Edit concept Question Editor Create issue ticket

Cradle Cap

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].

Italian
  • […] infantum, capitis; seborroe, seborroe; capitis, seborroe; sicca, sicca; seborroe, Seborrhoea capitis, hoofdroos French Dermite séborrhéique du cuir chevelu, Dermite séborrhéique de la tête, Séborrhée de la tête, Séborrhée du cuir chevelu, Pellicules Italian[fpnotebook.com]
Stridor
  • Croup (and Croup Audio Sound Clips) We did our research and pulled together five of the best croup sound files and stridor... Reflux What is baby reflux? A small number of babies who tend to spit up a lot are also...[mommyhood101.com]
Food Intolerance
  • Certain food intolerance (e.g. gluten, dairy products), common allergens or change in the atmosphere might lead to skin irritation and inflammation eventually causing cradle cap A family history of skin allergies, such as eczema, may increase your baby[pregmed.org]
Macrocephaly
  • Interesting Facts About Dolphins - January 21, 2019 21 Best Baby Laundry Detergents To Buy In 2019 - January 21, 2019 Baby's Chapped Lips: Causes, Home Remedies And Prevention - January 21, 2019 25 Best Baby Dolls For Your Little One - December 31, 2018 Macrocephaly[momjunction.com]
Eye Irritation
  • The product is non-toxic, and has similar eye irritation potential to typical family shampoos though less than anti-dandruff shampoos. Not applicable. Dentinox Cradle Cap Treatment Shampoo has a cleansing action.[medicines.org.uk]
Eczema
  • If the eczema doesn't get better, see a paediatric dermatologist. TIP! If baby has eczema, reduce contact with people that have cold sores as baby can develop infections from this virus.[kidspot.com.au]
  • Factsheet: Infantile Seborrhoeic Eczema. National Eczema Society.[babycentre.co.uk]
  • Good skin care (i.e. the use of emollients) will promote general skin health and reduce any dryness associated with co-existing atopic eczema.[ncbi.nlm.nih.gov]
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]
  • On DermNet NZ Diagnosis of scalp rashes Pityriasiform seborrhoeide Sebopsoriasis Pityriasis versicolor Malassezia folliculitis Dermatitis Psoriasis Pityriasis amiantacea Malassezia Cradle cap Leiner syndrome Dermatitis online course for health professionals[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]
Dry, Scaly Skin
  • Cradle cap This is a build up of natural oils and dry scaly skin, which can form a yellow/brown crust on baby's head, eyebrows or behind the ears.[kidspot.com.au]
  • Mineral oil: Rubbing some mild mineral oil on the scalp and keeping it covered with a wet warm washcloth for around an hour before shampoo to make any dry scaly skin to fall off.[pregmed.org]
Skin Bleeding
  • Don’t force the crusts, because this might make your baby’s skin bleed. If the crusts are inflamed, your GP might prescribe a combination mild corticosteroid and anti-yeast cream – for example, Hydrozole cream.[raisingchildren.net.au]
Fussiness
  • When I put it on a couple of weeks ago, he was very fussy as though it irritated his scalp. After brushing it in, leaving it on and then shampooing it off, initially his scalp seemed smoother, but all the thick flakes grew right back overnight.[walmart.com]
  • “In babies this age, itchiness may present as excessive fussiness, or baby may attempt to rub her head on anything that’s nearby,” she adds.[thebump.com]
Confusion
  • Periodically confused with infantile eczema, cradle cap is different from eczema in that it does not cause itching as eczema would.[earthclinic.com]
  • It's sometimes confused with another skin condition, atopic dermatitis. A major difference between these conditions is that atopic dermatitis usually causes significant itching.[mayoclinic.org]
  • Do not confuse seborrheic dermatitis with psoriasis, which presents as large, dry, thick, well-defined silvery scales.[growyouthful.com]
  • It can be confusing the first time you realise its not a liquid like other cooking oils, but it softens easily to apply on baby’s head. If you decide to warm it up yourself, please be careful of not getting it too warm on baby’s head.[bellybelly.com.au]
Hyperactivity
  • Two theories have been believed: it can be from either fungi or from hyperactivity of sebaceous glands. [ 3, 6 ] It is thought to be of fungal origin, particularly Malassezia, associated to maternal antibiotic use just before delivery, or that given to[ihealthblogger.com]
Agitation
  • ., says most cradle cap remedies aim to agitate the dry flakes off the scalp and then replenish hydration to the area.[mnn.com]
Tingling
  • - December 31, 2018 What Causes Tingling In Breasts And How To Deal With It? - December 31, 2018 Can You Have Pepto Bismol When Breastfeeding? - December 31, 2018 Rohit Garoo took writing as a profession right after finishing his MBA in Marketing.[momjunction.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.

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].

Sex distribution
Age distribution

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

Article

  1. 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.
  2. 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.
  3. Ruiz-Maldonado R, López-Matínez R, Pérez Chavarría EL, et al. Pityrosporum ovale in infantile seborrheic dermatitis. Pediatr Dermatol 1989; 6:16.
  4. Bikowski J. Facial seborrheic dermatitis: a report on current status and therapeutic horizons. J Drugs Dermatol. Feb 2009;8(2):125-33.
  5. 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.
  6. 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.
  7. Kligman AM, Marples RR, Lantis LR, McGinley KJ. Appraisal of efficacy of antidandruff formulations. J Soc Cosmet Chem. 1974;225:73-91.
  8. 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.
  9. 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.
  10. Taieb A, Legrain V, Palmier C, et al. Topical ketoconazole for infantile seborrhoeic dermatitis. Dermatologica 1990; 181:26.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:33