What is cradle cap?
Cradle cap is a common skin disorder affecting newborn babies, usually those younger than three months of age. It is also known as infant seborrheic dermatitis or infantile seborrheic dermatitis. It is generally not uncomfortable for the infant, except in severe cases when it may be itchy.
What causes cradle cap is not entirely certain, but it may be the result of overactive oil-producing sebaceous glands, which are stimulated by the mother’s hormones. These glands produce sebum, an oily or waxy substance that lubricates and waterproofs the skin.
Another factor contributing to cradle cap may be the colonization of the sebaceous glands by natural yeasts, specifically particular subspecies of the genus Malassezia It is possible that these yeasts do not cause cradle cap, but rather take advantage of the overproduction of sebum that is already happening.
It is also likely that stress, chemical irritants and dry, cold weather may play a role in causing cradle cap. Cradle cap is not caused by allergies, lack of hygiene or lack of care. It is not contagious.
Cradle cap can be treated quite easily and will usually clear up within a few weeks or months.
Symptoms of cradle cap
- The scalp
- 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 and gluteal cleft (the diaper area)
- Mild, patchy scales
- Extensive, thick scaly patches
- Thick, oily yellow scales
- Brown crusting patches
- Red skin surrounded by pink patches - more common in skin folds
- Swollen areas of skin - more common in skin folds.
Cradle cap is not the result of an infection and should not feel hot to the touch, itch, smell or weep fluids. If the infant’s rash itches, feels warm, smells bad or weeps fluids, infection may have occurred, and medical help should be sought.
Cradle cap is most common in babies younger than six months of age and often appears within the first few weeks of life. It does not usually persist once the baby is older than nine months of age. In older children, symptoms resembling those of cradle cap may instead suggest:
- Atopic dermatitis
- Contact dermatitis
Good to know: Atopic and contact dermatitis, impetigo, psoriasis and ringworm, which are also common skin conditions in babies and young children, can be easily distinguished from cradle cap as they are all itchy. Cradle cap is not usually itchy unless it is very severe.
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. Babies with diaper rash tend to be irritable because of the discomfort. For more information, see this resource on diaper rash.
Treatment of cradle cap
Mild cradle cap can be treated with easily available remedies like petroleum jelly, baby shampoo, almond or olive oil, baby oil and coal tar shampoo. In most cases, monitoring and home remedies suffice. However, if the rash bleeds, weeps fluid, is hot to the touch or spreads extensively, the infant should be taken to the doctor. More severe cases respond well to:
- Topical steroids such as hydrocortisone
- Antifungals such as ketoconazole or imidazole.
One way to treat cradle cap is to warm a small amount of clean, natural oil such as jojoba, almond or olive oil, and massage it into the area affected by cradle cap. 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. Flakes can be brushed from the skin by gently using a soft brush or terry cloth towel.
Good to know: There is some controversy about the efficacy of olive oil in the treatment of cradle cap. Some studies have shown that olive oil disturbs the natural skin barrier, but others have cast doubt on this.
White petroleum jelly can be applied daily and is known to soften scales, which can then be brushed off. Regular washing with baby shampoo is also useful. 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; as these can sting, they are not very suitable for use on babies.
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.