Seborrheic dermatitis is an idiopathic, chronic inflammatory disease that affects areas of the skin rich in sebaceous glands such as the scalp, nasolabial folds, eyebrows, ears, and presternal and intertriginous areas.
Infantile seborrheic dermatitis usually manifests in the second week of life and lasts 4-6 months. In infants, it characteristically presents on the face, diaper area, and folds of the neck and axillae.
Seborrheic dermatitis has a bimodal distribution, with peaks in infancy and adolescence / early adulthood. Although seborrheic dermatitis has been associated with HIV infection and neurologic disease, it typically presents in healthy individuals.
The yeast Malassezia has long been regarded as the central predisposing factor to disease development. Malassezia is a normal component of skin flora, but in individuals with seborrheic dermatitis, the yeast invades the stratum corneum, resulting in free fatty acid formation and the activation of the inflammatory cascade. Changes in the skin microbiome have also been implicated in pathogenesis. Additional factors related to the environment such as low temperatures and humidity have been identified as potential triggers.
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Important News & Links
Synopsis
Codes
ICD10CM:
L21.9 – Seborrheic dermatitis, unspecified
SNOMEDCT:
50563003 – Seborrheic dermatitis
L21.9 – Seborrheic dermatitis, unspecified
SNOMEDCT:
50563003 – Seborrheic dermatitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
The most difficult diagnoses to separate from infantile seborrheic dermatitis are atopic dermatitis and irritant contact dermatitis. Atopic dermatitis more often involves the scalp, cheeks, and extensor surfaces and is associated with a family history of other atopic conditions (asthma, allergic rhinitis). It is usually accompanied by moderate-to-severe pruritus that interferes with sleep and feeding, whereas infantile seborrheic dermatitis is asymptomatic. Irritant contact dermatitis (diaper dermatitis) caused by the irritant effects of urine and feces typically spares the deep body folds for lack of contact with the skin.
Psoriasis is extremely uncommon in neonates and infants. However, familial and genetically determined forms of psoriasis and other psoriasiform dermatitis do characteristically present with infantile psoriasis involving a similar distribution. The scaling is thicker in nonoccluded areas and plaques are better defined.
When localized in the diaper area, dermatoses to consider besides irritant contact dermatitis:
Psoriasis is extremely uncommon in neonates and infants. However, familial and genetically determined forms of psoriasis and other psoriasiform dermatitis do characteristically present with infantile psoriasis involving a similar distribution. The scaling is thicker in nonoccluded areas and plaques are better defined.
When localized in the diaper area, dermatoses to consider besides irritant contact dermatitis:
- Candidiasis
- Psoriasis – consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis
- Allergic contact dermatitis
- Tinea cruris - rare in infancy
- Intertrigo
- Langerhans cell histiocytosis
- Scabies
- Kawasaki disease
- Sexual abuse
- Acrodermatitis enteropathica
- Lichen sclerosus
- Perianal streptococcal infection
- Congenital syphilis
- Psoriasis – consider in those with particularly difficult-to-remove scales; examine the patient in locations characteristic for psoriasis
- Atopic dermatitis
- Candidal intertrigo
- Intertrigo
- Tinea cruris
- Intertrigo
- Lichen simplex chronicus
- Erythrasma
- Impetigo
- Darier disease
- Langerhans cell histiocytosis
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:03/08/2023
Last Updated:04/06/2023
Last Updated:04/06/2023
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