Neonatal seborrhoeic dermatitis
Background
- Also known as cradle cap, infantile seborrhoeic dermatitis, crusta lactea, milk crust, and honeycomb disease
- Starts between 2-6 weeks of life; improves by 6 months
- The role of malassezia furfur, a non-contagious fungus, in the pathogenesis of neonatal seborrheic dermatitis is unclear
Dermatitis Types
- Atopic dermatitis
- Candida dermatitis
- Cercarial dermatitis
- Contact dermatitis
- Dermatitis herpetiformis
- Diaper dermatitis
- Dyshidrotic dermatitis
- Neonatal seborrhoeic dermatitis
- Nummular dermatitis
- Perianal streptococcal dermatitis
- Perioral dermatitis
- Seborrheic dermatitis
- Stasis dermatitis
Clinical Features
- Greasy yellow-red scales
- Proclivity for scalp (cradlecap), but may find around ears, cheeks, neck, and nasolabial folds
- Not pruritic
- Also axilla and groin where there are significant sebaceous glands
Differential Diagnosis
Neonatal Rashes
- Atopic dermatitis
- Candidiasis
- Diaper dermatitis
- Erythema toxicum neonatorum
- Neonatal acne
- Psoriasis
- Seborrheic dermatitis
- Tinea capitis
- Impetigo
- Contact dermatitis
- Perianal streptococcal dermatitis
- Milia
- Miliaria
- Mongolian spots
- Omphalitis
- Pustular melanosis
- Sucking blisters
Plaques
- Psoriasis
- Bowen disease
- Discoid lupus erythematosus
- Drug eruption
- Erythema annulare centrifugum
- Lichen planus
- Lichen simplex chronicus
- Nummular dermatitis (nummular eczema)
- Parapsoriasis
- Pityriasis rosea
- Seborrheic dermatitis
Evaluation
- Clinical diagnosis
- Consider immunosuppression or HIV in severe or widespread lesions
Neonatal atopic dermatitis vs. seborrhoeic dermatitis
| Category | Neonatal atopic dermatitis | Neonatal seborrhoeic dermatitis |
| Presentation | 1-2 months | 2-6 months |
| Puritic (fussiness) | Yes | No |
Management
- Salicylic acid shampoo (Sebulex) OR
- Application of mineral oil followed by washing and removal of scales with comb
- Avoid topical steroids
Disposition
- Outpatient