Infantile seborrheic dermatitis L21.9

Infant seborrheic dermatitis

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

The etiopathogenesis of infantile seborrheic dermatitis has not yet been fully elucidated. One possible pathogenic factor under discussion is the physiologically increased sebaceous gland activity in early infancy, which is influenced by adrenal and gonadal androgens. Higher levels of DHEAS and testosterone have been associated with sebaceous gland hypertrophy and increased seborrheic activity in early infancy; however, a direct causal relationship with infantile seborrheic dermatitis has not been established (Kuiri-Hänninen T et al. 2013).

In addition, changes in the epidermal lipid composition and barrier function, as well as in the cutaneous microbiome, are discussed as possible pathogenic factors. Changes in essential fatty acids and stratum corneum lipids have been described in affected infants. Malassezia spp. have also been detected more frequently in some cases; however, the findings are inconsistent, so their causal significance has not yet been established (Rau A et al. 2024).

The involvement of Candida spp., particularly in the context of intestinal colonization, was also postulated in earlier studies. However, a definitive pathogenetic link could not be established; therefore, based on current knowledge, Candida is not considered a confirmed component of the pathogenesis (Oranje AP et al. 1987).

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.

1. Agache P et al. (1980). Sebum levels during the first year of life. British Journal of Dermatology, 103: 643–650.
2. Broberg A (1995). Pityrosporum ovale in healthy children, infantile seborrheic dermatitis, and atopic dermatitis. Acta Derm Venereol Suppl (Stockholm) 191: 1–47
3. Broberg A et al. (1989). Infantile seborrheic dermatitis and Pityrosporum ovale. British Journal of Dermatology 120: 359–362.
4. 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
5. Fukuda R et al. (2023) Association of lipid abnormalities in the stratum corneum and TGF-β1 and 2 in colostrum with the development of infantile seborrheic dermatitis: A prospective birth cohort study. Journal of Dermatological Science 112: 39–42.
6. Kim HJ et al. (2001) Generalized seborrheic dermatitis in an immunodeficient newborn. Cutis 67: 52–54
7. Krowuch DP et al. (1992) Pediatric dermatology update. Pediatr 90: 259–264
8. Kuiri-Hänninen T et al. (2013). Transient postnatal secretion of androgen hormones is associated with acne and sebaceous gland hypertrophy in early infancy. Journal of Clinical Endocrinology & Metabolism 98: 199–206.
9. Moises-Alfaro CB et al. (2002) Are infantile seborrheic and atopic dermatitis clinical variants of the same disease? Int J Dermatol 41: 349-35
10. Oranje AP et al. (1987). Is juvenile seborrheic dermatitis a candidiasis? Investigation of a possible association with microbial infections. Tijdschrift voor Kindergeneeskunde 55: 87–92.
11. Oranje AP et al. (1986). Infantile seborrheic dermatitis: A morphological and immunopathological study. Dermatologica 172: 191–195.
12. Rau A et al. (2024). Adult and infantile seborrheic dermatitis: Update on the current state of evidence and potential research frontiers. International Journal of Dermatology 63: 495–1502.
13. Seebacher C et al. (2006). Cutaneous candidiasis. J Dtsch Dermatol Ges 4: 591–596
14. Seebacher C (1981). On the etiology and pathogenesis of seborrheic dermatitis in infants. Mykosen, 24: 209–215.
15. Siegfried EC et al. (2015) Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications. J Clin Med 4: 884–917.
16. Tollesson A et al. (1993). Essential fatty acids in infantile seborrheic dermatitis. Journal of the American Academy of Dermatology 28, 957–961.
17. Tollesson A et al. (1997). Malassezia furfur in infantile seborrheic dermatitis. Pediatric Dermatology, 14: 423–425.
18. Victoire A et al. (2019) Interventions for infantile seborrheic dermatitis (including cradle cap).