Monday, March 28, 2016

Infantile seborrhoeic dermatitis


  • presenting within the first few months postpartum as cradle cap or napkin dermatitis. It sometimes spreads widely via the flexures.
  • most cases eventually resolve spontaneously within weeks to a few months.  Cases persisting beyond the age of 12 months are rare
  • Seborrhoeic dermatitis appears to be an inflammatory response to malassezia yeasts, which proliferate in oily skin (seborrhoea).
  • In infants it is supposed that maternal androgens are responsible.
  • Characteristically, the scale is yellowish and greasy or white and bran-like (pityriasiform) associated with variable nummular or annular pale pink to bright red patches.
  • Itching tends to be absent or mild.
Treatment
  • In infants, seborrheic dermatitis has a self-limited course and resolves spontaneously in weeks to several months.
  • suggest that initial treatment should be conservative, including education and reassurance of parents, and simple skin care measures
  • Application of an emollient (white petrolatum, vegetable oil, mineral oil, baby oil) to the scalp (overnight, if necessary) to loosen the scales, followed by removal of scales with a soft brush (eg, a soft toothbrush) or fine-tooth comb
  • Frequent shampooing with mild, non-medicated baby shampoo followed by removal of scales with a soft brush (eg, a soft toothbrush) or fine-tooth comb
Extensive/Persistent Cases
  • a short course of low-potency topical corticosteroids applied once per day for one week
    • Corticosteroids are preferred if there is a predominant inflammatory component
  • ketoconazole 2% cream or shampoo twice per week for two weeks
    • ketoconazole 2% cream or shampoo is an alternative in diffuse cases or if the use of topical corticosteroids is a concern for the parents.
Non-scalp seborrheic dermatitis
  • ketoconazole 2% cream (once a day for one to two weeks) or a low potency topical corticosteroid (eg, hydrocortisone 1% cream once a day)
  • topical corticosteroids should be limited to the time needed to achieve the clearing of the lesions, but no longer than one week
  • In addition, emolients, topical creams or ointments containing zinc oxide and/or petrolatum may be applied liberally
Other Treatments
  • selenium sulfide 2.5%, zinc pyrithione, salicylic acid
    • no clinical trials evaluating their efficacy and safety in infants.
  • shampoos and ointments containing salicylic acid
    • may result in systemic toxicity because of transcutaneous absorption
Evidence
  • no randomized trials of antifungal agents or topical corticosteroids for the treatment of cradle cap in infants
  • All the studies indicated that the two treatments (topical antifungals and topical corticosteroids)were equally effective
  • use of lower potency topical corticosteroids in children is generally safe when used for short durations.
  • 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
References:
  1. www.uptodate.com
  2. http://www.aafp.org/afp/2006/0701/p125.html
  3. http://www.dermnetnz.org/doctors/dermatitis/seborrhoeic.html

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