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 Fungal infections Acne rosacea Treatment 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