Cradle cap is a harmless, but unpleasant-looking skin condition affecting the scalp skin in very young infants. Usually starting within the first two months of life, it is caused by inflammation of the skin due to the excessive sebum secretion. The sebum is a fatty product released by the sebaceous follicles in the dermis.
The hypersecretion of sebum may be a response to the high levels of hormones (found in the baby’s blood) that stimulate its production and release. The increased hormone levels, in turn, come from the mother’s blood during pregnancy.
Cradle cap is a purely clinical diagnosis. The characteristic feature is yellow or white greasy scales on the skin of the infant’s scalp, without itching, weeping or pus formation – unless complicated by infection. While cradle cap occurs mostly on the scalp, sometimes it may be found on the face, neck, ears or in the skin folds. The skin may be reddened under the peeling scales. Sometimes hair fall occurs along with the removal of the scales, but it always grows back. The child is not otherwise sick, and grows normally.
If the cradle cap is infected, the skin around it becomes swollen and red (i.e. it shows typical signs of inflammation). Blisters or pustules may form, while weeping lesions may be found near the scaly ones.
Cradle cap is wholly benign when it is not complicated by infection; hence it tends to go away on its own, without any treatment. By the time they are one year of age or older, most babies are totally free of the condition.
However, the appearance of the scalp often represents a stimulus for caregivers to try and remove it. The most common way is to apply a very light coat of mineral oil (such as baby oil) to the scalp in the affected areas. Any pure natural oil such as almond or olive oil may also be used.
After leaving it on for an hour or two, a mild shampoo is then applied to remove the loosened scales. The scalp and hair should also be brushed gently with a soft toothbrush or a soft-bristle hairbrush to tease out the scales. This may be done daily till the scalp looks normal. Maintenance requires regular treatment twice a week for several months, because the lesions tend to recur for some time.
The scales should never be picked at to prevent the introduction of infection. The shampoo applied should be a hypoallergenic and very mild one. In most cases, an ordinary baby shampoo will suffice, albeit in very severe cases a dandruff shampoo may be carefully used. The shampoo should always be kept away from the baby’s eyes in order to prevent irritation. Shampoos with groundnut oil are not recommended for infant use.
Infected cradle cap should always be treated, as should spreading dermatitis. Thus if the scaly lesions appear on other parts of the body, the baby should be taken to the doctor. Similarly, if it becomes itchy, painful or swollen, or there is an appearance of pus or weeping blisters, the baby should be treated with antibiotics, antifungal cream or shampoo under medical supervision. Local steroid cream application may help to clear up the inflammation if present. Very severe cradle cap also warrants treatment.
Reviewed by: Dr Tomislav Meštrović, MD, PhD