Non-infectious Causes of Dry Scalp in Infants and Children

Dry scalp is a very common condition in infants and children. There are numerous causes of a dry, flaking scalp including atopic dermatitis, seborrheic dermatitis (also known as cradle cap in newborns) and psoriasis.

*Atopic dermatitis:

Atopic dermatitis is a type of reactive, inflammatory skin condition that occurs more often in children with asthma, hay fever, or seasonal allergies. This form of dry scalp also occurs more frequently in children who have asthma or allergies in their family history. Atopic dermatitis results in itchy, red, scaling plaques found most often on the back of the head. There are usually other areas of skin involved such as the arms and legs, which can help clarify the diagnosis.

*Seborrheic dermatitis:

Seborrheic dermatitis is characterized by erythema (skin redness) and greasy scales. This condition is a common cause of oily dandruff in both children and adults. Seborrheic dermatitis occurs most commonly on the scalp, but also on the face, ears, neck, and in the diaper area.

*Cradle cap:

Cradle cap usually occurs in the first three months of an infant's life. Newborn babies can quickly develop a greasy, scaly, flaky scalp. Cradle cap is actually a form of seborrheic dermatitis, similar to dandruff in adults, and is sometimes also called pityriasis capitis. Cradle cap is a condition that is unsightly but not infectious or harmful to the baby.

However, there is a similar condition to cradle cap that occurs in a rare disease called Letterer-Siwe disease or Langerhans cell histiocytosis. These young children will have greasy dandruff-like areas on the scalp, groin, trunk and/or face. Unlike normal seborrheic dermatitis, the affected areas of skin often have petechiae or tiny red dots. Affected children also have fevers, swollen lymph nodes, and enlarged livers and spleens.

*Psoriasis:

Psoriasis is a common chronic skin disorder typically characterized by erythematous papules (red bumps) and skin plaques covered with a silver scale, although other presentations occur. Most cases of psoriasis are not severe and are treated in the outpatient setting. However, rare life-threatening cases can occur that require in-hospital management.

Features that suggest a diagnosis of psoriasis include a family history of the disease, skin findings with no or mild itching, as well as localization of lesions to the elbows, knees, and lower back. Psoriasis often occurs at sites of trauma and in folds of skin. When psoriasis affects the scalp it is usually in discrete patches rather than diffusely across the scalp involvement.

There are numerous causes of non-infectious dry scalp in infants and children. Often it is difficult to tell and infectious cause that requires treatment from a non-infectious cause that will resolve with time. Children with persistent or severe flaking or scaling scalp rashes should be seen by a trained medical professional for an accurate diagnosis.

Source: Approach to the Patient with a Scalp Eruption. UptoDate Online. www.uptodate.com