Cradle Cap

Aka: Cradle Cap, Pediatric Seborrheic Dermatitis, Seborrheic Dermatitis in the Infant, Pityriasis Capitis

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II. Epidemiology

  1. Begins in first month of life

III. Pathophysiology

  1. Idiopathic (Malassezia furfur Skin Infection, and hormonal changes have been considered)

IV. Symptoms

  1. No Pruritus (unlike in adults)

V. Signs

  1. Scalp (Cradle Cap)
    1. Diffuse or focal thick greasy Scaling and crusting dermatitis
    2. No weeping or oozing
  2. Face, Eyebrows, Neck, Retro-auricular, Axillae (flexural folds and intertriginous areas)
    1. Dry, scaly, erythematous Papules
    2. Non-pruritic
  3. Diaper involvement
    1. See Diaper Rash for differential diagnosis

VI. Associated Conditions

  1. Immunodeficiency presentation (Leiner's Disease)
    1. Diarrhea
    2. Failure to Thrive
    3. Seborrheic Dermatitis

VII. Differential Diagnosis

  1. Atopic Dermatitis (contrast with onset in first month of a non-pruritic rash in Seborrhea)
  2. Langerhans Cell Histiocytosis
  3. Scabies
  4. Vitamin Deficiency
    1. Riboflavin deficiency
    2. Biotin Deficiency
    3. Pyridoxine Deficiency

VIII. Management: General Measures

  1. Be conservative as this is a benign condition that resolves spontaneously
    1. Measures listed below are purely cosmetic (do not alter course)
  2. Wet Compresses (Saline) to affected area
  3. Soft brush (e.g. ToothBrush) with Mineral Oil or petrolatum (e.g. vaseline) to remove scales from scalp
    1. May then wash with baby Shampoo
  4. Anti-seborrheic Shampoo (severe cases)
    1. Selenium Sulfide 1-2.5%
      1. Safety presumed but not established in infants
    2. Ketoconazole 2%
      1. Cream: apply to scalp 3 times weekly
      2. Shampoo: lather and rinse after 3 minutes, repeating 3 times weekly
      3. Brodell (1998) Pediatr Dermatol 15(5):406-7 +PMID:9796598 [PubMed]
  5. Other measures for inflammatory lesions
    1. Hydrocortisone 0.5 - 1%

IX. Course

  1. Self limited and resolves within first few months of life
  2. May persist in up to 8% of cases
    1. Mimouni (1995) J Pediatr 127: 744-6 [PubMed]

X. References

  1. Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
  2. Scwartz (2006) Am Fam Physician 74:125-30 [PubMed]
  3. Janniger (1993) Cutis 51:233-5 [PubMed]

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