Cradle cap is a yellowish, patchy, greasy, scaly and crusty skin rash

Rash

A rash is a change of the skin which affects its color, appearance or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cracked or blistered, swell and may be painful. The causes, and...

 that occurs on the scalp

Scalp

The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides and posteriorly.-Layers:It is usually described as having five layers, which can conveniently be remembered as a mnemonic:...

 of recently born babies. It is usually not itchy, and does not bother the baby. Cradle cap most commonly begins sometime in the first 3 months. Similar symptoms in older children are more likely to be dandruff

Dandruff

Dandruff is the shedding of dead skin cells from the scalp . Dandruff is sometimes caused by frequent exposure to extreme heat and cold. As it is normal for skin cells to die and flake off, a small amount of flaking is normal and common; about 487,000 cells/cm2 get released normally after...

 than cradle cap. The rash is often prominent around the ear, the eyebrows or the eyelids. It may appear in other locations as well, where it is called seborrhoeic dermatitis

Seborrhoeic dermatitis

Seborrhoeic dermatitis is an inflammatory skin disorder affecting the scalp, face, and torso. Typically, seborrheic dermatitis presents with scaly, flaky, itchy, and red skin. It particularly affects the sebaceous-gland-rich areas of skin...

 rather than cradle cap. Some countries use the term pityriasis capitis for cradle cap. It is extremely common, with about half of all babies affected. Most of them have a mild version of the disorder. Severe cradle cap is rare.

Causes

Cradle cap is not caused by a bacterial infection, allergy, nor from poor hygiene. Doctors are not in agreement as to the causes, but the two most common hypotheses include fungal infection and overactive sebaceous glands.

In many cases, what is commonly called cradle cap is actually a fungal infection. This infection may be related to antibiotics given to the mother just before the infant's birth, or the infection could be related to antibiotics routinely given to infants during the first week of life. Antibiotics kill both harmful bacteria as well as the helpful bacteria that prevent the growth of yeast, which is why people who are prone to fungal infections will often discover a fungal infection after taking a round of antibiotics http://hcd2.bupa.co.uk/fact_sheets/html/fungal_skin_infections.html. In infants, the fungus is mostly likely to appear on the scalp (cradle cap), diaper area (fungal diaper rash, jock itch), ear (fungal ear infection, or an ear infection that does not respond to antibiotics),or in the mouth (thrush).

Another common cause of cradle cap appears to be a common manifestation of biotin

Biotin

Biotin, also known as Vitamin H or Coenzyme R, is a water-soluble B-complex vitamin discovered by Bateman in 1916. It is composed of a ureido ring fused with a tetrahydrothiophene ring. A valeric acid substituent is attached to one of the carbon atoms of the tetrahydrothiophene ring...

 insufficiency. This may be due, in part, to the influence of biotin on fatty acid biosynthesis. Possibly it has to do with overactive sebaceous gland

Sebaceous gland

The sebaceous glands are microscopic glands in the skin that secrete an oily/waxy matter, called sebum, to lubricate and waterproof the skin and hair of mammals...

s in the skin of newborn babies, due to the mother's hormones still in the baby's circulation. The glands release a greasy substance that makes old skin cells attach to the scalp instead of falling off as they dry. There may be a relationship with skin yeasts (Pityrosporum ovale, newly renamed Malassezia furfur

Malassezia furfur

Malassezia is a genus of fungi. Malassezia is naturally found on the skin surfaces of many animals, including humans. In occasional opportunistic infections,...

). Seborrheic dermatitis is the adult version of cradle cap.

Warning signs

If the condition thickens, turns red and irritated, starts spreading, appears on other body parts, or if the baby develops thrush (fungal mouth infection), fungal ear infection (an ear infection that does not respond to antibiotics) or a persistent diaper rash

Diaper rash

Irritant diaper dermatitis is a generic term applied to skin rashes in the diaper area that are caused by various skin disorders and/or irritants.Generic rash or irritant diaper dermatitis is characterized by joined patches of erythema and...

