Sophie is an ex-preterm infant recently discharged from the neonatal unit. Her parents took her to the general practitioner (GP) because of a rash that had been present for about 10 days. She had been born at 27 weeks gestation with a birth weight of 1055 g and was discharged receiving supplemental oxygen via a nasal cannula. She was otherwise well and was being breast fed. The GP found a rash that was localised to her scalp (fig 1) and the underside of her chin. The rash on her scalp was red and scaly, and was well circumscribed and slightly raised. The rash on her chin consisted of a few pale pink macules. There were no papules or vesicles, and it was not angry looking. On further enquiry the GP elicited a history of a nappy rash the previous week. This had largely resolved with the use of proprietary creams.

The GP thought the chin rash was probably caused by mild irritation secondary to dribbling milk after feeds. He made a presumptive diagnosis of cradle cap and advised the use of simple emollients on the scalp.

The GP then reviewed the discharge letter from the neonatal unit.

The pregnancy was complicated by spontaneous rupture of the membranes at 18 weeks gestation and two doses of antenatal dexamethasone had been given. Sophie required three days of ventilation and was in air by the end of the first week, but had required supplemental oxygen since 2 weeks of age. She did not require parenteral nutrition and was on full feeds of expressed breast milk by the end of the first week of life. She received a combination of breast milk and preterm milk formula until 8 weeks of age (35 …