What is Cradle Cap (Seborrheic Dermatitis)?
Cradle cap, also known as pityriasis capitis, is a type of seborrheic dermatitis often found in infants. It is a very common skin condition that typically develops in the first couple of months after birth, with the highest occurrence around the 3rd month. Cradle cap isn’t usually harmful and tends to go away on its own. It appears as red patches with oily, yellow scales on the skin. The name “cradle cap” comes from the places on the body where it is commonly found – areas with many oil glands like the scalp, T line of the face, and outer ears. It’s crucial that parents understand how to manage this condition and be assured that it’s generally harmless.
What Causes Cradle Cap (Seborrheic Dermatitis)?
The exact cause of cradle cap is still unknown. However, scientists have a few ideas on what might influence its development. One theory suggests that hormones from the mother could be causing the baby’s oil-producing glands to work overtime. These glands produce something called sebum, a kind of oil. If there’s too much sebum, the dead skin cells stick around instead of shedding like they normally would.
Another clue is that seborrheic dermatitis, a skin condition associated with cradle cap, is more common during infancy and adolescence, indicating that hormones likely play a role. Also, a type of yeast called Malassezia might be involved in many cases of cradle cap. This yeast eats the sebum, leaving behind certain fatty acids.
Taking into account that two types of Malassezia, M. globosa and M. restricta, have been found in over 80% of people visiting outpatient dermatology clinics, regardless of their age, it might play a role in causing cradle cap. Furthermore, anti-fungal treatments have been found helpful, solidifying the link. However, it’s worth noting that many people without cradle cap also have this yeast, suggesting that there may be a certain susceptibility to it that hasn’t been identified yet.
Risk Factors and Frequency for Cradle Cap (Seborrheic Dermatitis)
Seborrheic dermatitis—a skin condition—is common in early infancy and affects both boys and girls equally. Within the first three months of a baby’s life, about 10% of all infants will have this condition. The likelihood of a baby getting this skin problem is highest at three months old—around 70% prevalence—after which it gradually decreases.
- By the time they are one year old, the rates fall considerably.
- About 7% of one-to-two-year-old children have this condition, and it is usually mild.
- The prevalence continues to decrease as the child grows, particularly by the fourth year.
Signs and Symptoms of Cradle Cap (Seborrheic Dermatitis)
Usually around the third year of a child’s life, parents or caregivers might notice a flaky rash on the child’s scalp, and possibly face, which doesn’t improve with regular home treatments. It’s not uncommon for the child to have a family history of conditions such as eczema or asthma. During a physical examination, doctors often find a greasy yellow flaking on the top and forehead of the scalp. This rash might also appear on the face as red, scaly patches on the forehead, brows, eyelids, folds around the nose, cheeks, and behind the ears.
- Red scaly patches may also occur around the belly button, diaper area, or in skin folds.
- These areas might have less flaking but more redness compared to the scalp.
- Occasionally, the condition can manifest as a very red, full-body rash.
- In such cases, the doctor may explore possible deficiencies in immunity or vitamins.
Testing for Cradle Cap (Seborrheic Dermatitis)
There’s no need for a biopsy or lab tests to diagnose cradle cap.
Treatment Options for Cradle Cap (Seborrheic Dermatitis)
Cradle cap is a skin condition that usually clears up on its own, and its cause isn’t precisely known. Some people think it might be related to hormonal changes. It’s challenging to prevent, but simple home remedies can treat mild cases. For example, washing your baby’s scalp daily using a gentle shampoo and a skin-soothing ingredient (like petroleum jelly, mineral oil, or baby oil) before shampooing can help. Leaving the soothing ingredient on the scalp for an extended period, even overnight, can help break up the flaky skin. After that, gently brushing the scalp with a soft toothbrush or a special comb can remove the flakes. Regular shampooing can help prevent flakes from forming again.
If these measures don’t work or the cradle cap is covering large areas of the scalp, an antifungal cream (like ketoconazole 2%) or a steroidal cream (like hydrocortisone 1%) can be used for 1-2 weeks. For cradle cap in skin folds, ketoconazole 2% cream is preferred.
A study found no significant difference in the effectiveness of ketoconazole 2% and hydrocortisone 1% in treating cradle cap, suggesting that moisturizing the skin might be the most crucial part of treatment.
While selenium sulfide, zinc pyrithione, and salicylic acid are sometimes used to treat similar conditions in adults, we don’t know yet if they are safe or effective in babies. It’s important for parents to know that cradle cap usually persists through the early years of a baby’s life, but it also tends to clear up on its own.
What else can Cradle Cap (Seborrheic Dermatitis) be?
Cradle cap can often be mistaken for various other skin conditions that affect infants. One of these is atopic dermatitis, which is characterized by severe itchiness that can disturb an infant’s sleep and feeding patterns. This condition also causes red, scaly patches on the cheeks, scalp and outer parts of the joints, which can sometimes become crusty.
Another condition often confused with cradle cap is impetigo, which typically begins as small blisters with thin covers. Tinea capitis, a fungal infection of the scalp, can appear similarly but may also lead to hair loss. Doctors can confirm this condition with a specific test (KOH examination) and if there is swelling of the lymph nodes.
Diaper dermatitis, also known as diaper rash, typically doesn’t affect the folds of skin around the groin area. Psoriasis is not commonly seen in infants, but if it does occur, it presents as clearly outlined, bright red patches covered with silvery scales that merge into larger areas called plaques.
Lastly, in stubborn cases of cradle cap that don’t respond to treatment, your doctor might consider a rare condition called Langerhans cell histiocytosis. This can cause ulcers, and reddish-purple bumps in similar areas as cradle cap. Confirmation of this condition would require a biopsy.
What to expect with Cradle Cap (Seborrheic Dermatitis)
Cradle cap is usually harmless and tends to go away on its own. However, if it continues after a child’s first birthday, other potential causes should be looked into.
Possible Complications When Diagnosed with Cradle Cap (Seborrheic Dermatitis)
A rare possible complication could be a bacterial co-infection. This is usually due to frequent scratching when the area is irritated.
Preventing Cradle Cap (Seborrheic Dermatitis)
Parents should be informed about the enduring, self-resolving, and harmless nature of the condition. This means that the condition may last for a long period but usually improves on its own without causing serious harm.
