Derm Cases · Dermatology / Paediatrics
OSCE — cradle cap: diagnose infantile seborrhoeic dermatitis, counsel gentle care, and spot red flags
An 8-minute OSCE on recognising cradle cap, differentiating infantile AD and nappy dermatitis, teaching oil-soften and gentle combing, cautious topicals, and red flags for immunodeficiency/LCH.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE on recognising cradle cap, differentiating infantile AD and nappy dermatitis, teaching oil-soften and gentle combing, cautious topicals, and red flags for immunodeficiency/LCH.
Brief (to candidate)
Parents of a well 10-week-old with greasy scalp and eyebrow scale are scraping crusts hard and asking for “strong steroid.” You have 8 minutes to diagnose cradle cap, stop harmful practices, give a safe plan, and list red flags.
Candidate instructions
- Diagnose infantile seborrhoeic dermatitis / cradle cap.
- Differentiate from infantile AD (itch) and irritant nappy dermatitis (fold sparing).
- Teach oil soften + gentle comb + mild shampoo.
- Discuss short low-potency steroid/imidazole only if needed; avoid prolonged potent steroids.
- Red flags: FTT/infections; resistant erosive/purpuric disease (LCH).
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Diagnosis | Greasy yellow scale, little itch, early infancy[3][4] |
| Differential | AD itchy/dry; irritant nappy fold-sparing |
| Pathogenesis | Sebum + Malassezia framing[5] |
| Therapy | Gentle care first; cautious topicals; no scraping trauma[2][3] |
| Evidence humility | Cochrane limited high-quality intervention evidence[1] |
| Red flags | Immunodeficiency / LCH pathways |
Model key actions
- Reassure self-limited course in most.
- Stop forceful picking.
- Safety-net poor feeding, fever, pustules, failure to improve.
Common errors
- Labelling as AD without itch history.
- Prescribing potent steroids for weeks.
- Missing systemic red flags.
References5ShowHide
- [1]Victoire A, et al. Interventions for infantile seborrhoeic dermatitis (including cradle cap). Cochrane Database Syst Rev, 2019.PMID 30828791
- [2]Clark GW, et al. Diagnosis and treatment of seborrheic dermatitis. Am Fam Physician, 2015.PMID 25822272
- [3]Nobles T, et al. Cradle Cap. StatPearls, 2026.PMID 30285358
- [4]O'Connor NR, et al. Newborn skin: common rashes. Am Fam Physician, 2008.PMID 18236822
- [5]Adalsteinsson JA, et al. Microbiology and immunology of seborrheic dermatitis. Exp Dermatol, 2020.PMID 32125725