Common Cases

Cradle Cap

A 2 months old female baby was brought by the mother to the OPD with complaints of whitish scaly lesion over the scalp and redness over the groin folds for the past 3 weeks.

The child is not irritable. Feeds well

No history of any pustules or erosions in the groin folds

No history of involvement of any other site

No history of fever

No family history of atopic disorders

 

O/e the baby is calm, not irritable

A febrile

No lymphadenopathy 

P/A – no organomegaly

On D/E

Greasy yellowish scales and crusts noted in the scalp, more over the vertex and frontal area, not extending beyond the hairline

Erythema with minimal scaling noted over the groin and gluteal folds; no pustules are seen

Face/axillary folds/neck – normal

Hair/Nail/mucosa/genitals – normal

Impression – Infantile seborrhoeic dermatitis/cradle cap

Cradle cap or pityriasis capitis

– is infantile seborrhoeic dermatitis(ISD) affecting the scalp

MC seen in infants aged between 3 weeks and 8months (peak at 3 months age)

Clinically there is a non-inflammatory eruption of greasy scales on the scalp. The vertex and frontal areas are most commonly affected and it is not usually pruritic and the infants are generally well and not-irritable.

ISD – the scalp and the diaper areas are the firsts to be involved followed by the face, retro-auricular fold, neck and axillary folds.

ISD spontaneously resolves – usually by 8 months age but occasionally the rash may spread and become generalised – earlier this was called as Leiner’s disease

Leiner’s disease – 

  1. Occurs in infants

  2. AKA erythroderma desquamativum

  3. It is seen in infants and characterised by severe generalised seborrhoeic dermatitis, recurrent diarrhoea, recurrent skin/internal infection and hence FTT

  4. Can Present at birth but usually occurs within the first few months of life

  5. Precise cause – not known; sometimes associated with familial complement C5 deficiency.

Cradle cap is benign and self-limiting. It usually resolves without intervention over the course of weeks to several months.

Mild and localised disease – emollients or shampooing with removal of scales

More extensive disease or resistant disease may require low potency topical steroids(if there is inflammatory component) and Azoles like 2% ketoconazole

Differential diagnosis for Infantile seborrhoeic dermatitis:

  1. Non-inflammatory tines capitis – scaly areas with broken hairs, hair loss and seen in prepubertal children
  2. Scalp psoriasis – well defined erythematous plaques with silvery scales
  3. Langerhans cell histiocytosis –  the child looks ill and has ulcers in the inguinal and axillary folds with lymphadenopathy and hepatosplenomegaly
  4. Atopic dermatitis – pruritis is seen, involves the forearms and shin. The eyebrows, Paranasal areas are more severely affected in Seborrhoeic dermatitis
  5. Candidiasis – satellite pustules seen with erythema and erosions with fringed borders
  6. Diaper dermatitis – spares the folds and affects the parts covered by the diaper
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