🩻 TOACS FCPS Station · Neonatal Scalp Rash: Cradle Cap

Nelson · 22nd Ed · “Seborrheic dermatitis, crusty scalp lesions, benign self‑limited”
⏱️ 7 minutes · Examiner-led · Observed station
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📷 Clinical Photograph – Neonatal Scalp

Clinical photograph showing cradle cap – yellow-brown crusty scales on the scalp of a neonate
Figure 1 · Neonatal scalp · Cradle Cap (Seborrheic Dermatitis)

🔍 Key clinical features:

  • ✓ Yellow-brown, greasy, crusty scales on the scalp
  • ✓ Thick, adherent plaques – may be mistaken for dirty scalp
  • ✓ No erythema or inflammation (mild erythema possible)
  • ✓ Usually appears in first weeks of life
  • ✓ Self-limited – resolves by 6-12 months

📋 Clinical scenario (examiner prompt)

A 4‑week‑old term infant is brought in for scaly patches on the scalp that started at 2 weeks of age. The scales are yellow-brown, greasy, and adherent. The infant is otherwise well, feeding well, and has no other skin lesions. There is no erythema or weeping. The parents are concerned that the “dandruff” is not washing off.

Greasy scales Yellow-brown crusts No erythema Healthy infant

🧑‍⚕️ Examiner tasks · TOACS

1. Identify the diagnosis from the clinical image and history.

2. Describe the clinical features (greasy, yellowish crusts, no inflammation).

3. Explain the pathophysiology (seborrheic dermatitis, Malassezia role).

4. Discuss management and parental reassurance (emollients, gentle removal).

⚠️ Key concept: Cradle cap (infantile seborrheic dermatitis) is a benign, self‑limited condition common in the first few months of life. It is characterized by greasy, yellow‑brown crusty scales on the scalp. It is not infectious and does not indicate poor hygiene. Reassurance is the mainstay of management, with gentle removal using emollients.

🎯 Expected answers (for examiners)

  • • Diagnosis: Cradle cap (infantile seborrheic dermatitis)
  • • Clinical features: Greasy, yellow-brown crusty scales on scalp, no erythema
  • • Pathophysiology: Sebaceous gland activity + Malassezia colonization; benign, self-limited
  • • Management: Reassurance, emollients (mineral oil, baby oil), gentle brushing, shampoo if needed

⚡ Quick FCPS‑style MCQ

A healthy 4‑week‑old with greasy, yellow‑brown crusts on the scalp and no erythema most likely has:

A. Cradle cap (seborrheic dermatitis) B. Atopic dermatitis C. Tinea capitis D. Impetigo

📌 Topic summary ·

Definition
Infantile seborrheic dermatitis
Onset
First weeks to months of life
Appearance
Greasy, yellow-brown crusts
Location
Scalp (may extend to face, behind ears)
Inflammation
Absent or mild
Treatment
Reassurance, emollients, gentle removal
ConditionKey FeatureManagement
Cradle capGreasy yellow-brown crustsEmollients, gentle brushing
Atopic dermatitisErythematous, pruritic, flexuralEmollients, steroids
Tinea capitisScaly patches, alopecia, broken hairsOral antifungals
ImpetigoHoney-crusted lesions, erythemaAntibiotics
Source: Nelson Textbook of Pediatrics 22nd Ed · TOACS FCPS station · Cradle Cap.