Seborrheic dermatitis

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Seborrheic dermatitis in an infant. Greasy scale and erythema in the scalp.

Greasy, yellow scales and redness of scalp of infant with seborrheic dermatitis.

CLINICAL FEATURES

Seborrheic dermatitis may be seen in the neonate or the adolescent.

In the neonate, focal or diffuse scaling of the scalp (cradle cap) may be the initial and at times only presentation. A greasy, scaly, erythematous dermatitis may involve the face, neck, retroauricular areas, axillae and diaper area. Pruritus is usually not present. The dermatitis may be patchy or focal or spread to involve almost the entire body. In extensive cases it mimics atopic dermatitis. In many instances initially called seborrheic dermatitis, the child develops typical flexural dermatitis with time.

In adolescence, seborrheic dermatitis is usually more localized, frequently affecting only the scalp, but also involving the eyelids, retroauricular areas, external auditory canals, nasolabial folds and flexural areas. Seborrheic dermatitis of the scalp must be differentiated from diffuse scaly tinea capitis due to Trichophyton tonsurans by fungal culture. If thick isolated plaques are present then psoriasis is in the differential. Severe seborrheic dermatitis may be the initial presentation of HIV infection. When associated with failure to thrive and recurrent infections, hereditary immunodeficiencies should be considered. Seborrheic dermatitis with crusted papules and petechiae is seen with Langerhans cell histiocytosis and this presentation requires skin biopsy.

TREATMENT

Low-potency topical steroids applied twice a day are effective.

For infants with severe cradle cap, mineral oil can be applied to the scalp for 5–10 minutes before shampooing with a mild shampoo and then the scale can be gently removed with a soft brush or toothbrush.

Adolescents with chronic scalp involvement will benefit from the use of shampoos containing zinc pyrithione, selenium sulfide or tar.

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