Putting the Cap on Cradle Cap

by Dr. Pamela Bandelaria, pediatrician

There are many conditions that can affect your baby’s skin. Some skin lesions are normal or common among infants and others can be a cause for concern. In this article, you learn about one of the common skin conditions that occur in babies, cradle cap, or in medical terms, seborrheic dermatitis. This article will outline what cradle cap is, what causes cradle cap, and how to prevent and cure cradle cap.

What does cradle cap look like?           

Cradle cap, also known medically as seborrheic dermatitis, is a chronic inflammatory disease wherein the sebaceous glands (glands that secrete oil) are involved. It is described as flaky and greasy scales that easily disintegrate when moved. It is called cradle cap because it is characterized by scaling and crusting usually found in the scalp, forehead, brows, cheeks, as well as behind and around the ears. However, seborrheic dermatitis can also be seen in the neck, armpits, umbilicus, and groin area. In severe cases, it can even cover the whole scalp. This is usually seen in babies but can also be seen in adolescents, in what is usually known as dandruff. In infants, it may also appear as salmon-red lesions that are greasy and scaly. These lesions are usually not itchy or painful and are not contagious, and are observed in the first month of life. It is a self-limiting disease and usually resolves by the time your baby turns a year old. Although it may not irritate your baby, cradle cap usually bothers parents which is why it is a common cause of concern.

What is cradle cap caused by?

You may be asking, why does cradle cap occur? How does it appear and how does my baby get it? The exact mechanism is still unknown. However, seborrheic dermatitis or cradle cap is associated with a microorganism named Malassezia furfur which is considered the causative agent, but how it causes the disease is still unknown. Malassezia furfur is a kind of fungi or yeast that can normally be found in the skin of humans. The yeast thrives in the chest, back, and scalp because of the fatty acids found in these areas. They are found in the skin as the first month of life. The occurrence of seborrheic dermatitis is dependent on the interplay of many factors namely the Malassezia yeast, oil (sebum) levels, hormones, and immune response. Sometimes other factors such as medications, temperature, and stress can promote or worsen it. Food intake does not affect the occurrence of cradle cap.

Does cradle cap smell bad? Does cradle cap make hair fall out?

Although cradle cap may look alarming, it is usually odorless. However, in moderate to severe cases of cradle cap, you might be able to smell something due to the buildup of oil in your baby’s scalp. It will smell oily, but it should not smell foul or unpleasant. Because cradle cap is scaly and flaky, sometimes pieces of skin and flakes may fall off. Mild brushing of the area is a recommended treatment for cradle cap, and as the skin comes off, some hair may too.  Don’t worry too much, the hair will grow back.

Can you pick cradle cap off the baby’s head?

It is not advisable to pick the crusts in cradle cap, although sometimes it can be tempting to do so. This can cause abrasions that can turn to wounds and lead to infection. Even if cradle cap is not itchy, sometimes it can also be tempting to scratch, but it might lead to complications mentioned above. Scratching can also lead to injuries that will eventually scar. Combing the scalp might also be abrasive, especially if the comb you are using is pointy and stiff. If the comb is fine-toothed and not sharp, it can be helpful but mild brushing of the scalp with a soft rubber brush or a soft toothbrush is preferred to remove the scales and flakes. Massaging the scalp gently is also preferred to loosen the flakes. It is best to massage or use a soft brush after the application of shampoo and emollients to break up the patches and scales.

How long does it take for cradle cap to heal?

Cradle cap is a self-limiting disease, meaning it resolves on its own. However, because it is a chronic inflammatory disease, it might take some time for the condition to improve and disappear. For some babies, it can last months or up to a year.

How do you get rid of cradle cap in babies?

Because cradle cap can resolve on its own, management is usually not drastic and does not require prescription medications. The main purpose of treatments and regimens is not curative, but to help reduce and alleviate symptoms. Treatment is usually conservative and makes use of things that can be easily found at home. These include baby oil, shampoo, and emollients. Careful brushing of the scalp to remove scales is also helpful.

If the cradle cap persists, treatments can be stepped up by applying prescribed medications. Prescribed creams include anti-inflammatories or antifungals. Anti-inflammatories such as corticosteroids reduce the inflammation while antifungals take care of the Malassezia organisms. Another group of medications called keratolytics is prescribed to prevent the formation of crusts and help other medications to seep in and be absorbed. When actively managing cradle cap, it is important to control any acute infection first, then use long-term medications to prevent flare-ups.

