Seborrhoeic dermatitis and cradle cap — branching viva

Branching framework

Open with the three features and the one-sentence problem representation. This is a well, non-itchy infant of the first three months with the greasy yellow scale over the scalp, the face, the flexures, and the nappy area, and this is the infantile seborrhoeic dermatitis, or the cradle cap, until proven otherwise — a diagnosis made on the three features: the greasy rather than dry scale, the nappy-area involvement, and the absent pruritus. State the recognition aloud before you discuss anything else. The examiner is listening for whether you separate the cradle cap from the atopic dermatitis before you reach for the treatment. [1] [5]

Name the absent pruritus as the single decisive discriminator. The atopic dermatitis is itchy, irritable, and sleep-disturbed, with the dry, eczematous scale on the cheeks and the extensors then the flexures, and the nappy area is characteristically spared because the moisture preserves the barrier. The cradle cap is none of these: the infant is well and settled, the scale is greasy, and the nappy is involved. Be ready for the probe on the family history — the atopy supports the atopic when the picture is mixed, but the absent pruritus settles the diagnosis. [5]

Branch to the management and the Cochrane evidence. The first-line management is the reassurance and the gentle scalp care: the emollient or the vegetable oil to soften the scale, the gentle brushing, and the mild baby shampoo, with the picking and the harsh scrubbing avoided. The Victoire 2019 Cochrane review of the six trials and the three hundred and ten children found the very low-certainty evidence for the active treatments and the favourable prognosis regardless of the intervention, and it noted that no trial had tested the mineral oil, the salicylic acid, or the antifungal. The candidate who cites the Cochrane evidence and then prescribes the gentle scalp care demonstrates the evidence-based practice the fellowship rewards. [1]

Branch to the second-line treatment. The ketoconazole two per cent shampoo is applied to the scalp briefly and rinsed, on the safety basis of the Brodell 1998 study, for the refractory scalp disease. The short course of the hydrocortisone one per cent is used for the inflamed facial or the flexural disease, and the ketoconazole cream for the body involvement. The potent topical steroids are avoided on the infant skin because of the atrophy and the absorption. [6] [5]

Branch to the red flags. The generalised erythroderma and the desquamation, with the diarrhoea, the recurrent infection, and the failure to thrive, is the Leiner disease (erythroderma desquamativum), a life-threatening emergency of the complement C3 deficiency or the C5 dysfunction that demands the admission, the complement studies, the fresh-frozen plasma, and the antibiotics, on the Sanghvi 2021 review. The refractory or the severe disease beyond infancy demands the immunodeficiency, the HIV, and the Langerhans cell histiocytosis workup. The scaly scalp with the hair loss and the lymphadenopathy is the tinea capitis, and it needs the oral antifungal. The fellowship candidate who holds these three escalations — the Leiner erythroderma, the refractory workup, and the tinea — is the candidate the boards reward. [3] [5]