, medical intervention is recommended.

Severe cases of cradle cap, especially with cracked or bleeding skin, can provide a place for bacteria to grow. If the cradle cap is caused by a fungal infection which has worsened significantly over days or weeks to allow bacterial growth (impetigo, most commonly), a combination treatment of antibiotics and antifungals may be necessary. Since it is difficult for a layperson to distinguish the difference between sebaceous gland cradle cap, fungal cradle cap, or either of these combined with a bacterial infection, medical advice should be sought if the condition appears to worsen.

Cradle cap is occasionally linked to immune disorders. If the baby is not thriving and has other problems (e.g. diarrhea

Diarrhea

Diarrhea , also spelled diarrhoea, is the condition of having three or more loose or liquid bowel movements per day. It is a common cause of death in developing countries and the second most common cause of infant deaths worldwide. The loss of fluids through diarrhea can cause dehydration and...

), a doctor should be consulted.

Prognosis

Assurances that this condition will clear as the baby matures are very common. However, studies have shown that the condition occasionally persists into the toddler years, and less commonly into later childhood. It tends to recur in adolescence and persists into adulthood. In an Australian study, about 15 percent of previously diagnosed children still had eczema

Eczema

Eczema is a form of dermatitis, or inflammation of the epidermis . In England, an estimated 5.7 million or about one in every nine people have been diagnosed with the disease by a clinician at some point in their lives.The term eczema is broadly applied to a range of persistent skin conditions...

 10 years later. Sometimes, cradle cap turns into atopic dermatitis

Atopic dermatitis

Atopic dermatitis is an inflammatory, chronically relapsing, non-contagious and pruritic skin disorder...

. Rarely, it turns out to be misdiagnosed psoriasis

Psoriasis

Psoriasis is an autoimmune disease that appears on the skin. It occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. However, psoriasis has been linked to an increased risk of...

.

Treatment

Treatment other than gentle washing is not necessary in most mild cases (flaking, with or without small patches of yellow crusting), as the problem often resolves itself whether the cause is sebaceous-gland-related or fungal, but since many patients (and/or parents) are concerned about cosmetic issues, the following options are often considered:

-For all ages: Home remedies include the application of various oils, lotions, or petroleum jelly. There is little adequate or controlled research to support or negate the usefulness of most common home remedies at any age, but there is anecdotal evidence to support either position. When cradle cap is related to fungal infection, treatment for other fungal infections can also work. Tinea capitis is one example of a fungal cause. Doctors may prescribe a seven-day daily application of clotrim (commonly prescribed for jock itch or athlete's foot) or miconazol nitrate (commonly prescribed for vaginal yeast infections).

-For infants: in cases that are related to fungal infection, doctors may recommend once-daily application of clotrim (1%) or miconozal nitrate (2%) for seven to fourteen days.

-For toddlers: doctors may recommend a treatment with a mild dandruff shampoo such as Selsun Blue or Neutrogena T-gel, even though the treatment may cause initial additional scalp irritation. A doctor may instead prescribe an antifungal soap such as ketoconazole (2%) shampoo, which can work in a single treatment and shows significantly less irritation than over-the-counter shampoos such as selenium sulfide shampoos, but no adequate and controlled study has been conducted for pediatric use as of 2010.

-For adults: Seborrheic dermatitis (the adult version of cradle cap) usually requires the use of an antifungal shampoo, possibly along with the nightly application of an antifungal cream or an anti-itch cream/gel like Scalpicin. Some doctors also recommend the supplementation of a B-vitamin complex to improve fatty acid metabolism.

Scalp, behind ears, eyebrows

The common home remedy of applying oil (vegetable, particularly olive oil, or mineral oil

Mineral oil

A mineral oil is any of various colorless, odorless, light mixtures of alkanes in the C15 to C40 range from a non-vegetable source, particularly a distillate of petroleum....