Cradle cap usually takes months before it goes away on its own, however, the aforementioned products and medications have antimicrobial and anti-inflammatory properties that can hasten recovery and reduce symptoms. Still, every baby is different and their reactions to the different products we recommend can vary.  Some of these medications also have side effects.  As such, it is important to consult your local doctor before applying anything to your baby’s skin. 

What shampoo should I use for cradle cap?

There are shampoos specific for scaling in the scalp, such as what occurs in cradle cap. These shampoos can also be used for other conditions such as psoriasis. Shampoos that can be used for cradle cap are those that have special ingredients that contain or act as detergents. Examples of these ingredients include sulfur, salicylic acid, zinc, selenium sulfide, or tar. By using these special shampoos, the scaling from cradle cap is controlled. The shampoo is lathered in your baby’s head for five to ten minutes before rinsing it completely. Shampoo containing antifungals should be used carefully because they are not tear-free and can be irritating for your baby’s eyes. If the lesions are inflamed, shampoos containing corticosteroids can be used daily for around two to four weeks.

Are oils good for cradle cap? Is coconut oil good for cradle cap?

One of the common home remedies for cradle cap is to apply oils that can easily be found in the home. Oils act as an emollient and are compounds that can soften skin. These are part of the management of cradle cap. Examples include baby oil, vegetable oil, mineral oil, or coconut oil. Sometimes petroleum jelly is also used because it is readily available. The remedy is given by application of the oil on the affected area and left for at least 15 minutes or overnight. This is done to soften the scales and loosen them so that they will be removed easily during shampooing. However, be aware that the kind of oil and fat it contains can promote the growth of the Malassezia organism or it can trigger further inflammation or scaling. For example, avoid peanut oil because of the risk of allergy.

Should you put lotion on cradle cap?

Lotions can be used for cradle cap as an alternative however they are not the first-line management for seborrheic dermatitis. It may be effective in some babies and worsen or have no effect on others. Sometimes they are used because it has lesser side effects than corticosteroids. Other times it is used as an alternative when items such as mineral oil are not available. It is preferred that products put on the skin for cradle cap are in the form of oil in water, emulsions, or gels. These are found to be the best mediums to apply in babies with cradle cap because they do not exacerbate the symptoms.

Can I apply breast milk to cradle cap?

Breast milk for cradle cap is used by some mothers, but just like lotions, they are not the first-line management for seborrheic dermatitis. There are no approved therapeutic claims for breast milk, and there are mixed outcomes. Some mothers report improvement, while others report no effects. Studies documenting the effectiveness of breast milk in cradle cap are also lacking.

Can you prevent cradle cap? How often should you bathe a newborn?

Just because your baby has cradle cap doesn’t mean that they are dirty or have poor hygiene. As mentioned earlier, the occurrence of cradle cap is dependent on many factors. You can prevent cradle cap or lessen its chances of occurring by cleaning your baby’s hair with a mild shampoo. Washing the scalp daily or every few days will prevent cradle cap from occurring. Make sure that all the shampoo is rinsed off. Another way to prevent cradle cap is to avoid stress. Stress can lead to or contribute to the occurrence of cradle cap. Stress in babies can be seen as fussiness, frowning, or irritability. Making sure that your baby is comfortable, well-fed, and at ease to prevent cradle cap.

Another way to prevent cradle cap is making sure that your baby’s skin stays moisturized and supple. It is important to prevent your baby’s skin from becoming dry as this can trigger the occurrence of cradle cap. Although you can apply products, you can already ensure that your baby’s skin will not dry if you limit bathing to 1 to 3 times a week, especially for newborns. This will prevent drying out of the skin and lessen the chances of developing cradle cap.

Conclusion

Although cradle cap is a skin condition that is normal in babies, it is a cause of concern for parents because of how it appears, especially in severe cases. Cradle cap is a skin condition that can commonly occur in your baby. It also goes away on its own, although it may take some time for it to disappear. However, knowing home regimens and knowing when to bring your baby to the doctor will help lessen your uneasiness. When home treatments are not successful or when there is a spread of the lesions on your baby’s face or body, it is best to have your baby be evaluated at a clinic for further management.