Cradle cap

Cradle cap (infantile seborrhoeic dermatitis) is a self-limiting greasy, scaly rash of unknown cause that most commonly affects the scalps of babies.  Overactive sebaceous glands, maternal hormones and skin yeasts have been suggested as possible causes.

Presentation

• Can present in the first month of life (unlike atopic dermatitis which tends to present later)
• Typically the scalp is affected with greasy, scaly patches that may eventually affect the whole scalp
• The faces, ears, neck and nappy area may also be affected
• Unlike atopic dermatitis, the baby is usually not affected by the condition, although mild pruritus may occur

Management

Most cases will clear spontaneously between 8-12 months of age

Tends to respond well to treatment but can be recurrent in nature

Moisturisers and emollient bath oils can help soften scales for removal with gentle brushing

Mild shampoos help

Ketoconazole 2%

Selenium sulphide shampoo

Tar containing shampoo

Some authors have suggested avoiding olive oil in treating this condition, on the basis that it can promote the proliferation of Malassezia yeasts, a proposed virulence factor.  However, there is no evidence that use of olive oil worsens cradle cap.

Differential Diagnosis

• Atopic dermatitis
• Consider immunodeficiency in children with extensive disease and failure to thrive (e.g., Wiskott-Aldrich syndrome, HIV infection)

Selected references

E-learning for healthcare – Paediatric Dermatology, Dermnet NZ, JAMA Network, NHS Evidence Search – Cradle Cap