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Therapeutics in Dermatology
A reference textbook in dermatology
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Infantile seborrhoeic dermatitis, Leiner-Mossous disease

3 May 2013, by BODAK N.

Infantile Seborrhoeic Dermatitis (ISD) is a skin condition that affects infants, generally before the age of 6 months. It is related to a yeast of the genus malassezia, which develops in excessive amounts on the skin of certain babies. Three different types of symptoms may be variably observed, i.e. scaly patches affecting the scalp, rash in the nappy area and rash in the folds of the skin. On the scalp, the scales are thick, greasy and adherent, white or yellow in colour and they may occur on all or part of the scalp. Hair grows through the scales but falls out when the scales fall off. The scales may also be visible on the hairline and may even affect the eyebrows. “Milk crusts” correspond to a mild or moderate form of ISD of the scalp. In the nappy area, the rash may be limited to the folds or have the appearance of a bright red panty covering all of and sometimes extending beyond the nappy area. A combination of head scales and nappy area rash is characteristic of the condition. Rash may also be observed in the folds of the skin (axillary, inguinal, and sometimes the elbow or knee folds). The condition does not lead to scratching.

In the vast majority of cases, SD heals and symptoms disappear at 5-6 months, on average. Sometimes, the condition develops into atopic eczema. In such cases, eczema succeeds SD.

Treatment is based on daily cleansing of the skin with soap and the application of antifungal or corticosteroid creams whose efficacy for SD is similar to that of antifungals. If the symptoms are similar to those observed with eczema, it is better to use a corticosteroid from the start. Thick milk scales are best treated by application of Vaseline 2 hours before bathing and washing the infant’s hair. Hair falls out with the scales but grows back again afterwards. Less thick scales may be treated with an antifungal cream or shampoo. The products sold in pharmacies for the treatment of milk crusts also produce results, but symptoms reappear very rapidly after treatment discontinuation. The disappearance of red plaques following treatment is followed by the appearance of depigmented spots which become spontaneously repigmented after a few weeks.

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