Snapshot
- A 1-week-old infant is brought to his pediatrician for a skin concern. His mom complains of a strange, scaly rash on his scalp. No matter how much she washes it, the flakes come back. She wants to know what she can do about it.
Introduction
- Common, chronic, inflammatory skin disease
- associated with Malassezia furfur (formerly Pityrosporum ovale)
- Involves scalp and eyebrows
- aka dandruff (adults), cradle cap (infants)
- More severe in
- patients with neurologic disease (traumatic brain injury, Parkinson’s disease, stroke)
- HIV patients
Presentation
- Symptoms
- “dandruff” in hair and face
- burning, itchy, scaling
- Physical exam
- scaly, greasy, flaky (dandruff) skin on scalp margins and face
- can be erythematous
Evaluation
- Diagnosis is made by clinical history and exam
- skin biopsy typically not necessary
- KOH prep
- to rule out fungal infection if resistant or suspicion for other fungal infections
Differential
Treatment
- Medical management
- topical antifungals
- selenium or zinc pyrithione or tar shampoo
Prognosis, Prevention, and Complications
- Prognosis
- most infections respond well to therapy
- may recur, especially in immunocompromised individuals
- Prevention
- shampoos mentioned above work well if used properly
- good skin hygiene
- Complications
- can become secondarily infected with bacterial, fungal, or viral agents