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.

Summary

• Cradle cap is a skin condition that appears as slightly greasy, yellow or reddish scales and patches of skin flakes on a baby's scalp.
• The condition commonly occurs in babies younger than three months.
• In more severe cases, the areas involved may include the eyelids, eyebrows, forehead, the ears, the skin creases of the body and in 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 may appear unsightly, it is harmless and there are no serious complications. 
• Cradle cap does not usually cause any itching or discomfort in babies.

Definition

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 and is not part of any illness and does not imply that a baby is not being well cared for.

Symptoms

• Mild cases: flaky, dry scales of skin on the scalp that look like dandruff
• More severe cases usually involve greasy yellow or reddish plaques or patches or crusting. In some cases the areas involved may include the eyelids and eyebrows, the ears, skin creases, the forehead and in the nappy area.
• Generally the rash of seborrhoeic dermatitis does not itch, but, rarely, a yeast infection may cause this rash to itch. This occurs more commonly in the crease areas rather than on the scalp. 
• In seborrhoeic dermatitis the affected skin can become red and sometimes crack. Fortunately this is rare.

Cause

The cause remains unknown, but experts believe that hormones produced by the mother and passed to her baby during childbirth may be involved.

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, ears, the  body 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 which slowly clears up over a period of weeks or months as the mother’s hormones in the baby's body reduce and disappear. 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 usually clears up by the age of 6 months, but  rarely may last up to the age of two years. The great majority of cases clear up spontaneously.

Treatment

Cradle cap will eventually clear up on its own. However, there are a few things you can do to help with the baby's appearance and to 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 olive oil, mineral oil, or petroleum jelly a few hours before washing your baby’s scalp to help to lift off 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 may be too harsh for babies they are used only after consulting a 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 your baby 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 mild hydrocortisone cream is commonly used to clear the rash.

Severe cases are usually referred to a skin specialist.

Diagnosis

The doctor will make the diagnosis by examining the baby's head. The appearance of flakes or yellow greasy plaques is usually quite characteristic.

Although cradle cap usually clears up on its own, the more extensive seborrhoeic dermatitis of infancy may require treatment.

Cradle cap which only affects the scalp and no other parts of the baby’s body, is regarded 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.

Risk factors

Cradle cap is very common in babies. It usually appears during the first couple of weeks of the infant's life and usually clears up spontaneously before the age of 6 months.

In adults, seborrhoeic dermatitis appears to run in families. Factors like stress and a yeast infection called Pityrosporum ovale may be involved in the cause. Also in adults seborrheic dermatitis may be associated with HIV-disease, stress, Parkinson’s disease and epilepsy.

Complications

Secondary bacterial or yeast infections, which fortunately are very rare in infants.

Previously reviewed by Prof H.F. Jordaan

Reviewed by Prof Eugene Weinberg, Paediatrician, February 2011