Pictorial case study: Infantile seborrhoeic dermatitis of the scalp

The case
A mother brought her six-week-old baby to the surgery concerned about raised scaly patches on his scalp, which had appeared in the previous week. The baby was otherwise well and thriving.

On examination, there were greasy yellow scaly patches in the skin of the scalp. What is the diagnosis, management and differential diagnosis? 

Diagnosis and management
The diagnosis is infantile seborrhoeic dermatitis of the scalp, or cradle cap, which occurs in almost half of all babies, and may appear in the eyebrows as well as on the head. Babies who have cradle cap are more likely to have eczema later. Management in severe cases is to massage olive or baby oil into the scaly area overnight, followed by washing with a mild shampoo the following day.

Possible different diagnosis

  • Tinea capitis (fungal infection of the scalp).
  • Eczema.

Differential diagnosis
Tinea capitis:

  • Is a dermatophyte infection of the scalp.
  • Mainly affects children, is contagious and may be epidemic.
  • Round patches of dry scale appear on the scalp, and there may be alopecia.
  • Treatment is with a topical antifungal agent.

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire

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