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
P/A – no organomegaly
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 –
Occurs in infants
AKA erythroderma desquamativum
It is seen in infants and characterised by severe generalised seborrhoeic dermatitis, recurrent diarrhoea, recurrent skin/internal infection and hence FTT
Can Present at birth but usually occurs within the first few months of life
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:
- Non-inflammatory tines capitis – scaly areas with broken hairs, hair loss and seen in prepubertal children
- Scalp psoriasis – well defined erythematous plaques with silvery scales
- Langerhans cell histiocytosis – the child looks ill and has ulcers in the inguinal and axillary folds with lymphadenopathy and hepatosplenomegaly
- Atopic dermatitis – pruritis is seen, involves the forearms and shin. The eyebrows, Paranasal areas are more severely affected in Seborrhoeic dermatitis
- Candidiasis – satellite pustules seen with erythema and erosions with fringed borders
- Diaper dermatitis – spares the folds and affects the parts covered by the diaper