Cradle cap and seborrheic dermatitis in infants
- Denis Sasseville, MD, FRCPC
Denis Sasseville, MD, FRCPC
- Professor of Dermatology and Research Coordinator, Division of Dermatology
- McGill University Health Centre
- Section Editors
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Joseph Fowler, MD
Joseph Fowler, MD
- Section Editor — Dermatitis
- Clinical Professor of Dermatology
- University of Louisville School of Medicine
Seborrheic dermatitis is a self-limiting eruption consisting of erythematous plaques with greasy-looking, yellowish scales distributed on areas rich in sebaceous glands such as the scalp, the external ear, the center of the face, and the intertriginous areas.
This topic will discuss cradle cap and seborrheic dermatitis in infants. Seborrheic dermatitis in adolescents and adults is discussed separately. (See "Seborrheic dermatitis in adolescents and adults".)
Seborrheic dermatitis occurs in infants between the ages of 3 weeks and 12 months. It has been reported in about 10 percent of infants younger than one month . The prevalence peaks at the age of three months (about 70 percent) and decreases steadily in the following months, affecting about 7 percent of children aged one to two years .
The pathogenesis of infantile seborrheic dermatitis is not known. Transplacental transfer of maternal androgens stimulates the growth of the infant's sebaceous glands, which are necessary but not sufficient for the development of seborrheic dermatitis. The role of Malassezia, a lipid-dependent yeast, is not clear; Malassezia colonization has been reported in infants with seborrheic dermatitis, infants with other dermatologic conditions, and in normal infants [3-5].
The most common manifestation of seborrheic dermatitis in newborns and infants is "cradle cap," an asymptomatic and non-inflammatory accumulation of yellowish, greasy scales on the scalp (picture 1A-B). The vertex and the frontal area are commonly involved. Sometimes the eruption starts on the face, with erythematous, scaly, salmon-colored plaques (picture 2). The forehead, the retroauricular areas, eyebrows and eyelids, cheeks, and nasolabial folds are commonly affected (picture 3). Seborrheic dermatitis may also occur in the napkin (diaper) area (picture 4), on the trunk, with a predilection for the umbilical area, or in the intertriginous areas. It also may occur simultaneously at multiple sites (picture 5).To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Sachdeva M, Kaur S, Nagpal M, Dewan SP. Cutaneous lesions in new born. Indian J Dermatol Venereol Leprol 2002; 68:334.
- Foley P, Zuo Y, Plunkett A, et al. The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap). Arch Dermatol 2003; 139:318.
- Ruiz-Maldonado R, López-Matínez R, Pérez Chavarría EL, et al. Pityrosporum ovale in infantile seborrheic dermatitis. Pediatr Dermatol 1989; 6:16.
- Broberg A, Faergemann J. Infantile seborrhoeic dermatitis and Pityrosporum ovale. Br J Dermatol 1989; 120:359.
- Wananukul S, Chindamporn A, Yumyourn P, et al. Malassezia furfur in infantile seborrheic dermatitis. Asian Pac J Allergy Immunol 2005; 23:101.
- Sarkar R, Garg VK. Erythroderma in children. Indian J Dermatol Venereol Leprol 2010; 76:341.
- Al-Dhalimi MA. Neonatal and infantile erythroderma: a clinical and follow-up study of 42 cases. J Dermatol 2007; 34:302.
- Cohen S. Should we treat infantile seborrhoeic dermatitis with topical antifungals or topical steroids? Arch Dis Child 2004; 89:288.
- Wannanukul S, Chiabunkana J. Comparative study of 2% ketoconazole cream and 1% hydrocortisone cream in the treatment of infantile seborrheic dermatitis. J Med Assoc Thai 2004; 87 Suppl 2:S68.
- Brodell RT, Patel S, Venglarcik JS, et al. The safety of ketoconazole shampoo for infantile seborrheic dermatitis. Pediatr Dermatol 1998; 15:406.
- Taieb A, Legrain V, Palmier C, et al. Topical ketoconazole for infantile seborrhoeic dermatitis. Dermatologica 1990; 181:26.
- Morra P, Bartle WR, Walker SE, et al. Serum concentrations of salicylic acid following topically applied salicylate derivatives. Ann Pharmacother 1996; 30:935.