HPI: This healthy 16 yo has had a 4 cm roughley circular plaque on the mid-forehead. Takes no medications by mouth and is not aware of any OTC meds taken infrequently, She has bued 1% hydrocortisone cream and also a topical imidazole without improvement.
O/E: The lesion has fairly sharp borders. The surface is somewhat gready. KOH prep failed to demonstrate hyphae or spores. The remainder of the cutaneous examination is unremarkable.
Diagnosis: The picture is suggestive of seborrheic dermatitis, but the circular nature is unusual. What are your thoughts?
Plan: Betamethasone valerate 0.1% cream b.i.d. x 2 weeks sand then Elidel cream. If it does not respond or if it recurs a biopsy will be done.