) liberally to the scalp and letting it soak in overnight or for lesser periods of time seems to conflict with the fact that Malassezia yeasts thrive in oily environments preferring saturated fats, although anecdotal reports suggest it may be effective. This may be because olive oil is primarily unsaturated fat and does not promote fungal growth. If the cradle cap is not severe, you may try to comb it out gently after bathing. The softened scales can then be brushed away with a soft brush, comb or cloth, but if not done very gently, this can worsen the condition and bring about temporary hair loss. There has been no studies done on these recommendations. Applying petroleum jelly

Petroleum jelly

Petroleum jelly, petrolatum, white petrolatum or soft paraffin, CAS number 8009-03-8, is a semi-solid mixture of hydrocarbons , originally promoted as a topical ointment for its healing properties...

 (e.g., Vaseline

Vaseline

Vaseline is a brand of petroleum jelly based products owned by Anglo-Dutch company Unilever. Products include plain petroleum jelly and a selection of skin creams, soaps, lotions, cleansers, deodorants and personal lubricants....

) liberally overnight is another popular treatment. The softened scales either fall off during the night, or can be brushed off in the morning. Making a paste from sodium bicarbonate

Sodium bicarbonate

Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...

 (baking soda) and leaving it on the affected area for 10 minutes can also help lift the scales.

There is broad disagreement regarding the role of shampoo

Shampoo

Shampoo is a hair care product used for the removal of oils, dirt, skin particles, dandruff, environmental pollutants and other contaminant particles that gradually build up in hair...

s. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, but the exact denotation of the label "mild" in this context is not quite clear. Baby shampoo

Baby shampoo

Baby shampoo is formulated so that it is less irritating to the eyes than regular shampoo. Most contain sodium trideceth sulfate. Alternatively, baby shampoo may be formulated using other classes of surfactants, most notably non-ionics which are much milder than any charged anionics used. Baby...

s often contain detergent surfactants, perfumes, quaternium-15

Quaternium-15

Quaternium-15 is a quaternary ammonium salt used as a preservative in many cosmetics and industrial substances. It acts as a formaldehyde releaser...

 and other eczemagenic irritants. Again, no studies have been performed on non-prescription shampoos.

Keratolytic

Keratolytic

Keratolytic therapy is treatment to remove warts and other lesions in which the epidermis produces excess skin. In this therapy, acid medicine, such as salicylic acid is put on the lesion. Keratolytic therapy thins the skin on and around the lesion. It causes the outer layer of the skin to loosen...

 (dandruff) shampoos (e.g. with sulfur

Sulfur

Sulfur or sulphur is the chemical element with atomic number 16. In the periodic table it is represented by the symbol S. It is an abundant, multivalent non-metal. Under normal conditions, sulfur atoms form cyclic octatomic molecules with chemical formula S8. Elemental sulfur is a bright yellow...

, selenium

Selenium

Selenium is a chemical element with atomic number 34, chemical symbol Se, and an atomic mass of 78.96. It is a nonmetal, whose properties are intermediate between those of adjacent chalcogen elements sulfur and tellurium...

, zinc pyrithione

Zinc pyrithione

Zinc pyrithione is a coordination complex of zinc. This colourless solid is used as an antifungal and antibacterial agent. This coordination complex, which has many names, was first reported in the 1930s.- Structure of the compound :...

, or salicylic acid

Salicylic acid

Salicylic acid is a monohydroxybenzoic acid, a type of phenolic acid and a beta hydroxy acid. This colorless crystalline organic acid is widely used in organic synthesis and functions as a plant hormone. It is derived from the metabolism of salicin...

) are generally not recommended as they sting eyes and may worsen the dermatitis. In stubborn cases some doctors do recommend them while others warn against the use of medicated shampoos in newborns due to systemic absorption. Dandruff shampoos often contain sodium dodecyl sulfate

Sodium dodecyl sulfate

Sodium dodecyl sulfate , sodium laurilsulfate or sodium lauryl sulfate is an organic compound with the formula CH311OSO3Na). It is an anionic surfactant used in many cleaning and hygiene products...

