EpistemisSevere or disseminated infantile seborrheic dermatitis
Specialty: Pediatrics.
Why it occurs
- Transient hyperactivity of neonatal sebaceous glands due to persistence of transplacental maternal androgenic hormones
- Fungal colonization by yeasts of the genus Malassezia (formerly Pityrosporum, which proliferate in lipid-rich sebum and trigger an inflammatory response)
- Underlying nutritional or metabolic deficiencies (rare, such as deficiency of essential fatty acids or biotin, associated with erythrodermic forms)
- Primary immunodeficiencies (especially suspicious if it presents in a generalized erythrodermic form and is associated with chronic diarrhea and weight loss, as in Leiner's disease due to deficiency of complement components such as C3 or C5)
Initial workup
The diagnosis of common cradle cap is clinical. In severe, disseminated forms or suspected immunodeficiency: Complete blood count with count of T, B and NK lymphocyte subpopulations. Determination of serum immunoglobulins (IgG, IgA, IgM, IgE). Dosage of complement factors (C3, C4, CH50). Bacteriological and mycological culture of percutaneous exudative lesions. Analysis of fatty acids and biotin levels in plasma if metabolic disorder is suspected.
red flags
Rapid spread that evolves to erythroderma (red, scaly skin on more than 90% of the body surface) with thermal instability (hypothermia or fever); appearance of deep, exudative fissures with signs of secondary bacterial superinfection (impetiginization by Staphylococcus aureus or Streptococcus pyogenes with purulent discharge and yellowish crusts); association with chronic intractable watery diarrhea and weight growth arrest (suggestive of severe immunodeficiency); affectation of the general condition with lethargy or constant irritability.
Standard management
- Sweet almond oil, liquid Vaseline or mineral oil — gentle topical application on scalp scabs to soften them for 30-60 minutes, followed by gentle combing and washing with neutral children's shampoo
- Ketoconazole 2% in cream or shampoo — topical imidazole antifungal of choice; apply 1-2 times a day for a maximum of 2 weeks
- Hydrocortisone 1% cream — very low potency corticosteroid, indicated only in highly inflamed areas for a strict period of 3-5 days to avoid systemic side effects due to percutaneous absorption
- Systemic antibiotics such as Cloxacillin or Amoxicillin-Clavulanic Acid (indicated only in case of obvious bacterial superinfection; dose of amoxicillin-clavulanic acid of 40-50 mg/kg/day divided every 8 hours orally).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Pediatrics
- Listed causes
- 4
- Treatment options
- 4