in certain immunocompromised populations. So it really helps to set the stage for how we might better understand overlap of these skin conditions and whether this concept of sebopsoriasis is just lazy diagnosis or truly a common overlap.

With seborrheic dermatitis, the distinguishing features you're going to be thinking about clinically are a greasy, almost yellowish type of scale that's quite flaky as well as redness that's going to typically occur in what we describe as sebaceous areas. So this includes the face, forehead, eyebrows, nasolabial folds, mustache and beard region, the preauricular, the postauricular, and even in the ears itself, as well as the underarms, the groin folds, or even the central chest region as well. Typically, seborrheic dermatitis is going to be a bit more diffuse and flaky as opposed to thick, concrete, well-defined plaques.

This is where psoriasis comes in. With psoriasis, commonly, what you're going to be seeing is a thicker, more well-defined plaque—a silvery scale. Oftentimes, even if you scratch some of that scale, you might see a little bit of bleeding. And then other systemic associations. We don't really have a good handle on seborrheic dermatitis’ increases in certain comorbid risks. But with psoriasis, we do know, for instance, psoriatic arthritis is oftentimes a very common comorbidity that can affect patients.

And when thinking about diagnosis, it can be really difficult, especially in areas where there's a lot of overlap in terms of morphology. The scalp is a big problem oftentimes. Misdiagnosis can occur, even on other areas of the face, especially if you're dealing with milder, more diffuse psoriasis where it's not this very well-defined plaque and you're also dealing with uncontrolled seborrheic dermatitis. So that's one of the reasons why this concept of sebopsoriasis is oftentimes the moniker put on areas where you can't really tell between one or the other, but you're making this clinical assumption that there's a couple things going on.

So there really isn't a formal consensus. I think that more and more people are aware that this type of inflammatory picture is actually much more common than we realize, and really a lot of our scalp dermatoses are just really darn difficult to treat. So sebopsoriasis can be a helpful term if you're really getting hung up on what you are seeing, especially if you need to define that to be able to take the next step to treatment.

Announcer Close
That was Dr. Raj Chovatiya talking about our approach to overlapping psoriasis and seborrheic dermatitis. To access this and other episodes in our series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!