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PUID: 51 || PLAB 2 Mock 7 :: Rash16: Cradle Cap

Summary:

This case involves a consultation with a parent concerned about a rash on their two-month-old baby's scalp, identified as cradle cap or infantile seborrheic dermatitis—a common, benign dermatological condition in neonates due to overactive sebaceous glands and interaction with Malassezia yeast.



Key Points:


Dermatological Presentation (Scalp/Face)

  • Condition: Infantile seborrheic dermatitis (cradle cap)

  • Age group: Common in first few months of life

  • Appearance: Yellowish, greasy scales; possible underlying erythema

  • Etiology: Overproduction of sebum; interaction with commensal yeast (Malassezia)

  • Misconceptions: Not related to hygiene


Symptoms to Rule Out Red Flags

  • Breathing difficulties

  • Fever

  • Lethargy or poor feeding

  • Rash spreading or becoming red, swollen, or oozing (suggestive of secondary infection)


Parental Education

  • Normalize: Condition is common and self-limiting

  • Address parental concerns and expectations

  • Explain that it's not due to poor hygiene or parental fault


Important Considerations:

  • Always confirm the patient's full name and age—here, the baby is the patient.

  • Take a thorough history: onset, duration, associated symptoms (itching, redness, swelling), recent illnesses, changes in behavior, allergies, family history, living conditions.

  • Discuss feeding patterns, urination, stooling, and overall well-being of the child.

  • Safety netting: Highlight amber signs—when to seek immediate medical help.


Diagnostic Approach:

  1. History Taking:

    • Onset, progression, any triggering factors

    • Associated symptoms: irritability, systemic signs

    • Similar past issues or family history of dermatitis

  2. Physical Examination:

    • Head-to-toe exam (verbalize it clearly in the exam)

    • Scalp examination: assess for crusting, erythema, signs of secondary infection

  3. Exclude Differentials:

    • Atopic dermatitis (typically pruritic)

    • Psoriasis (more defined plaques)

    • Tinea capitis (rare in neonates)


Management:

  • First-line treatment:

    • Apply baby oil or petroleum jelly to soften crusts

    • Wash gently with mild baby shampoo

    • Use a soft brush to remove loosened flakes

  • Avoid:

    • Picking scales (can cause scarring)

    • Harsh shampoos or antifungals initially

  • If persistent or worsening:

    • May consider ketoconazole or mild topical antifungal

    • Seek pediatric consultation if secondary infection suspected

  • Follow-up:

    • Reassess if not improving within 1-2 weeks

    • Earlier follow-up if amber/red flag signs present


Communication Skills:

  • Use layman's terms when explaining the diagnosis and management

  • Be empathetic and normalize the condition to alleviate parental anxiety

  • Acknowledge emotions, ask about concerns and expectations

  • Reassure using clear and confident language

  • Signpost before sensitive questions (e.g., family or social history)


Ethical Considerations:

  • Maintain professional boundaries and privacy

  • Ensure non-judgmental language (avoid implying poor hygiene)

  • Adhere to GMC standards for clear communication and reassurance


Additional Resources:

  • NICE guidelines: Management of childhood skin conditions

  • RCPCH child health resources

  • GMC “Good Medical Practice” – Domains 1 and 2

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