Cradle cap is a condition that causes scaly patches on a baby’s scalp. It is a common name for infantile seborrheic dermatitis and is also known as milk crust or honeycomb disease. It can cause thick crusts and scales which could be white or yellow.
Presentation
The most common presenting sign is thick crusts or patchy scales on the scalp. Other signs are skin flakes, oily skin covered with flaky white scales, scales could also be yellow. There is also a possibility if mild redness. There could be similar lesions on the ears, eyelids, groin, armpits and nose. It generally does not irritate the baby or cause pruritus. It there are suspicions of prurits then another skin condition should be considered [5].
Entire Body System
- Fatigue
Risk factors include: Stress or fatigue Weather extremes Oily skin, or skin problems such as acne Infrequent shampoos or skin cleaning Using lotions that contain alcohol Obesity Neurologic conditions, including Parkinson disease, head injury or stroke [web.archive.org]
It may be due to a combination of factors: Oil gland activity Yeasts, called malassezia, which live on the skin, mainly in areas with more oil glands Changes in skin barrier function Your genes Risk factors include: Stress or fatigue Weather extremes [nlm.nih.gov]
Fatigue 4. Oily skin 5. Weather extremes 6. Skin disorders such as acne 7. Lotions containing alcohol 8. Infrequent shampoos or skin cleaning Let’s just touch on a these things a little bit. [hairfinder.com]
Weakened immune system from stress, fatigue, sleep deprivation, immuno-suppression or illness or individual susceptibility. People with seborrhoeic dermatitis appear to have a reduced resistance to the above yeast. [growyouthful.com]
Gastrointestinal
- Nausea
Bulging of the soft spot in an infant's skull ( fontanelle ) Changes in alertness or consciousness Decreased appetite Dizziness Double vision (in young children) Drowsiness Hair changes, such as hair loss and oily hair Headache Irritability Liver damage Nausea [medlineplus.gov]
- Vomiting
[…] hair Headache Irritability Liver damage Nausea Poor weight gain (in infants and children) Skin changes, such as cracking at corners of the mouth, higher sensitivity to sunlight, oily skin, peeling, itching, and yellow color to the skin Vision changes Vomiting [medlineplus.gov]
Liver, Gall & Pancreas
- Jaundice
Your newborn can develop a number of deficiencies and conditions—from eczema to jaundice—and you may not know what they are or how to deal with them. One of those “What’s this here?” conditions is cradle cap. [mustelausa.com]
Skin
- Eczema
Factsheet: Infantile Seborrhoeic Eczema. National Eczema Society. [babycentre.co.uk]
Periodically confused with infantile eczema, cradle cap is different from eczema in that it does not cause itching as eczema would. [earthclinic.com]
Your baby may also have cradle cap if there's a family history of allergic conditions, such as eczema. [babycenter.com.au]
- Skin Disease
Different species will start or aggravate different skin diseases. In the seborrheic dermatitis, M.restricta will play an important role, in the atopic dermatitis, M.globosa and/or M.restricta are major cutaneous microflora. [doi.org]
Overview Seborrheic dermatitis: Despite its appearance, this skin disease is not caused by poor hygiene. Seborrheic dermatitis: Overview This is a very common skin disease that causes a rash. [aad.org]
- Skin Lesion
In time, these scales begin to flake, leaving the affected skin not just red in hue, but also with loss of hair. [ 10, 11 ] In more severe cases, the skin lesions may appear thickened and more erythematous in character. [ihealthblogger.com]
[…] redness Hair loss Diagnosis is based on appearance and location of the skin lesions. [web.archive.org]
A physical examination was performed to verify the presence of skin lesions. [ncbi.nlm.nih.gov]
Similar skin lesions may also appear on the forehead, face, elbows, buttocks or in the skin underneath the diapers. These kinds of conditions are categorized as eczema. Underneath the spots, the skin is red and irritated. [firstderm.com]
- Skin Rash
[…] cradle; cap; dermatitis; seborrhoeic; rash; scalp; Cradle cap is a yellowish, patchy, greasy, scaly, crusty and sometimes smelly skin rash that occurs on the scalp of recently born babies. [cyh.com]
If your baby has a skin rash or a dry, scaly look to her scalp, she may be suffering from eczema or cradle cap. This is what you need to know about these two common baby conditions. What causes or aggravates eczema? It can run in families. [kidspot.com.au]
Cradle cap is a common baby skin condition that most often appears within the first three months of a baby’s life. It is a flaky skin rash that can cause more concern than needed. [babypibu.com]
Concerns about your baby's skin If you are worried about your baby's skin, talk to your GP, your public health nurse or your pharmacist. Always get skin rashes checked by your GP, particularly if your baby is unwell [hse.ie]
Medical review by: Khanh-Van Le-Bucklin, Liat Simkhay Snyder Last medical review: October 10, 2013 Updated: January 26, 2017 Diseases & Conditions Top Newborn Top Skin & Rashes Dr. [drgreene.com]
- Scalp Rash
