Seborrheic dermatitis in Infant/Neonate
See also in: Anogenital,Hair and ScalpAlerts and Notices
Synopsis
Infantile seborrheic dermatitis usually manifests in the second week of life and lasts 4-6 months. It has no racial / ethnic or sex predilection. It characteristically presents on the face, diaper area, and folds of the neck and axillae.
The pathophysiology of infantile seborrheic dermatitis is not well known. However, many factors have been postulated to influence its development. Maternal androgens, transferred to the baby in utero, are thought to result in overactive sebaceous gland activity. In addition, the yeast Malassezia has been implicated.
Codes
ICD10CM:L21.9 – Seborrheic dermatitis, unspecified
SNOMEDCT:
50563003 – Seborrheic dermatitis
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Differential Diagnosis & Pitfalls
The most difficult diagnoses to separate from infantile seborrheic dermatitis are atopic dermatitis and irritant contact dermatitis. Atopic dermatitis more often involves the scalp, cheeks, and extensor surfaces and is associated with a family history of other atopic conditions (asthma, allergic rhinitis). It is usually accompanied by moderate-to-severe pruritus that interferes with sleep and feeding, whereas infantile seborrheic dermatitis is asymptomatic. Irritant contact dermatitis (diaper dermatitis) caused by the irritant effects of urine and feces typically spares the deep body folds for lack of contact with the skin.Psoriasis is extremely uncommon in neonates and infants. However, familial and genetically determined forms of psoriasis and other psoriasiform dermatitis do characteristically present with infantile psoriasis involving a similar distribution. The scaling is thicker in nonoccluded areas and plaques are better defined.
When localized in the diaper area, dermatoses to consider besides irritant contact dermatitis:
- Candidiasis
- Psoriasis – consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis
- Allergic contact dermatitis
- Tinea cruris - rare in infancy
- Intertrigo
- Langerhans cell histiocytosis
- Scabies
- Kawasaki disease
- Sexual abuse
- Acrodermatitis enteropathica
- Lichen sclerosus
- Perianal streptococcal infection
- Congenital syphilis
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:03/07/2023
Last Updated:04/06/2023
Last Updated:04/06/2023
Patient Information for Seborrheic dermatitis in Infant/Neonate
Overview
Seborrheic dermatitis in infants is a common condition of skin areas rich in oil glands (including the face, scalp, and upper trunk). Overproduction of skin cells leads to flaking and sometimes inflammation, with color changes to the skin and itching. In lighter skin colors, the affected area may be pink or red. In darker skin colors, the affected area may be pinkish, purplish, dark brown, or gray, or some of the patches might look lighter in color (hypopigmented).Seborrheic dermatitis varies in severity from mild dandruff of the scalp to scaly patches on the skin. The normal skin yeast Pityrosporum ovale lives in oil-rich skin regions and plays a role in this disorder.
Cradle cap is the common name for seborrheic dermatitis affecting the scalp of newborns. It is often seen in babies up to age 3 months. The skin becomes flaky and inflamed, sometimes with a yellowish scale. If the scale is picked off, the skin underneath will look pink, red, or dark brown. Cradle cap is not serious, but the areas can become infected if not treated properly.
Any baby can develop cradle cap. It is not contagious and does not occur because of poor hygiene.
Who’s At Risk
- Seborrheic dermatitis is most often seen in newborns and infants up to age 6 months.
- Seborrheic dermatitis typically resolves by age 6-12 months.
- Severe seborrheic dermatitis may be associated with a disease that causes a lowered immune system (immunodeficiency).
Signs & Symptoms
In newborns and infants, seborrheic dermatitis is seen on the scalp (most commonly known as cradle cap) and body folds.- The scalp is itchy and sheds white, oily skin flakes. When severe, the scalp can have thick, yellow scale and crust.
- One or more of the following areas has patches of red, purplish, brown, gray, or whitish scaly skin: the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, breastbone, midback, groin, and underarms.
- In people with darker skin, some of the patches might look lighter in color (hypopigmented).
- Mild – only some flaking and skin color change (as outlined above) in a few small areas.
- Moderate – several areas affected with bothersome skin color change and itch.
- Severe – large areas of skin color change, severe itch, and shampoos do not reduce scales.
Self-Care Guidelines
Scales 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 their scalp with a soft bristle baby brush, and then wash the hair with a gentle shampoo (eg, Johnson's Baby Shampoo) or an over-the-counter antidandruff shampoo, such as a shampoo containing 2% zinc pyrithione (Head & Shoulders). Be careful not to get medicated shampoo in the baby's eyes.Some over-the-counter creams will help if the medicated shampoo is not working well enough. These are often added to the shampoo until you notice improvement. You can stop using them and then start using them again temporarily as needed. These include:
- Creams that reduce the Pityrosporum yeast (clotrimazole [Lotrimin], miconazole [Monistat]).
- Hydrocortisone (eg, Cortaid) cream.
When to Seek Medical Care
See your child's medical professional or a dermatologist if there is no response to self-care measures.Be sure to call your child's medical professional if the seborrheic dermatitis looks inflamed and oozes or if your baby has a fever. These could be signs of an infection.
Treatments
Your child's medical professional may recommend a prescription shampoo. If your baby's skin is very inflamed, they may prescribe a mild corticosteroid cream or solution. If your baby has a skin infection, they will prescribe antibiotics.Seborrheic dermatitis in Infant/Neonate
See also in: Anogenital,Hair and Scalp