skip to main content

Refractory Seborrhoeic Dermatitis HIV — SCE Infectious Diseases MCQ

Instant feedback + full explanation. One question, done properly.

ModerateHIV MedicineRefractory Seborrhoeic Dermatitis HIVSCE Infectious Diseases

A 35-year-old man with HIV on ART develops severe seborrhoeic dermatitis affecting his scalp, face, and chest. Standard topical treatments (Ketoconazole shampoo, mild topical steroid) have been tried. What second-line approach is available for refractory seborrhoeic dermatitis in HIV?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Topical Calcineurin inhibitors (Tacrolimus 0.1% or Pimecrolimus 1%) — steroid-sparing agents effective for facial seborrhoeic dermatitis without the skin atrophy risk of prolonged topical steroids

Topical Calcineurin inhibitors (TCIs — Tacrolimus, Pimecrolimus) are effective second-line agents for facial seborrhoeic dermatitis, particularly valuable when prolonged topical steroid use risks skin atrophy (face, flexures). They modulate T-cell activation without the atrophic effects of corticosteroids. For scalp disease: alternating Ketoconazole and coal tar shampoos, with topical Betamethasone scalp application for flares. Systemic antifungals (oral Itraconazole) may be considered for severe/widespread disease but carry hepatotoxicity risk. The underlying driver (Malassezia) is not eradicated — management is long-term/chronic.

Reference: BAD 2023 – Seborrhoeic dermatitis; NICE CKS 2024; BHIVA 2022