Seborrheic dermatitis (cradle cap) often causes cracking and scaling in the crease behind the ear as well as involving the face and scalp. This image displays red, scaling, slightly elevated lesions with a yellowish-white, greasy appearance typical of seborrheic dermatitis in infants. Seborrheic dermatitis can cause redness on the face. Seborrheic dermatitis can be severe, involving many skin areas. Seborrheic dermatitis often involves body folds, such as the armpits, in infants. Seborrheic dermatitis can have pink, scaly, slightly elevated lesions, typically involving the head and neck. Seborrheic dermatitis can also have small bumps (papules) on infants.  In infants with darker skin, the inflammation in seborrheic dermatitis can lead to lightening of the skin (hypopigmentation).
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Seborrheic Dermatitis (Pediatric)  A parent's guide for infants and babies

Picture of Seborrheic Dermatitis (Pediatric): Seborrheic dermatitis (cradle cap) often causes cracking and scaling in the crease behind the ear as well as involving the face and scalp. Divider line
Seborrheic dermatitis (cradle cap) often causes cracking and scaling in the crease behind the ear as well as involving the face and scalp.
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Overview
Seborrheic dermatitis in infants is a common non-contagious condition of skin areas rich in oil glands (eg, the face, scalp, and upper trunk). Seborrheic dermatitis is marked by overproduction of skin cells (leading to flaking) and sometimes inflammation (leading to redness and itching). It varies in severity from mild dandruff of the scalp to scaly, red patches on the skin. The normal skin yeast, Pityrosporum ovale, lives in oil-rich skin regions and plays a role in this disorder.
Who's At Risk
  • Seborrheic dermatitis is most often seen in newborns and infants up to 6 months of age.
  • Seborrheic dermatitis typically resolves by 6–12 months of age.
  • Severe seborrheic dermatitis may be associated with immunocompromised diseases.
Signs and Symptoms
In newborns and infants, seborrheic dermatitis tends to affect the scalp (often called cradle cap) and body folds.
  • The scalp is itchy and sheds white, oily skin flakes. When severe, the scalp can have dense, thick, adherent yellow scale and crust.
  • One or more of the following areas has patches of red, scaly skin: the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, breastbone, midback, groin, and armpit. In people with darker skin, some of the areas might look circular or lighter in color.
The condition may be:
  • Mild – only some flaking and redness in a few small areas.
  • Moderate – several areas affected with bothersome redness and itch.
  • Severe – large areas of redness, severe itch, and unresponsive to self-care measures.
Self-Care Guidelines
Most cases of seborrheic dermatitis are easy to control with non-prescription home measures. These include the following:
  • Frequent (daily) shampooing or a longer lather time.
  • Consider using shampoos containing ketoconazole, selenium sulfide, 2% pyrithione zinc, or salicylic acid or tar-based shampoos. Sometimes one will work well for a time and then become less helpful; then, it may help to switch to a different type.
  • Eyelid changes (blepharitis) can often be managed by gentle cleaning of the edges of the eyelids, by the lashes, with Q-tips® and baby shampoo.
Scale on the scalp can be removed. Apply warm oil (be careful not to apply oil that is too hot for your baby's skin) to the scalp for a few hours. Before bathing your baby, gently rub his/her scalp with a soft bristle baby brush, and then wash hair with a shampoo listed above. Be careful not to get it in the baby's eyes.

Some over-the-counter creams will help if the medicated shampoo is not quite good enough. These can be added to the shampoo; use until you notice improvement, and then use should be discontinued. These include:
  • Creams that reduce the Pityrosporum yeast (clotrimazole, miconazole, terbinafine)
  • Hydrocortisone cream may work rapidly but may be less helpful if used for a long time.
When to Seek Medical Care
See your child's doctor or a dermatologist if there is no response to self-care measures.
Treatments Your Physician May Prescribe
Sometimes, in addition to the self-care suggestions, a prescription shampoo or mild corticosteroid cream or solution may be given.



References

Bolognia, Jean L., ed. Dermatology, pp.215-218. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1198, 1200, 1374. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008