Cradle Cap

Cradle cap is a common skin disorder affecting newborn babies, usually those younger than three months of age. The medical name for this condition is infant seborrheic dermatitis. It is generally not uncomfortable for the infant, except in severe cases when it may be itchy. 1 Cradle cap in children, teenagers and adults is usually known as seborrheic dermatitis, or seborrhea. Seborrheic dermatitis can affect any part of the body, whereas cradle cap is usually restricted to the scalp and face

Cradle cap is a form of seborrheic dermatitis, which is a form of dermatitis, or skin inflammation. It is related to eczema, or atopic dermatitis, another form of dermatitis. However, seborrheic dermatitis is not as itchy or inflamed as atopic dermatitis. For more information, see this resource on atopic dermatitis.

Psoriasis is not a form of dermatitis, but it is often difficult to distinguish between psoriasis and dermatitis. Psoriasis, like seborrheic or atopic dermatitis, can affect the scalp or skin fold area. It is an inflammatory skin disorder, often appearing as red skin overlaid with white, flaky areas, which leads some people to confuse it with seborrheic dermatitis. However, psoriasis is caused by an overactive immune system causing inflammation, which causes new skin cells to be produced and pushed to the surface too quickly. Because the body cannot shed these cells quickly enough, they build up on the skin surface and form red, scaly, itchy plaques. 2

Yes, although in older children, teenagers and adults it is generally not known as cradle cap, but is instead called seborrheic dermatitis or seborrhea. Dandruff of the scalp is a mild form of seborrheic dermatitis commonly found in teenagers and adults.

Cradle cap usually occurs on the parts of the body that have the highest density of oil-producing (sebum) glands, which produce an oily, waxy substance. The parts of the body that are affected by cradle cap in babies include: 1 3

• The scalp
• The eyelids
• The face, around the nose, chin, and mouth
• The forehead, the back of the ears, or the back of the neck
• In other skin folds, for example in the armpits, inner elbows, and backs of the knees
• The buttocks, gluteal cleft (groove between the buttocks), upper thighs, and lower abdomen (the diaper area)

In cases of seborrheic dermatitis in toddlers, older children, teenagers, and adults, other parts of the body can be affected. 4 The general appearance of cradle cap/seborrheic dermatitis is the same in infants, toddlers, children, teenagers, and adults.

Cradle cap usually appears as a yellow or brown scaly layer on a baby’s scalp, that may look oily or waxy. The skin usually looks normal underneath the scales. However, the appearance of cradle cap can vary. It can also present as: 1 3 5

• Mild, patchy scales
• Extensive, thick scaly patches
• Thick, oily yellow scales
• Brown crusting patches
• Red skin surrounded by pink patches; this is more common in skin fold areas
• Swollen areas of skin - more common in skin folds

Cradle cap is not the result of bacteria, an allergy or an infection and should not feel hot to the touch, itch, smell or weep fluids. If the rash feels warm, smells bad or weeps fluids, infection may have occurred, 1 and medical help should be sought.4

However, although cradle cap is not always itchy, other skin conditions affecting babies do itch. These include diaper rash and atopic dermatitis, as well as ringworm. If you are concerned that your baby may have a skin condition, you can do a free symptom assessment using the Ada app at any time.

Cradle cap is most common in babies younger than six months of age and often appears within the first few weeks of life. It usually goes away once the baby is older than nine months of age. In older children, conditions that cause symptoms that look like cradle cap include: 6

• Atopic dermatitis
• Impetigo
• Psoriasis
• Contact dermatitis including diaper rash
• Ringworm

Cradle cap can spread to the diaper area, but diaper rash is a separate condition, which manifests as irritated, tender and red skin. This is caused by the infant’s skin coming into contact with a diaper that is soiled by urine or feces. 7 Babies with diaper rash tend to be irritable because of the discomfort. 8 For more information, see this resource on diaper rash.

What causes cradle cap is not entirely certain, but in babies it may be the result of overactive oil-producing sebaceous glands, which are stimulated by the mother’s hormones. 3 These glands produce sebum, an oily or waxy substance that lubricates and waterproofs the skin.

Another factor contributing to cradle cap or seborrhea in adults may be the colonization of the sebaceous glands by natural yeasts, 3 specifically particular subspecies of the genus Malassezia. 5 It is possible that these yeasts do not cause cradle cap, but rather take advantage of the overproduction of sebum that is already happening. 6

It is also likely that stress, chemical irritants and dry, cold weather may play a role in causing cradle cap. 1 Cradle cap is not caused by bacteria, allergies, lack of hygiene or lack of care. ref1 It is not contagious. 3

Cradle cap can be treated quite easily and will usually clear up within a few weeks or months. 9

In older people, cradle cap, or seborrheic dermatitis, can be caused by the same factors that lead to the condition in infants. 10

To diagnose cradle cap or seborrheic dermatitis, a doctor will make a visual inspection of the affected skin. Blood and other laboratory tests are not usually needed.

However, if the condition does not improve with treatment, it is possible that it is not cradle cap or seborrhea, but something that looks similar such as psoriasis or an allergic reaction. In such cases it may be necessary to return to the doctor and possibly undergo tests to determine what is causing the problem.

