Peds

Cradle Cap

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

  • See Also
  • Epidemiology
  1. Begins in first month of life
  • Pathophysiology
  1. Idiopathic (Malassezia furfur Skin Infection, and hormonal changes have been considered)
  • Symptoms
  1. No Pruritus (unlike in adults)
  • Signs
  1. Scalp (Cradle Cap)
    1. Diffuse or focal thick greasy Scaling and crusting dermatitis
    2. No weeping or oozing
  2. Face, 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
  • Associated Conditions
  • 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
  • Management
  • General Measures
  1. Be conservative as this is a benign condition that resolves spontaneously
    1. Measures listed below are purely cosmetic
  2. Wet Compresses (Saline) to affected area
  3. Soft brush to remove scales from scalp
  4. Anti-seborrheic Shampoo
    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
  5. Other measures for inflammatory lesions
    1. Hydrocortisone 0.5 - 1%
    2. Zinc Pyrithione 0.025% qd to qid
      1. Supplier: DermaZinc 800-753-0047
  • 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]