• 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.
  • 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
  • Symptoms
    • dandruff” in hair and face
    • burning, itchy, scaling
  • Physical exam
    • scaly, greasy, flaky (dandruff) skin on scalp margins and face
    • can be erythematous
  • 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
  • Fungal infections
  • Acne rosacea
  • Medical management
    • low-potency topical steroids (e.g., hydrocortisone) 
    • 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

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