What Is Cradle Cap?

Cradle cap is the lay term for a condition called seborrheic dermatitis (also called seborrhea or dandruff in older kids and adults); cradle cap is the specific name that indicates the condition affects an infant.

Cradle cap is a relatively common condition in infants. It can occur in up to 10% of infants under 4 weeks of age and is seen in babies between the ages of 3 weeks and 12 months.

Cradle cap is not a contagious disorder, and neither is it a result of poor hygiene.

This article reviews the types, symptoms, causes, diagnosis, and treatment of cradle cap.

Types of Cradle Cap

Cradle cap usually appears on an infant's scalp; less commonly, it can occur on the:

• Eyebrows
• Eyelids
• Ears
• The crease of the nose
• Back of the neck
• Armpits
• Back of the knees
• Diaper area

When cradle cap appears on the body, it’s no longer called cradle cap but is referred to as seborrheic dermatitis.

Cradle Cap Symptoms

The appearance of cradle cap can differ from one baby to another. For example, the crusty appearance may be bunched together in crops, it can be spread out on the scalp, or it may appear in various areas of the body (such as behind the ear). Sometimes the scales appear in small areas; other times they can be found all over the scalp.

Symptoms of cradle cap include:

• Thick plaques or crusts, particularly on the scalp, but may appear in other areas of the body
• Scaly or flaky skin
• Greasy patches covered with yellow or white scales
• Dandruff (skin flakes)
• Red, moist skin folds (such as in the folds of the neck)
• Hair loss (which may or may not occur and usually grows back once the cradle cap is gone)
• Mild to moderate redness on the scalp
• Reddened, itchy skin (itchiness is uncommon, but does occur in some instances)

Causes

The exact underlying cause of cradle cap is unknown. It is thought that contributing factors may include an excess of skin oil (called sebum) in the oil glands and hair follicles (which occurs due to overactive sebaceous glands) along with a reaction to a type of yeast called Malassezia.

Malassezia yeast is a type of yeast that normally lives on the skin. The scalp microbiome is an environment involving a community of organisms that grow on the skin (as well as the scalp). There is a diverse mix of bacteria, fungi, and other organisms that must have a proper balance in numbers to work together optimally and stave off infections. When the balance is disturbed, skin conditions, such as those that cause itching, flaking, and irritation, can develop.

Diagnosis

Cradle cap can be diagnosed by a healthcare provider during a physical examination. By assessing the way the skin appears and where the rash is, a diagnostician can usually make the determination.

Treatment

In most cases of cradle cap, the condition will resolve itself without any treatment. But many parents choose to provide home remedies to help loosen and remove scales on the infant’s scalp. The home remedy steps include:

• Gently massage the infant’s scalp with the fingers or a washcloth.
• Wash the infant’s hair once per day with mild, tear-free baby shampoo (during the time that the scales are present).
• Brush the baby’s hair with a soft (clean) brush to help remove the scales before rinsing the shampoo.
• If the scales are not easily removed, try rubbing a small amount of mineral oil (do not use olive oil) into the infant’s scalp. Allow the oil to absorb into the scales for a few minutes, then resume the regimen of shampooing with mild baby shampoo and brushing with a soft brush, then finally rinsing. Do not use a large amount of mineral oil; too much oil may contribute to the buildup of scales and worsen the cradle cap condition.
• Shampoo the hair twice each week (once the scales are gone) to control cradle cap.

If the regular shampooing/brushing routine is ineffective, consult with the pediatrician about using some type of over-the-counter dandruff or medicated shampoo and possibly an antifungal shampoo, called ketoconazole, to help treat flaking and dryness of the scalp.

Rarely, stronger forms of these medications may be prescribed, and hydrocortisone cream may be given to reduce inflammation. A type of hydrocortisone may be given that is combined with an anti-yeast cream. But healthcare providers are cautious not to overtreat cradle cap. These stronger medications are prescribed only when the condition doesn’t respond to initial treatment.

Note that symptoms of cradle cap may go away for up to several months at a time, and then reappear. If the condition does recur, following the home remedy regimen is often enough to control it.

Prognosis

Usually, cradle cap resolves on its own between 6 months and 12 months of age. Because the condition is not generally known to cause itchiness or discomfort, treatment is optional and is primarily done for cosmetic reasons. The brushing and shampooing help to reduce the thickness of the scales and may shorten the duration of the scales.

Summary

Cradle cap is a relatively common condition in infants that causes a dandruff-like substance to accumulate on the scalp.