Mild cradle cap can be treated at home with easily available remedies like baby shampoo, baby oil, or almond or olive oil. A pharmacist may recommend trying petroleum jelly or coal tar shampoo. In most cases, these monitoring and home remedies do work. However, if the rash bleeds, oozes fluid, is hot to the touch or spreads extensively, it is very important to see a doctor. In more severe cases, a doctor may prescribe: 11

• Topical steroids such as hydrocortisone
• Antifungals such as ketoconazole or imidazole

Home remedies can be effective in reducing discomfort and improving symptoms of mild or moderate cradle cap. More severe, or persistent, cases may need specialized treatments prescribed by a doctor. How long treatment is necessary for depends on the method being used and how severe the condition is.

Cradle cap in babies can be treated at home. One way to treat cradle cap is to warm a small amount of clean, natural oil such as jojoba, almond, coconut or olive oil, and massage it into the affected area. After 15 minutes, the flakes can be gently brushed off. The area should then be thoroughly shampooed, with special care taken to ensure that no oil remains on the skin. 3 Flakes can be removed from the skin by softly brushing with a soft brush or terry cloth towel. Do not scratch the scalp with fingernails or other implements, as this may break the skin.

White petroleum jelly can be applied daily to the baby’s scalp and is known to soften scales, which can then be brushed off. Regular washing with baby shampoo is also useful. 5 In some cases, coal tar shampoo may be used, but this can sometimes irritate the skin. The same is true for shampoos devised to control dandruff on adult scalp; as these can sting, they are not very suitable for use on babies. 11 6

Severe, persistent or recurrent infantile seborrheic dermatitis can be treated with shampoos, creams, and gels. Hydrocortisone, imidazole or ketoconazole are all available as prescription creams or gels for use in the treatment of severe cases of cradle cap. Imidazole or ketoconazole creams are applied several times a week, while hydrocortisone cream is applied daily. 12 10

Cradle cap cannot be prevented. However, it is easily treated and need not affect the infant’s quality of life. Not all infants will be affected by cradle cap. Some ways of reducing the chance of skin irritation include:

• Making sure that all traces of shampoo, soap or cleansers are rinsed off the body during bathing, to reduce the chance of skin irritation
• Dressing the baby in well-fitting clothing that allows air to circulate, reducing the chances of skin irritation
• Choosing clothes made of natural rather than artificial fibers, as these improve air circulation and moisture regulation

Q: Does cradle cap itch?
A: Cradle cap in babies can, but does not always, itch. Adults with seborrheic dermatitis of the scalp, ears and/or body appear to be more itchy than babies with cradle cap of the scalp. Severe cases of cradle cap do itch.

Q: Can cradle cap cause hair loss?
A: In cases of significant cradle cap or seborrheic dermatitis, sometimes the process of brushing or combing the scalp to loosen and remove scales can cause some hair to come away along with the scales. 13 While this may be distressing to the adults concerned, the hair will grow back and the hair loss is therefore only temporary. 14

Q: Does cradle cap have a smell?
A: In some cases, cradle cap may have a slight oily smell. This is due to the buildup of oil/sebum from sebaceous glands that causes cradle cap. However, cradle cap should not have an unpleasant smell. 15 If an unpleasant smell is detected, the rash may have been infected by bacteria, and the affected person should be examined by a doctor or nurse.

Q: Can cradle cap cause sores?
A: Generally, cradle cap manifests only as oily flakes. Occasionally, the skin beneath the flakes is red and swollen. However, if the skin begins to weep, feels hot, and develops sores, it is possible that the skin has become infected or may become infected by bacteria, and the affected person should be examined by a doctor or nurse.

Q: Can cradle cap be black in color?
A: No. If black spots are appearing on the scalp, it is not simple cradle cap - a fungal infection may be affecting the scalp. The affected person should be examined by a doctor to determine exactly what might be causing the spots. An antifungal cream may be prescribed if the cause is a fungal infection. 16

Q: Can cradle cap come back once it has cleared up?
A: In babies, cradle cap usually clears up on its own by the age of six months. It may recur after treatment, possibly several times, until the oil-producing glands settle down.

Q: Can cradle cap come back in later life?
A: There is some evidence that people who had cradle cap as infants may experience a recurrence of the problem at puberty. When affecting older people, cradle cap is known as seborrheic dermatitis or seborrhea. Teenagers and adults who have seborrheic dermatitis may have recurrent flare-ups throughout life. Often these flares are triggered by cold, dryness, or stress. 4

Q: Is there a link between cradle cap/seborrheic dermatitis and thrush?
A: Thrush is caused by a kind of yeast called Candida, which often affects the genital area but can also colonize other parts of the body. In some people, especially those with HIV-related seborrheic dermatitis, there appears to be some evidence that having candida in the gut may increase the risk of developing seborrheic dermatitis. 17

Q: Can cradle cap affect facial hair, such as eyebrows, beards and mustaches?
A: Yes. In adults, seborrheic dermatitis can affect the facial skin beneath facial hair. In infants, the skin beneath the hair of the eyebrows can be affected.