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INFANTILE SEBORRHEIC DERMATITIS
Etiology and pathogenesis

The existence of infantile seborrheic dermatitis as a distinct entity

Figure. 6.80  Grover disease. (a) This older man presented with very pruritic papulovesicles on the abdomen and trunk, which proved to be Grover disease. (b) Close-up view of the crusted erythematous papules.

Figure. 6.81  Papuloerythroderma of Ofuji. (a,b) The deckchair sign is the appearance of horizontal bands of erythema separated by normal skin. The normal skin occurs in the folds made by bending forward.

has been questioned recently, although some authors have reported changes in density of Pityrosporum yeasts, as in the adult variant. Cradle cap may be a form of seborrheic dermatitis. The onset is from 2 weeks to 6 months.

Clinical
In seborrheic dermatitis of infants, the groin is red and scaly, with prominent involvement of the flexures (in contrast to diaper dermatitis). The scalp is frequently red and scaly. Axillary involvement may be seen (Fig.6.78). Facial involvement may be prominent, and there is often greasy yellowish scalp scaling, termed cradle cap. In severe cases, the entire body may be affected (Fig. 6.79).

Differential diagnosis
This varies according to the sites affected. Intertrigo, napkin candidiasis, primary irritant dermatitis, AD, infantile psoriasis, Leiner syndrome, and Langerhans cell histiocytosis are all in the differential diagnosis. Involvement of the scalp helps confirm the diagnosis of seborrheic dermatitis, although this is also a feature of the (very rare) condition Langerhans cell histiocytosis.
    Atopic dermatitis is an important differential diagnosis, usually present on other areas of the body and sparing the folds in neonates but becoming more flexural later. By contrast to AD, itch is relatively less prominent in seborrheic dermatitis; a useful question is whether the rash is mainly bothering the child (atopic, miserable, and scratching) or the parents (happy child, but something must be done ). However, both conditions are common, and their age group of predilection overlaps, so they may coexist (especially in about the second month of life), in which case the differential diagnosis is clearly impossible.
    An irritant contact dermatitis usually accompanies diarrhea in the diapered infant, but skin folds are relatively spared.

Treatment
A daily bath with the use of a medicated shampoo, followed by application of hydrocortisone 1% cream to the flexures and hydrocortisone 1% ointment to the body, is recommended. Alternatively, ketoconazole cream may be applied daily.

White/Cox: Diseases of the Skin, 2ed.(c) 2006, Elsevier Inc. All rights reserved.