Frequently, a stubborn diaper rash accompanies the scalp rash. The specific causes are not known. Current theories for the cause of the disease include a weakened immune system, the lack of specific nutrients or issues with the nervous system. [en.wikipedia.org]
Infantile seborrhoeic dermatitis Infantile seborrhoeic dermatitis causes cradle cap (diffuse, greasy scaling on scalp). The rash may spread to affect armpit and groin folds (a type of napkin dermatitis ). [dermnetnz.org]
Frequently, a stubborn diaper rash accompanies the scalp rash. Older children and adults may develop a thick, tenacious, scaly rash with large flakes of skin. [web.archive.org]
Psychiatrical
- Low Self-Esteem
The condition may result in: Psychological distress, low self-esteem, embarrassment Secondary bacterial or fungal infections Call for an appointment with your health care provider if seborrheic dermatitis symptoms do not respond to self-care or over-the-counter [web.archive.org]
The condition may result in: Psychological distress, low self-esteem, embarrassment Secondary bacterial or fungal infections Call for an appointment with your provider if your symptoms don't respond to self-care or over-the-counter treatments. [nlm.nih.gov]
In addition, because SD frequently occurs on the face and other visible areas, it has significant negative effects on patients’ quality of life (QOL) in the form of psychological distress or low self esteem; the willingness to pay for relief of the symptoms [doi.org]
Neurologic
- Stroke
Risk factors include: Stress or fatigue Weather extremes Oily skin, or skin problems such as acne Infrequent shampoos or skin cleaning Using lotions that contain alcohol Obesity Neurologic conditions, including Parkinson disease, head injury or stroke [web.archive.org]
[…] genes Risk factors include: Stress or fatigue Weather extremes Oily skin, or skin problems such as acne Heavy alcohol use, or using lotions that contain alcohol Obesity Nervous system disorders, including Parkinson disease, traumatic brain injury, or stroke [nlm.nih.gov]
Neurologic conditions including Parkinson's disease, head injury or stroke may be associated with seborrheic dermatitis. Seasonal changes / weather extremes. Prevention / remedies / treatment for seborrhoeic dermatitis Good scalp hygiene. [growyouthful.com]
- Agitation
Paul Sirna, a pediatrician in Verona, N.J., says most cradle cap remedies aim to agitate the dry flakes off the scalp and then replenish hydration to the area. [mnn.com]
Workup
Diagnosis of cradle cap is based solely on the history and physical findings. Laboratory, imaging or histological evaluation are of no added value.
Microbiology
- Malassezia Furfur
furfur (formerly Pityrosporum ovale ), but a causative mechanism has not been identified. 1, 2 Overnight use of emollients such as mineral oil to soften scales followed by gentle brushing and washing with baby shampoo is an accepted treatment, although [mdedge.com]
The salicylic acid works as an antimicrobial for cradle cap treatment target the yeast-like Malassezia furfur, and it also helps to exfoliate away the waxiness and flakiness of cradle cap. [babypibu.com]
To test this, preparations of capsulated or acapsular [10% (v/v) Triton X-100 treated], viable and nonviable, exponential or stationary phase Malassezia furfur, Malassezia globosa, Malassezia obtusa, Malassezia restricta, Malassezia slooffiae and Malassezia [ncbi.nlm.nih.gov]
Mayser P, Wille G, Imkampe A et al. (1998) Synthesis of fluorochromes and pigments in Malassezia furfur by use of trypophan as single nitrogen source. Mycoses 41: 265–271 PubMed Google Scholar 14. [springerlink.com]
Treatment
There is no treatment for cradle cap as it is self-limiting and disappears on its own, whether it is caused by hormones or yeast. However, if the parents of the babies have cosmetic concerns, the following options may be considered. Gentle washing of the scalp is the commonest prescribed home remedy. The scales are then combed out gently and brushed off with a soft brush or cloth. This has to be done gently to avoid worsening the condition or causing baldness. Also, applying petroleum jelly and leaving it overnight is another popular home remedy. The scales readily fall off during the night and the remaining brushed off in the morning. Making a paste from sodium bicarbonate and applying in in the affected place for about 10 minutes can help to lift the scales. These are home remedies with no research data to back them up [6].
The use of shampoos remain controversial.
Mild baby shampoo is recommended by some sources for washing the infant hair. Dandruff shampoos that contain salicylic acid aren’t recommended as the active ingredient could be absorbed through the skin of the baby.
If the symptoms show no sign of abating after these home remedies, ketoconazole shampoos and creams may be useful. Ketoconazole has been shown to have a high level of efficacy in the treatment of moderate to severe forms of this condition and it is not absorbed through the skin. The corticosteroid hydrocortisone cream is useful in reducing redness and inflammation [7].
If the lesion is on the eyelid. The eye should be cleansed by a cotton swab soaked in well diluted baby shampoo.
Prognosis
This condition often clears as a baby grows older. It however, on rare occasions, persists into toddler years and even early childhood.
