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Cradle Cap - Seborrheic Dermatitis in Newborns

By Liji Thomas, MD

Cradle cap is a term used to describe a form of seborrheic dermatitis that affects infants in the first three months of life. It is a self-limited inflammation of the skin of the scalp, presenting as yellow crusted lesions. The condition usually subsides within the first year.  

The cause is thought to be a reaction to some substance in the sebum or fatty material that is released by the sebaceous glands of the scalp skin. This is possibly caused by an excess of sebum-producing hormones in the infant’s blood, which have been transferred from the mother in the last few weeks of pregnancy.

Cradle cap comb - Image Copyright: Luca Lorenzelli / Shutterstock
Cradle cap comb - Image Copyright: Luca Lorenzelli / Shutterstock

Symptoms

Cradle cap is not infectious, nor is it the result of unhygienic practices. It has the appearance of greasy whitish-yellow crusts or large flakes or scales of skin, while the surrounding skin may appear reddened. The scales may detach carrying the overlying hair with it; the hair, however, does grow back.

Itching or swelling of the lesions is not characteristic of this condition, thus other diagnoses should be sought if such symptoms are present. While the most common site of cradle cap is on the scalp, it can also occur on the face and neck, the ears, diaper area, and skin folds such as behind the knee or under the arm.

Complications

Cradle cap may become infected in some children. In these cases, the skin under the crust will look red and possibly swollen. Furthermore, blisters, pus, or weeping lesions may develop. Usually caused by the same skin bacteria, such as Staphylococcus aureus or Streptococcus, this may require topical antibiotic treatment. Secondary fungal infection may be treated with antifungal ointments.

The infection may spread to other parts of the body to cause impetigo or school sores. The baby may appear sick or become feverish if more severe infection sets in.

Management

While cradle cap is not dangerous or troublesome, many parents do not like the way it looks. It usually subsides quickly, within a few weeks. If it is to be removed earlier, the following methods may be of use:

Rub baby oil or any natural oil into the scalp each night gently, to loosen the scalp crusts overnight. In the morning, the loose crusts can be brushed off with a soft brush, and the head shampooed with a mild shampoo. The process can be repeated daily till the crusts are cleared. The brush should be cleansed each day with mild soap and rinsed in clean water thoroughly. Once the scales are off, the frequency of scalp shampooing may be reduced to twice a week to prevent recurrence.

However, cradle cap may be hard to keep off because of the overactive sebum glands. In severe cases, an anti-dandruff shampoo may be of use, but it should not be allowed to get into the infant’s eyes, because it is irritating. In other babies, maintenance cleaning of the scalp is necessary to treat recurrences for a few months, following which it usually subsides on its own.

When the lesion spreads to other parts of the scalp or body, medical help should always be sought. It is noteworthy that infants who have cradle cap often tend to develop dandruff of the scalp when they grow up.

Reviewed by: , MD, PhD

Further Reading

Last Updated: Oct 20, 2016

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