When should I consider referring a patient with seborrhoeic dermatitis

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

You should consider referring a patient with seborrhoeic dermatitis to a dermatologist in several key situations:

Severity and Extent: Refer if the seborrhoeic dermatitis is severe or widespread . For infants and children, this includes severe, extensive, or recalcitrant disease .
Diagnostic Uncertainty: Referral is appropriate if there is uncertainty regarding the diagnosis .
Treatment Failure: Consider referral if the condition fails to respond to routine treatment . This also applies if first-line treatments are ineffective . For infants and children, this includes recalcitrant disease .
Eyelid Involvement: If simple eyelid hygiene measures have been unsuccessful for eyelid involvement, consider referring the patient to dermatology .
Suspected Underlying Conditions: Referral is necessary if extensive or severe disease may be associated with immune deficiency, to identify a possible serious underlying cause . Generalized seborrhoeic dermatitis in otherwise healthy children is uncommon and may be associated with immune deficiencies such as HIV .
Need for Specialist Treatment: Referral is indicated if systemic therapy may be required for widespread or refractory lesions . Additionally, treatment with calcineurin inhibitors should not be initiated in primary care without specialist advice due to possible adverse effects and off-label indication .

When should I consider referring a patient with seborrhoeic dermatitis to a dermatologist?