Cradle cap and seborrheic dermatitis in infants

Infantile seborrheic dermatitis - Erythematous, scaly plaques on the face and neck of this infant with seborrheic dermatitis.
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SUMMARY AND RECOMMENDATIONS

● Seborrheic dermatitis in infants is a common and self-limited condition most frequently involving the scalp (cradle cap (picture 13)).

● The initial treatment of scalp seborrheic dermatitis includes education, reassurance, and conservative measures (emollients and frequent shampooing) to soften and remove the scales. If conservative measures fail, we suggest either topical low potency corticosteroids (group seven (table 1)) or ketoconazole 2% shampoo or cream (Grade 2C). Topical corticosteroid is applied once per day for one week. Ketoconazole 2% shampoo or cream is used twice per week for two weeks.

● For seborrheic dermatitis of areas other than the scalp, we suggest ketoconazole 2% cream or a low-potency corticosteroid cream (table 1) (Grade 2C). Ketoconazole 2% cream should be applied once a day for one to two weeks. Topical corticosteroid is applied once a day for up to one week.

● For seborrheic dermatitis of the intertriginous areas, we suggest ketoconazole 2% cream or other azole cream (Grade 2C). The azole cream is applied once a day for one to two weeks. In addition, topical creams or ointments containing zinc oxide and/or petrolatum may be applied liberally.

● If the rash does not resolve after one week of corticosteroid therapy or two weeks of antifungal therapy as described above, the diagnosis should be reconsidered (see ‘Differential diagnosis’ above). If the diagnosis of infantile seborrheic dermatitis is confirmed, intermittent courses of treatment may be needed, since the disease may recur for weeks to months before disappearing.

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