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Cradle Cap – Causes, Symptoms and Treatment

Cradle cap is a common, harmless skin condition in infants, characterized by yellowish, greasy scales and crusts on the scalp.

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Things worth knowing about "Cradle Cap"

Cradle cap is a common, harmless skin condition in infants, characterized by yellowish, greasy scales and crusts on the scalp.

What Is Cradle Cap?

Cradle cap (medically known as infantile seborrhoeic dermatitis) is a non-contagious, inflammatory skin condition that commonly affects newborns and infants during the first months of life. It presents as greasy, yellowish-white scales and crusts, mainly on the scalp, but it can also appear on the face, eyebrows, ears, and neck. Despite its sometimes striking appearance, cradle cap is generally harmless and does not cause itching or pain in the child.

Causes

The exact cause of cradle cap has not yet been fully established. However, several contributing factors are discussed:

Overactive sebaceous glands: Maternal hormones passed to the baby during pregnancy can remain active for several weeks after birth, overstimulating the infant's sebaceous glands.
Malassezia yeast: The naturally occurring skin yeast Malassezia is associated with the development of seborrhoeic dermatitis. It breaks down sebum and can irritate the skin as a result.
Not an allergy: Cradle cap is not an allergic reaction and is not caused by breastfeeding or the mother's diet.

Symptoms

The typical signs of cradle cap include:

Yellowish-brown, greasy scales or crusts on the scalp
Reddish, mildly inflamed skin beneath the scales
Possible involvement of the eyebrows, forehead, ears, or neck
Generally no itching in the infant
No fever or general feeling of illness

Diagnosis

The diagnosis is usually made through a clinical examination by a pediatrician. The typical appearance of the scales and crusts is usually sufficient to identify cradle cap with confidence. Further investigations are generally not necessary. The physician can differentiate cradle cap from other skin conditions such as atopic dermatitis (eczema) or diaper rash.

Treatment

In most cases, cradle cap resolves on its own without requiring treatment. However, several measures can help to loosen the scales and care for the skin:

Home Remedies and Basic Skin Care

Oil softening: Natural plant oils (e.g., olive oil or almond oil) can be gently applied to the scalp and left on for a few hours to soften the scales.
Gentle brushing: A soft baby brush can be used to carefully remove the loosened scales.
Mild shampoos: Specially formulated baby shampoos can help remove excess sebum.

Medical Treatment

For more pronounced cradle cap, a pediatrician may recommend ketoconazole shampoos or creams, which act against the Malassezia yeast.
In rare cases, mild corticosteroid creams may be used short-term to reduce inflammation.
Scales should never be forcibly scraped off, as this can cause injury and infection of the scalp.

Course and Prognosis

Cradle cap is a self-limiting condition, meaning it resolves on its own in the majority of cases. In most infants, cradle cap disappears completely within the first 6 to 12 months of life. In rare cases, it may persist into toddlerhood or develop into chronic seborrhoeic dermatitis. Parents should seek medical advice if there are signs of infection, significant spreading, or if the child appears to be distressed by the skin changes.

References

Deutsche Dermatologische Gesellschaft (DDG) - Guideline on Seborrhoeic Dermatitis, 2020.
Naldi L, Rebora A. - Seborrheic Dermatitis. New England Journal of Medicine, 2009; 360(4):387-396.
Leung AKC, Lam JM, Leong KF. - Seborrhoeic Dermatitis. Advances in Therapy, 2020; 37(10):4198-4210.

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