Cradle Cap (Infantile Seborrheic Dermatitis on the Head)

Definition

Cradle cap (infantile seborrhoeic dermatitis, milk crust, honey comb disease) is a skin condition affecting infants and characterized by yellowish, scaly patches on the scalp. Cradle cap usually affects children around the first three months of the life. It does not bother the infants as it is not itchy and usually does not require any treatment since it disappears on its own. Washing with a mild shampoo can easily loosen the patches but severe persistent patches require treatment with medicated shampoo. Seborrheic dermatitis can also occur in older children, teens and adults in which case it is known as dandruff.

Symptoms

Common symptoms are :

  • Appearance of greasy, scaly yellowish to brownish patches or crusts on the scalp.
  • Usually itching is absent.
  • Mild redness may be seen at the affected area of the scalp
  • Associated skin flakes are seen in other areas like ear, eyebrows, eyelids or areas adjacent to nose and groin.

Cradle cap is not contagious meaning that it does not spread from person-to-person.

Causes

Although the exact cause of cradle cap is not known, allergies, bacterial infections and poor hygiene do not cause cradle cap as is often thought. There are two common theories regarding the cause of seborrheic dermatitis.

  1. Infection by fungus usually due to administration of antibiotics to the mothers before delivery of the baby or to the baby during the first week after birth may kill beneficial bacteria besides the harmful bacteria. The beneficial bacteria are known to protect from fungal infections and overgrowth. In infants the fungal infection or overgrowth of fungi (without infection) apart from the scalp (cradle cap) may affect the diaper area, ear or mouth (oral thrush).
  2. Overactivity of the oil (sebaceous) glands may occur due to biotin deficiency and circulation of hormones in the baby passed from the mother. These hormones or deficiency increases the production of sebum from the sebaceous gland.

Risk factors

  • Appearance of skin flakes on eyelids, eyebrows, ear, groin region (diaper rash) may precede before the scalp lesions (cradle cap).
  • History of antibiotic treatment in mothers just prior to the birth of the baby or antibiotic administration to babies around the first week of life.
  • May be associated with immune disorders.

Treatment

Usually cradle cap resolves with age but sometimes it may turn into atopic dermatitis (eczema). Mild cases of cradle cap is usually managed with gentle washing of the scalp with mild shampoo and brushing with a soft brush which allows the scaly flakes or patches to easily dislodge. In persistent cases where other body parts are affected, medicated shampoos containing ketoconazole or selenium to dissolve the flakes is prescribed.

Topical (local) application of steroid to reduce inflammatory changes is rarely recommended as there is chance of development of toxicity in the infants. Sometimes severe cases of cradle cap presenting with cracking and bleeding provide a favorable place for bacterial growth. In these cases a combination of antifungal and antibiotic treatment is required. Parents need to be advised about the condition and not to undertake aggressive measures on the baby’s scalp.

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