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The pathogenic role of microbes in seborrheic dermatitis.

To the Editor.— The review of skin infections in the immunocompromised host in a recent issue of theArchives 1 omitted what is probably the most common example of that occurrence, ie, the frequent appearance of seborrheic dermatitis in patients with the acquired immunodeficiency syndrome (AIDS). 2 Despite the objections that have been expressed about the role of microbes in the pathogenesis of seborrheic dermatitis, 3 there is now over-whelming evidence in favor of microbes playing a pathogenic role, 4-8 and a recent reviewer has declared the argument ended. 9 In our own experience, AIDS-related seborrheic dermatitis is associated with large numbers of Malassezia organisms on affected sites and responds rapidly to treatment with 2% ketoconazole cream, thus providing further evidence of a microbial origin. 10