Cradle cap is a skin condition that appears as oily, yellow or reddish scales or patches of skin flakes on a baby's scalp.
The condition commonly occurs in babies younger than three months of age.
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In more severe cases, the areas involved may include the eyelids and eyebrows, behind the ears and skin creases, the forehead and around the nappy area. This condition is then known as seborrhoeic dermatitis of infancy.
The cause is unknown. However, it is thought that hormones stimulating the oil-producing sebaceous glands in the skin may play a role.
Although the condition can look unsightly, it is harmless and there are no serious complications. It is not a part of any illness and does not imply that a baby is not being well cared for.
Most experts believe that cradle cap does not cause any itching or discomfort to a baby.
What is cradle cap?
Cradle cap is a harmless skin condition that appears as oily, yellow or reddish scales or patches of skin flakes on a baby's scalp. In more severe cases, the condition can spread to other areas of the body including the eyelids and eyebrows, behind the ears and skin creases, the forehead and around the nappy area. This condition is then called seborrhoeic dermatitis of infancy.
The condition commonly occurs in babies younger than three months of age and is not part of any illness and does not imply that a baby is not being well cared for.
What are the symptoms?
Mild cases: flaky, dry scales of skin on the scalp that looks like dandruff.
More severe cases are marked by thick, oily, yellow or reddish plaques or crusting patches. In rare cases, areas involved may include the eyelids and eyebrows, behind the ears and skin creases, the forehead and around the nappy area.
Generally the rash of seborrhoeic dermatitis does not itch. However, a yeast superinfection can cause the area to itch. This occurs more commonly in the crease areas rather than on the scalp. Consult your doctor who will probably prescribe an anti-yeast cream treatment.
In seborrhoeic dermatitis of infancy, affected skin can become red and sometimes crack. Consult your doctor if this happens or if the area becomes inflamed or if breaks in the skin cause infections or bleeding.
Cause
No one knows the exact cause of this rash, however, many experts believe that hormones (androgens) a mother produces and passes to her child during childbirth may be involved. The oil turns into oily patches and then dries and flakes off.
When the rash occurs on the scalp alone, it is known as cradle cap. Once it has spread to other areas of the skin, face, down the back of the neck, nose, eyebrows, behind the ears, in the external ear, and the skin of the trunk and along skin folds, it is known as seborrhoeic dermatitis of infancy.
Infantile seborrhoeic dermatitis is a non-infectious form of eczema, commonly occurring during the first weeks of life and slowly disappearing over a period of weeks or months as hormones in the baby's body level out.
Unlike other forms of eczema, it is unlikely to be itchy or uncomfortable.
Cradle cap is not contagious and it is not caused by poor hygiene or inadequate washing.
Seborrhoeic dermatitis of infancy may occur up to the age of two years. Most cases clear spontaneously. Unsightly hypopigmentation resolves with time.
How is it treated?
Cradle cap will eventually go away on its own. However, there are a few things you can do to help with the baby's appearance and keep the area free of infection.
If the condition is confined to the scalp and has not spread to other parts of the skin, home treatment is appropriate.
Home treatment
Shampoo daily with a mild baby shampoo.
Gently massage the baby's scalp with your fingers or brush the scalp daily with a baby brush to loosen plaques.
For more severe cases, rub the scalp with baby oil, mineral oil, or petroleum jelly for a few hours before washing to help lift the crusts and loosen scales. Make sure you do not just use the oil and do nothing else, as this allows scales to build up on the scalp.
Rinse the oil off before shampooing and then gently scrub the scalp with a soft-bristled brush or toothbrush for a few minutes to remove the scales.
Wash the scalp with baby shampoo, rinse well, and gently towel dry.
Stronger anti-dandruff shampoos may loosen the scales more quickly, but since they can also be irritating, use them only after consulting your doctor.
When to call a doctor
Call your doctor if:
There is no improvement with frequent shampooing after a week
You notice any redness or irritation and the child scratches the scalp
The rash spreads to the baby's face, neck and crease areas
The scalp becomes painful and there is evidence of infection (fever, swelling, scales drain fluid or pus)
Your doctor will probably suggest a stronger shampoo and might also prescribe a cortisone cream or lotion. A weakened hydrocortisone cream is a commonly used preparation.
Severe cases are usually referred to a skin specialist.
How is a diagnosis made?
The doctor will make the diagnosis by examining the baby's head. The appearance of flakes or plaques is usually quite characteristic.
Although cradle cap usually clears up on its own, seborrhoeic dermatitis of infancy is controllable with treatment.
Cradle cap should be viewed as a localised form of seborrhoeic dermatitis of infancy.
Prevention
Once the condition has improved, cradle cap can be prevented by frequent hair washing with a mild baby shampoo.
Occasionally, a stronger medicated shampoo may be needed, but only on the advice of a doctor.
What are the risk factors?
Cradle cap is very common in babies. It usually appears during the first couple of weeks of the infant's life.
In adults, seborrhoeic dermatitis appears to run in families. Factors like stress and a fungus, Pityrosporum ovale, may be involved in the pathogenesis.
Seborrheic dermatitis may be associated with HIV-disease, stress, Parkinson’s disease and epilepsy.
Complications
Secondary bacterial or fungal and/or yeast infections.
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