Rosh Pediatrics Practice Exam

A 1-month-old boy presents with a scaly rash on his scalp. What is the initial management for his condition?

1. Ketoconazole shampoo

2. Mineral oil and scalp combing

3. Salicylic acid shampoo

4. Topical hydrocortisone to scalp

The correct answer is: Mineral oil and scalp combing

The initial management of a scaly rash on the scalp of a 1-month-old boy, often identified as seborrheic dermatitis or cradle cap, typically involves gentle techniques rather than aggressive treatments. Mineral oil and scalp combing are recommended because they effectively help to loosen and remove the scales present on the baby's scalp. Mineral oil serves as a lubricant that can soften the scales, making them easier to remove during gentle scalp massage or combing. This method is safe and well-tolerated in infants, promoting comfort and potentially leading to the resolution of the condition without the use of medicated shampoos or corticosteroids, which might be more appropriate later if the condition does not improve. Other options, such as ketoconazole shampoo, salicylic acid shampoo, or topical hydrocortisone, are often utilized for more severe cases or when the condition persists despite basic care. However, they are not considered the initial approach for mild cases of seborrheic dermatitis in infants, where lighter, non-medicated options are preferred. Thus, starting with mineral oil and scalp combing aligns with the best practice for managing this common pediatric condition.