Seborrheic dermatitis of the infant L21.9

Infant seborrheic dermatitis

Common infant disease that occurs in 2-5% of infants.

Unexplained, in > 90% of the affected children, intestinal candidosis can be detected.

Under the influence of high temporary endogenous androgen production by the adrenal cortex, the sebaceous glands of the newborn are active, become inactive again later and remain inactive until the beginning of puberty.

Mostly manifested in the first 3 months of life. This results in a clear difference to atopic dermatitis of the infant, which only becomes manifest after the 3rd month of life.

Predilection sites: capillitium (parietal region) also known as gneiss, face, neck and chest region and intertriginous areas.

Greasy, yellow scaly crusts on the head or retroauricular, also in the area of the eyebrows, nasolabial folds and cheeks. Dry scaling on the trunk and in the intertriginous areas is also not uncommon. In generalisation one speaks of Erythrodermia desquamativa (a term that has been largely left out today).

Atopic dermatitis: in the first months of life, DD is difficult to detect, as the clinical picture of atopy only develops with increasing age (not before 3 months of age).

Psoriasis capitis: in pronounced forms, psoriasis (capitis) can be excluded.

Langerhans cell histiocytosis: this rare diagnosis must be taken into account in the case of clinical courses resistant to therapy.

Overall drying and anti-inflammatory.

Head lesions: In case of light dandruff, head wash with blanched external agents (e.g. Dermowas, Satina, Sebamed liquid). Heavily scaling or crusting head areas can be treated with 0.5-2% salicylic acid oil (olive oil base) over several days with a head bandage. Caution! Resorption of salicylic acid! For babies only apply in a circumscribed manner!

Tanning agents, e.g. tannolact, have proven to be effective, first as lotio, then in cream form when the skin condition is calmed. Weeping bends and wrinkles can be treated with drying pastes (APP Children's Ointment, Candio Hermal Soft Paste). Alternatively, zinc oil can be used (shake well before use).

In the case of mycotic superinfection of seborrhoeic eczema, antimycotic topicals should be used, preferably clotrimazole due to age, and nystatin for pure candidosis.

In case of bacterial superimposition: experiment with topical antibiotics like a cream containing fucidic acid.

Handwarm baths with anti-inflammatory additives such as wheat bran and oat straw extract (Silvapin).

For severe itching, antihistamines such as doxylaminosuccinate (e.g. mereprine syrup 1-2 times/day 1 teaspoon) for infants from 6 months. In case of positive stool findings, sanitation with nystatin-containing topicals (Candio Hermal Suspension, Moronal) 4 times/day 1 ml p.o.

Systemic therapy with a glucocorticoid (prednisolone 1.0mg/kgkgKG) is only necessary in exceptional cases.

Antibiotics are to be used if necessary (signs of bacterial superinfection) after antibiogram.

Clinical. In case of weeping changes, bacterial/mycotic overlay should be excluded by means of a smear. Check stool for yeast.

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2. Foley P et al (2003) The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap). Arch Dermatol 139: 318-322
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8. Victoire A et al (2019) Interventions for infantile seborrhoeic dermatitis (including cradle cap).
   Cochrane Database Syst Rev 3:CD011380.