, a noted skin irritant.

Steroid

Glucocorticoid

Glucocorticoids are a class of steroid hormones that bind to the glucocorticoid receptor , which is present in almost every vertebrate animal cell...

 and tar

Tar

Tar is modified pitch produced primarily from the wood and roots of pine by destructive distillation under pyrolysis. Production and trade in tar was a major contributor in the economies of Northern Europe and Colonial America. Its main use was in preserving wooden vessels against rot. The largest...

 preparations have also been used but have significant drawbacks. Immunomodulators (tacrolimus

Tacrolimus

Tacrolimus is an immunosuppressive drug that is mainly used after allogeneic organ transplant to reduce the activity of the patient's immune system and so lower the risk of organ rejection...

/Protopic, pimecrolimus

Pimecrolimus

Pimecrolimus is an immunomodulating agent used in the treatment of atopic dermatitis . It is currently available as a topical cream, once marketed by Novartis under the trade name Elidel.-Pharmacology:Pimecrolimus is an ascomycin macrolactam derivative...

/Elidel) have not been approved for babies under two years.

Ketoconazole

Ketoconazole

Ketoconazole is a synthetic antifungal drug used to prevent and treat fungal skin infections, especially in immunocompromised patients such as those with AIDS or those on chemotherapy. Ketoconazole is sold commercially as an anti-dandruff shampoo, topical cream, and oral tablet.Ketoconazole is...

 shampoos and creams are taking first place in medical treatment of moderate to serious cradle cap. Research so far indicates that this anti-fungal medication is not absorbed into the bloodstream. Ketoconazole shampoo is currently made with a number of problematic irritants and allergens.

A Swedish study found good results from massaging the scalp with small amounts of borage oil

Borage seed oil

Borage seed oil is derived from the seeds of the Borago officinalis . It is used medicinally as an anti-inflammatory, for treating arthritis, as well as certain skin conditions and respiratory inflammation....

 twice a day.

Other home remedies recommended in various alternative sources and parent forums are herbal washes (e.g. burdock

Burdock

Burdock is any of a group of biennial thistles in the genus Arctium, family Asteraceae. Native to the Old World, several species have been widely introduced worldwide....

 or chamomile

German Chamomile

Matricaria chamomilla or German chamomile, also spelled camomile, is an annual plant of the composite family Asteraceae. Synonyms are: Chamomilla chamomilla, Chamomilla recutita , Matricaria recutita, and Matricaria suaveolens.-Distribution:It usually grows near populated areas all over Europe and...

), aloe

Aloe

Aloe , also Aloë, is a genus containing about 500 species of flowering succulent plants. The most common and well known of these is Aloe vera, or "true aloe"....

 gel, and tea tree oil (Melaleuca oil)

Tea tree oil

Tea tree oil, or melaleuca oil, is a pale yellow colour to nearly clear essential oil with a fresh camphoraceous odor. It is taken from the leaves of the Melaleuca alternifolia, which is native to the northeast coast of New South Wales, Australia...

shampoo. Tea tree oil and aloe can be sensitizers; any worsening should be an occasion to discontinue the remedy in question. Both remedies have been tested in medical trials and found useful.

Eyelids

Typical medical advice is to use diluted baby shampoo on a cotton swab to cleanse the eyelid. There is no agreement on the dilution, which ranges from a few drops to a half cup warm water, to a 50/50 mix. No studies have been performed on the efficacy or safety of this treatment. (Please note the problems with baby shampoo noted above.) In adults, a study comparing soap and baby shampoo to commercial eyelid scrubs found that patients strongly preferred not to put soap or shampoo on their eyelids. Baking soda has also been recommended (a teaspoonful in a cup of boiled water) and is well accepted by adults. Boiled warm water wash may help.

External links

• BBC
• Cradle Cap – PrimeHealthChannel