Cradle cap

Cradle cap is a very common condition in babies affecting the scalp (the skin on the head). It can happen anytime from birth, but usually develops within the first 6 weeks of life. More often than not, it is gone by the time the baby reaches one year of age.

Cradle cap isn’t painful, contagious or dangerous, and usually it is quite mild. However, if you are concerned about your baby’s scalp, talk to your doctor. Treatments are available if needed.

What is cradle cap?

Cradle cap is a type of dermatitis known as ‘seborrhoeic dermatitis’. Because cradle cap happens in babies (infants) it is called ‘infantile seborrheic dermatitis.’

This type of dermatitis can affect other parts of a baby’s body – such as the eyebrows, in skin creases of the neck, armpits, or groin – but when it only affects their scalp, it is called cradle cap.

Seborrhoeic dermatitis can also affect adolescents and adults, but is considered a different type of condition to that found in babies, and generally requires ongoing treatment.

Symptoms of cradle cap

The symptoms of cradle cap can include:

  • a patchy looking scalp
  • greasiness or oiliness of the scalp
  • crusts forming on the scalp, which can be white or yellow coloured
  • redness of the skin around the crusts
  • scales or flakes of skin that rub off when dry, like dandruff, sometimes described as scurf.

Some babies can also lose a small amount of hair from parts of their scalp affected by cradle cap. Cradle cap is generally not itchy. If your baby is itchy it suggests that they may have a different skin condition such as eczema.

Causes

The causes of cradle cap are not well understood. It is known, though, that the condition is nothing to do with being unclean or having an allergy or infection.

One theory about what causes cradle cap in babies is that glands in the skin, called sebaceous glands, may become overactive and produce too much sebum - an oily substance that normally helps waterproof the skin. The sticky sebum prevents the normal shedding of skin flakes from the scalp, trapping them and allowing them to build up on the scalp.

There also seems to be an association between cradle cap and a type of fungus known as Malassezia which exists – usually completely harmlessly – on the skin. It is thought that some babies react against the fungus, causing inflammation which aggravates the symptoms of cradle cap.

After about 3 months of age, sebum production changes. This may help explain why cradle cap tends to affect young babies, rather than older children.

Who is at risk of cradle cap?

Nobody knows why some babies get cradle cap while others don’t. For this reason, doctors are unable to say what the risk factors for cradle cap are, or whether some babies are more at risk of this condition than others.

Complications of cradle cap

Cradle cap is not serious and usually doesn’t lead to complications. However, in some babies, the skin under the crusts that form on their scalp can become infected with bacteria. This secondary infection of bacteria can cause their skin to become red and blister, and the infection can then spread to other parts of their body, as well as to other people who come into contact with them.

Diagnosis

A doctor can usually diagnose cradle cap by examining a baby’s scalp, since the symptoms are quite distinctive. In some cases, a tiny amount of skin may be scraped off and tested, to see if it is infected with a fungus.

Self-care for cradle cap

Cradle cap usually gets better on its own, within a few weeks of appearing.

There are several things you can do at home (self-care) to try to improve cradle cap.

  • Wash the scalp regularly using a baby shampoo (this is milder than adult shampoo). If your baby has eczema, check with your doctor whether shampoo is suitable.
  • Gently brush the scalp to remove loose skin scales, using a soft baby’s hair brush, a soft toothbrush, or a cotton bud. Never scratch your baby’s scalp.
  • If the scales aren’t loose enough to come off with a soft brush, you can try softening your baby’s scalp with a little bit of baby oil (mineral oil), leaving it in for up to a few hours, then brushing. This can also be done overnight. (Don’t use olive oil, which can disrupt the skin and encourage fungal growth, or nut oils, which may lead to a nut allergy.)

If your baby's cradle cap isn't getting better after a few weeks, see your doctor. It is also important to seek medical advice if any other parts of your baby’s body or face appear to be affected, because it may be a different condition causing the problem, and treatment may be necessary.

How is cradle cap treated?

If the cradle cap doesn’t improve, you may want to seek medical advice. Depending on your baby’s symptoms and their severity, your doctor may recommend treatment, such as using:

  • a mild medicated (antifungal) shampoo – if you use this, you will need to be very careful the shampoo doesn’t get in your baby’s eyes. These shampoos can only be used short term.
  • a medicated ointment (such as containing salicylic acid, sulfur and a tar-based product), applied to the scalp and left on for a number of hours to help loosen the scales
  • a mild corticosteroid (such as hydrocortisone), applied to the scalp as a lotion after bathing, to help reduce inflammation of the skin.

Some dandruff shampoos and anti-fungal creams aren't recommended for babies, so always check with your doctor or pharmacist if a product is suitable before using it on your baby.

Once treatment has been started, the cradle cap usually starts to get better within a week. However, in some cases it can come back after it was cleared. While the condition is usually gone by the time a baby turns one, it can persist for longer in some cases.

Can cradle cap be prevented?

Because it is not known what causes cradle cap, there is no known way to prevent it. However, washing your baby's hair every few days using a mild baby shampoo is a good way to help keep their scalp in good health and prevent a build-up of flakes and scales.

Last Reviewed: 13 July 2016
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References

1. Infantile seborrhoeic dermatitis. In: eTG complete. Melbourne: Therpaeutic Guidelines Limited, March 2016 edition. http://online.tg.org.au/complete/ (accessed July 2016).
2. Australasian College of Dermatologists. Seborrhoeic dermatitis and cradle cap. https://www.dermcoll.edu.au/atoz/seborrhoeic-dermatitis-cradle-cap/ (accessed July 2016)
3. DermNet NZ. Cradle cap (infantile seborrhoeic dermatitis). http://www.dermnetnz.org/dermatitis/cradle-cap.html (accessed July 2016)
4. The Royal Children’s Hospital Melbourne. Cradle cap. http://www.rch.org.au/kidsinfo/fact_sheets/Cradle_Cap/ (accessed July 2016)
5. Patient. Seborrheic dermatitis in babies (cradle cap).
http://patient.info/health/seborrhoeic-dermatitis-in-babies-cradle-cap (accessed July 2016)
6. Mayo Clinic. Cradle cap. http://www.mayoclinic.org/diseases-conditions/cradle-cap/home/ovc-20156917 (accessed July 2016)
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