Cradle Cap or crib cap is a noninflammatory skin condition of the scalp in infants. Besides the scalp, it may also affect the face, diaper area, and skin folds.
It is a type of seborrheic dermatitis seen in infants.
Read more about Seborrheic Dermatitis- Clinical Features, Causes, and Treatment
Cradle cap commonly affects infants within the first few weeks of life. Around 10% of infants get cradle cap and the majority of them develop it by 3 months of age. With increasing age, the chances of cradle cap keep on decreasing. In the majority of cases, it requires no treatment and gets cured on its own.
Seborrheic dermatitis commonly involves the following sites in infants:
- Scalp (called cradle cap or crib cap)
- Diaper area (called diaper rash/napkin dermatitis)
- Forehead and face
- Behind the ears
- Armpits, and other skin folds and creases
Seborrheic dermatitis can develop in an infant within the first few weeks of life.
The condition slowly resolves and disappears by the age of 6 months to one year without any treatment.
The most common site is the scalp where it is called cradle cap.
Signs and symptoms
- Thick greasy patches or crusts on the scalp
- Flaky white to yellow scales
- Rarely mild redness of the involved area
- No itching
Cradle cap might look painful, itchy, or irritating to the skin. But it is harmless and not itchy. The baby is often undisturbed by the rash, even if it is widespread.
Cradle cap may spread to involve other areas of the body. In some cases, the rash first appears on the face or diaper area and then spreads to other parts of the body.
The skin in areas of skin folds and creases may appear red and moist.
Causes of cradle cap
The exact cause is unknown. The following factors are thought to cause cradle cap:
- Certain hormones that pass from the mother to the baby before birth may lead to the overproduction of oil (sebum) by the skin. This excess oil causes the dead skin cells (which normally fall off) to stick to the skin forming yellow crusts and scales.
- Malassezia yeast, (a fungal organism that normally lives on the surface of the skin), is also thought to contribute to the formation of cradle cap. Overgrowth of this fungus may lead to an inflammatory reaction that results in skin changes.
- Dry, cold weather or emotional stress may also be responsible for causing cradle cap.
Cradle cap is not contagious meaning it can’t spread from one person to another through contact.
Also, it is not a type of allergy, though the skin lesions can look similar to an allergic reaction.
The disease is not caused by poor hygiene.
The diagnosis is mainly based on the appearance of skin lesions and the typical sites of involvement.
No blood tests are required to make a diagnosis.
No medical treatment is usually required for cradle cap as it goes away on its own by the age of 6 months to 1 year.
Home remedies are all that is required in the majority of the cases. These include:
Gently massaging the scalp with oil
This helps to soften and loosen the scaly patches. Any type of oil or emollient can be used including baby oil, coconut oil, olive oil, or petroleum jelly. It is best to leave the oil on the scalp for sometime before washing the hair.
Massaging the scalp also provides relaxation to the baby. Since stress can act as a trigger for the condition, relaxation and comfort are important to prevent further flare-ups.
Regularly washing the baby’s hair using a mild shampoo.
Regularly washing the scalp (preferably daily) is important to get rid of the scaly patches. It also helps to prevent future outbreaks. It is important to use a mild shampoo for washing the hair and scalp.
Massaging the scalp while washing hair
This further helps to loosen and break up the patches so that they are removed from the scalp.
Rinsing the hair and scalp thoroughly after shampooing.
Rinse the baby’s hair and scalp thoroughly with water after applying shampoo. This is important so that no residual shampoo or chemical is left behind which can irritate the delicate skin of the infant.
Brushing the baby’s hair with a soft-bristled brush
Brushing the baby’s hair gently also helps to break down the scales so that they fall off.
A normal-sized soft toothbrush can be used to brush the baby’s scalp as it is both small and soft. A soft brush made with rubber-bristles instead of hard plastic can also be used. Once the hair and scalp have been brushed, a fine-toothed comb may be used to catch and remove the scaly flakes as it passes through the hair.
Don’t scratch the skin
Even if the scales do not come off even with regular massaging and daily shampooing, resist the temptation to scratch away the scales from the scalp.
Vigorously scratching the skin may cause injuries from the nails, scarring of the skin, or even infection.
Moreover, since the cradle cap does not itch or cause any other problem to the baby, scratching is not required.
Reduce baby’s stress
Since stress may trigger a cradle cap, so it is important to reduce it.
Ensuring that the baby gets sufficient sleep and paying attention to his or her needs can ensure that the baby feels relaxed, comfortable, and safe.
As discusses earlier, most of the cases do not require medical treatment and get completely cured with home remedies or on their own. Medical treatment is used only in severe cases or in babies not responding to home treatment.
Over the counter dandruff shampoo may be used. They usually contain zinc pyrithione, tar, or selenium sulfide which help to break down and remove the scaly patches.
Since these shampoos are for adults, they may irritate the delicate skin and eyes of the infants. Therefore utmost care should be taken while using these. They should not be left for a longer period on the baby’s scalp and must be thoroughly rinsed with water so that no residual chemical remains on the baby’s scalp.
For more severe cases, prescription shampoo may be prescribed by the pediatrician. These contain 2% salicylic acid and sulfur. Both these compounds are keratolytics that help to soften and shed the outermost layer of the skin.
Alternatively, a topical cream may be prescribed by the doctor. 2% ketoconazole (an antifungal cream) or 1% hydrocortisone (a topical steroid cream) may be used. Improvement usually occurs within 1- 2 weeks.
- Sasseville D. Cradle cap and seborrheic dermatitis in infants. https://www.uptodate.com/contents/search.
- AskMayoExpert. Seborrheic dermatitis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.
- Barbara Woodward Lips Patient Education Center. Caring for your newborn. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.