What should be done for a patient with biopsy-proven seborrheic dermatitis on the scalp and central forehead (presenting as a large annular scaly thin plaque) who has failed treatment with fluconazole, antifungal creams, and Zoryve (which is too expensive)?

I don't think dupilumab is reasonable for seborrheic dermatitis. For seborrheic dermatitis, I'd typically prescribe a potent topical steroid in a vehicle the patient prefers and have them use it twice a day for just 3 days (along with ketoconazole or other medicated shampoo). Adherence to topical treatment-- especially on the scalp-- is very difficult, but patients will often use the treatment well if they think it is just for 3 days. When they see it work, they can continue using it as needed.

The large annular, scaly, thin plaque appearance raises the possibility of tinea infection. I'd want to rule that out. Failing fluconazole makes it less likely, but I'd want to know that a PAS stain was done on the biopsy.