Comparison of Treatments for Infantile Seborrhoeic Dermatitis

Infantile seborrhoeic dermatitis (ISD) is a chronic inflammatory skin condition that causes redness and greasy scaling in infants and young children. It typically lasts from weeks to months, and when it appears on the scalp, it is known as 'cradle cap.' While ISD is generally benign and self-limiting, it can cause distress for parents. The effectiveness of widely recommended treatments remains uncertain.

This review aimed to evaluate the effects of various interventions for ISD in children aged from birth to 24 months. Research was conducted in several databases including the Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, Embase, and LILACS. The review included RCTs involving interventions for ISD in children up to 24 months. The studies compared any treatment with no treatment or placebo, as well as direct comparisons between multiple treatments.  Primary outcomes measured included changes in severity from baseline to study end and the percentage of infants experiencing adverse effects. A secondary outcome focused on improvements in quality of life (QoL) as reported by parents.

The findings of the study revealed:

• The researchers included 6 RCTs involving 310 children, with outcomes reported for 297. 
• Majority of participants were under seven months old, and the severity of ISD varied. 
• Two studies compared oral biotin to placebo, while others examined proprietary products versus placebo and topical corticosteroids against alternative treatments.
• Most studies had short durations of 10 to 42 days, with only one following participants until resolution or eight months of age.
• For biotin, one trial did not report on severity changes, and neither reported adverse events. 
• Proprietary products showed mixed results, with one trial indicating a slight advantage for a moisturizing agent. 
• Comparisons of topical steroids showed no significant differences in cure rates or adverse effects.
• No studies evaluated QOL, and commonly used treatments like mineral oils and antifungals were not tested.

To conclude, there is limited evidence on the effectiveness and safety of ISD treatments in young children. Most studies demonstrated a high risk of bias and were hampered by imprecision and poor reporting. Future research should focus on larger, well-conducted trials of commonly recommended interventions, ensuring standardized outcome measures are reported.

Source: Victoire A, Magin P, Coughlan J, van Driel ML. Interventions for infantile seborrhoeic dermatitis (including cradle cap). Cochrane Database Syst Rev. 2019 Mar 4;3(3):CD011380. doi: 10.1002/14651858.CD011380.pub2. PMID: 30828791; PMCID: PMC6397947.