From the Guidelines
For treating seborrheic dermatitis in an 18-month-old infant, gentle skin care and the application of topical antifungal medications and anti-inflammatory medications are recommended. When managing seborrheic dermatitis in infants, it's crucial to consider the delicate nature of their skin. The condition is characterized by greasy yellowish scaling, itching, and secondary inflammation from Malassezia yeast, as noted in the clinical practice guideline for acute otitis externa 1. Key aspects of treatment include:
- Gentle skin care to prevent irritation and secondary infection
- Topical antifungal medications to reduce yeast overgrowth
- Topical anti-inflammatory medications to reduce inflammation and itch It's essential to avoid using harsh products, including adult anti-dandruff shampoos and essential oils, which can exacerbate the condition. Instead, consider using mild baby shampoo and applying a thin layer of over-the-counter 1% hydrocortisone cream for short periods to reduce inflammation, as well as ketoconazole 2% shampoo for scalp involvement, as these approaches are gentle and effective for infant skin 1. Regular follow-up with a pediatrician is necessary to monitor the condition and adjust treatment as needed, especially if symptoms persist or worsen, indicating potential need for prescription-strength medications.
From the FDA Drug Label
Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. For an 18-month-old infant with seborrheic dermatitis, the treatment is Ketoconazole Cream 2% applied to the affected area twice daily for four weeks or until clinical clearing 2.
- Note: The FDA label does not provide information on the use of ketoconazole in infants, so this treatment should be used with caution.
- Alternatively, hydrocortisone may be used to temporarily relieve itching associated with seborrheic dermatitis, but its use should only be under the advice and supervision of a doctor 3.
From the Research
Treatment for Seborrheic Dermatitis in Infants
The treatment for seborrheic dermatitis in an 18-month-old infant can be approached in several ways, based on the available evidence:
- Application of emollients followed by hair brushing and shampooing may be effective 4
- Topical ketoconazole shampoo, gel, or lotion is safe and effective if the condition does not improve with emollients and shampooing 4
- Antifungal shampoos, such as bifonazole 1% shampoo, have been shown to be effective and safe in treating scalp seborrheic dermatitis in infants and young children 5
- Topical corticosteroids and calcineurin inhibitors can be used as second-line agents for treatment of scalp seborrheic dermatitis, but their use should be limited due to possible adverse effects 6, 4
Considerations for Treatment
When considering treatment options, it is essential to note that:
- The evidence for the effectiveness of treatments for infantile seborrheic dermatitis is limited and of very low certainty 7
- Further research is needed to determine the best treatment approaches for infantile seborrheic dermatitis, particularly in primary care settings 7
- Treatment should be individualized based on the severity of the condition, the age of the child, and the presence of any underlying health conditions 4