An evaluation of the ambulatory diagnosis and treatment of seborrheic dermatitis in PWH in a regional healthcare system

Background: Seborrheic dermatitis is a common inflammatory skin condition which disproportionately impacts persons with HIV (PWH). Non-dermatologists, including primary care and HIV clinicians, are often the first providers to diagnose and manage inflammatory dermatoses. Data is lacking regarding the quality of management of such common dermatoses by non-dermatologist compared to dermatologic specialists. Methods:/ We evaluated the treatment of and referral patterns for seborrheic dermatitis relative to accepted standards of care among outpatient dermatologists and non-dermatologists in a regional healthcare system. Using a cross-sectional design, we analyzed a random sample of 100 persons 18 years or older with a diagnosis of HIV and more than one visit to a regional primary care or HIV clinician with an ICD code for treatment of seborrheic dermatitis. Results: Seborrheic dermatitis was the most common specific inflammatory dermatosis among PWH in the healthcare system. Non-dermatologists were significantly more likely to prescribe one medication compared to dermatologists (62.2% vs. 50.9%, p = 0.05). 28.9% of persons initially diagnosed by a non-dermatologist were referred to a dermatology specialist. When considering immediate initiation of treatment as optimal management, 33/45 (73.3%) of non-dermatologists had optimal management compared with 53/55 (96.4%) of dermatologists (p < 0.01). However, when considering referral as optimal management, then 86.7% of patients initially diagnosed by non-dermatologists were optimally managed. Discussion: Seborrheic dermatitis remains a common issue among PWH in a multispeciality ambulatory setting. Non-dermatologists appear significantly less likely to provide optimal initial management which may affect quality of life given potential for delayed treatment in settings with limited specialists. Additional training should be provided to non-dermatologists to facilitate appropriate treatment of common inflammatory dermatological conditions.