Seborrheic dermatitis represents a spectrum ranging from localized lesions to generalized exfoliative erythroderma. All ages are affected. Lesions have an erythematous base with a yellow, greasy scale. The scalp, external auditory canal, postauricular ear, eyebrows, eyelids, and face (especially the nasolabial folds) are common locations. Infants can have lesions at the above sites, but focal and confluent lesions are most common on the scalp and called “cradle cap.” Atypical presentations can occur in the axillae, umbilicus, chest, and inguinal folds.
Management and Disposition
Seborrheic dermatitis is a lifelong disease and has no cure; management is directed at control. Localized cases are effectively treated with topical steroids. Scalp involvement can be treated with selenium sulfide, ketoconazole, or zinc pyrithione shampoos. Parents of affected infants should be reassured that infantile seborrheic dermatitis is self-limited and can be controlled. Refer to a dermatologist for confirmation of diagnosis and chronic care.
Seborrheic Dermatitis. Erythema and yellow-orange scales and crust on the scalp of an infant (“cradle cap”). Eczematous lesions are also present on the arms and trunk. (Used with permission from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology. 5th ed. New York, NY: McGraw Hill; 2005: 51.)
Seborrheic Dermatitis. Intense erythema on the forehead and cheeks. (Photo contributor: David Effron, MD.)
Seborrheic Dermatitis. Typical erythematous, scaling patches on the pinna and conchal bowl. Note also similar lesions on the anterior and posterior hairlines. (Photo contributor: J. Matthew Hardin, MD.)
In an adult, new-onset, severe, or prolonged seborrheic dermatitis may indicate a new HIV infection or immunosuppression.
Although there is no cure, reassure patients the rash can be well controlled with topical medications.
In infants, seborrheic dermatitis can appear indistinguishable from Langerhans cell histiocytosis. Always have a clear discharge plan to follow up with a pediatrician or dermatologist.