II. Epidemiology
- Begins in first month of life
III. Pathophysiology
- Idiopathic (Malassezia furfur Skin Infection, and hormonal changes have been considered)
IV. Symptoms
- No Pruritus (unlike in adults)
V. Signs
- Scalp (Cradle Cap)
- Diffuse or focal thick greasy Scaling and crusting dermatitis
- No weeping or oozing
- Face, Eyebrows, Neck, Retro-auricular, Axillae (flexural folds and intertriginous areas)
- Dry, scaly, erythematous Papules
- Non-pruritic
- Diaper involvement
- See Diaper Rash for differential diagnosis
VI. Associated Conditions
- Immunodeficiency presentation (Leiner's Disease)
VII. Differential Diagnosis
- Atopic Dermatitis (contrast with onset in first month of a non-pruritic rash in Seborrhea)
- Langerhans Cell Histiocytosis
- Scabies
-
Vitamin Deficiency
- Riboflavin deficiency
- Biotin Deficiency
- Pyridoxine Deficiency
VIII. Management: General Measures
- Be conservative as this is a benign condition that resolves spontaneously
- Measures listed below are purely cosmetic (do not alter course)
- Wet Compresses (Saline) to affected area
- Soft brush (e.g. ToothBrush) with Mineral Oil or petrolatum (e.g. vaseline) to remove scales from scalp
- May then wash with baby Shampoo
- Anti-seborrheic Shampoo (severe cases)
- Selenium Sulfide 1-2.5%
- Safety presumed but not established in infants
- Ketoconazole 2%
- Cream: apply to scalp 3 times weekly
- Shampoo: lather and rinse after 3 minutes, repeating 3 times weekly
- Brodell (1998) Pediatr Dermatol 15(5):406-7 +PMID:9796598 [PubMed]
- Selenium Sulfide 1-2.5%
- Other measures for inflammatory lesions
- Hydrocortisone 0.5 - 1%
IX. Course
- Self limited and resolves within first few months of life
- May persist in up to 8% of cases
X. References
- Claudius and Behar in Herbert (2020) EM:Rap 20(8): 5-7
- Scwartz (2006) Am Fam Physician 74:125-30 [PubMed]
- Janniger (1993) Cutis 51:233-5 [PubMed]