Etiology
The cause of seborrheic dermatitis still remains largely unknown. Although it has been speculated that around the time of birth, some unidentified hormones are passed from mother to baby. These hormones then cause an abnormal stimulation of the oil producing glands (seborrheic glands) and hair follicles leading to increased production of oil (sebum) [2]. Another speculated cause is the yeast Malassezia. Malassezia is a fungus that grows in the sebum produced by the seborrheic glands.
Epidemiology
It is generally a disease of infancy and it occurs between the ages of 3 weeks and 12 months. The peak prevalence age is 3 months as 70% of cases are seen in infants of that age. The prevalence decreases steadily afterwards. There has however been some reported cases in children over 1 year with as much as 7% of cases occurring in children between the ages of 1 and 2 years. It is common in all races and equally distributed between sexes [3].
Pathophysiology
In the same vein as the cause, the pathophysiology is not known. It is believed that there is transplancental migration of maternal androgens to the fetus. This androgens then stimulate the infant’s sebaceous glands. This stimulation even though seemingly insufficient to cause cradle cap, is necessary for its development.
A yeast fungus, Malassezia, has also been implicated although its role is unclear. Malassezia is a lipid dependent yeast whose colonization has been reported in infants with cradle cap. This fungus however has also been reported in other dermatological conditions and in normal infants.
Another implicated factor is biotin deficiency, possibly due to the effect of biotin on sebaceous glands. Biotin is a water soluble vitamin involved in the synthesis of fatty acids [4].
Prevention
Daily shampooing of the baby’s hair with mild baby shampoo can help prevent the development of this condition [8].
Summary
Cradle cap is a harmless condition and it is usually self-limiting with most cases resolving within 12 months. Some children may have it for longer necessitating a medical visit. Although it is called cradle cap, similar lesions may appear on the baby’s armpits, eyebrows or eyelids [1].
Patient Information
- Definition: Cradle cap, also known as infantile seborrheic dermatitis, is a common condition in infancy in which there are white or yellow scaly lesions on the baby’s head. Similar lesions could also be seen on the eyelids, armpits and groin.
- Cause: There is no known specific cause although it has been attributed to some maternal hormones that are passed through the placenta to the fetus just before birth. These hormones act on the oil producing glands by overstimulating them. It could also be caused by a yeast fungus that grows in the secretion of these glands.
- Symptoms: The symptom of this condition is the scaly or crusty skin. This scales may be white or yellow in color and there could be redness due to inflammation. It doesn’t itch or cause any form of discomfort. If there are suspicions of itching, medical advice should be sought as it could be due to another skin condition [9].
- Diagnosis: The diagnosis is usually made from history and physical examination by the doctor. No laboratory tests are required.
- Treatment: It usually requires no treatment and tends to disappear as the child grows older. Some home tips could however help to manage the condition, like rubbing the baby’s scalp to loosen the scales, washing the hair with mild baby shampoo, and rubbing petroleum jelly to soften the scales. After the scales are gone, there should be periodic washing with shampoo to prevent a recurrence [10].
References
- Wannanukul S, Chiabunkana J. Comparative study of 2% ketoconazole cream and 1% hydrocortisone cream in the treatment of infantile seborrheic dermatitis. J Med Assoc Thai 2004; 87 Suppl 2:S68.
- Foley P, Zuo Y, Plunkett A, et al. The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap). Arch Dermatol 2003; 139:318.
- Ruiz-Maldonado R, López-Matínez R, Pérez Chavarría EL, et al. Pityrosporum ovale in infantile seborrheic dermatitis. Pediatr Dermatol 1989; 6:16.
- Bikowski J. Facial seborrheic dermatitis: a report on current status and therapeutic horizons. J Drugs Dermatol. Feb 2009;8(2):125-33.
- High WA, Pandya AG. Pilot trial of 1% pimecrolimus cream in the treatment of seborrheic dermatitis in African American adults with associated hypopigmentation. J Am Acad Dermatol. Jun 2006;54(6):1083-8.
- Tatlican S, Eren C, Eskioglu F. Insight into pimecrolimus experience in seborrheic dermatitis: close follow-up with exact mean cure and remission times and side-effect profile. J Dermatolog Treat. 2009;20(4):198-202.
- Kligman AM, Marples RR, Lantis LR, McGinley KJ. Appraisal of efficacy of antidandruff formulations. J Soc Cosmet Chem. 1974;225:73-91.
- Seite S, Rougier A, Talarico S. Randomized study comparing the efficacy and tolerance of a lipohydroxy acid shampoo to a ciclopiroxolamine shampoo in the treatment of scalp seborrheic dermatitis. J Cosmet Dermatol. Dec 2009;8(4):249-53.
- Tajima M, Sugita T, Nishikawa A, Tsuboi R. Molecular analysis of Malassezia microflora in seborrheic dermatitis patients: comparison with other diseases and healthy subjects. J Invest Dermatol. Feb 2008;128(2):345-51.
- Taieb A, Legrain V, Palmier C, et al. Topical ketoconazole for infantile seborrhoeic dermatitis. Dermatologica 1990; 181:26.