Definition

Cradle cap, a condition characterized by rough plaques on the scalp, is commonly observed in newborns. Although it resembles dandruff, cradle cap does not cause itchiness or pain. This benign condition is common and typically resolves without intervention within 6 to 12 months. However, the rough plaques are scaly and, at times, can be challenging to remove.

Causes

The precise etiology of cradle caps remains unclear. Nonetheless, it is hypothesized that the condition may result from excessive sebum production by the sebaceous glands on the scalp, leading to the adherence of dead skin cells.

Risk Factor

Several factors may contribute to the development of the cradle cap, including maternal hormones that passed to the fetus before birth. This can stimulate sebum production in the sebaceous glands and hair follicles. Additionally, the Malassezia furfur fungus, which thrives on skin oils, is implicated as a potential factor. Given the efficacy of antifungal treatments like ketoconazole, it helps prove that fungi is one of the risk factors of cradle cap. It is important to note that cradle cap is not contagious and is not attributed to poor hygiene.

Symptoms

Cradle cap typically manifests between the second and sixth weeks after pregnancy, presenting with the following symptoms:

• Oily and flaky scalp. The scalp of infants may appear oily with white or yellow scaly plaques that eventually shed naturally.
• Changes in scalp color. The scalp might exhibit discoloration without textural changes. Despite its appearance, the cradle cap does not induce itchiness.
• Hair loss. Although rare, some infants may experience hair loss in affected areas, with hair regrowth occurring once the condition resolves.
• Cradle cap on other body parts. Besides the head, this condition can affect the face, behind the ears, diaper area, and underarms. Cradle cap in other parts of the body typically presents with fewer scales and a reddish hue.

Cradle cap is most prevalent around three months of age, decreasing in incidence as infants’ ages approach one year. It often coexists with a family history of atopic dermatitis or asthma. The condition usually improves within 6 to 12 months, but persistent cases beyond this period warrant a medical consultation.

Diagnosis

Diagnosis of cradle cap is primarily established clinically, based on the observation of unique changes on the infant’s scalp and other affected areas. Additional diagnostic tests are generally unnecessary unless the physician suspects other conditions, such as immunodeficiency disorders or vitamin deficiencies.

Differential diagnoses include atopic dermatitis, which, unlike cradle cap, is typically pruritic and can interfere with sleep and feeding, especially when the disease affects the cheeks. Other conditions to consider are impetigo or bacterial infections, indicated by the presence of vesicles, and tinea capitis, a fungal infection causing hair loss and lymph node swelling. Skin scraping may be performed to identify suspected fungi that cause infections. Diaper dermatitis, confined to body folds, can also mimic cradle cap.

Management

Upon diagnosing cradle cap in infants, there are steps you can take to manage the condition:

• Hair washing. Maintaining a clean scalp can alleviate cradle cap symptoms by removing excess oil. Use baby shampoo and gently massage it into the scaly scalp. The doctor may recommend washing infants' hair more frequently, possibly every other day (more than once every few days). If baby shampoo is ineffective, consult your doctor about medicated shampoos. Avoid using anti-dandruff shampoos without medical advice, as not all are safe for infants.
• Brushing. After cleaning the infants’ hair and scalp, gently brush the hair with a soft baby brush. Brushing gently can help remove the scales naturally.
• Moisturizing. Consult your doctor about applying lotion, baby oil, or ointment to the scalp after shampooing and hair brushing. Some parents find this effective in managing cradle cap.
• Applying Creams. In cases of inflammation, doctors may prescribe anti-inflammatory creams, though this is typically unnecessary. Avoid using medicated creams without a doctor's recommendation.

For optimal results, follow this treatment sequence:

• Wash the infants’ hair with gentle baby shampoo to help remove scalp oil.
• Apply oil to the hair and leave it on to soften and break down the scales.
• Brush the hair with a soft brush or soft toothbrush to remove the scales softened by oil.
• Repeat hair washing with gentle baby shampoo. These steps can reduce symptoms and help prevent recurrence.

There are some things that should be avoided:

• Do not use olive oil on the baby's scalp, as it may cause irritation.
• Do not use peanut oil due to allergy risks.
• Do not use adult shampoos or soaps.
• Do not pick at the scales to prevent the risk of infection.

Complications

Cradle cap rarely leads to complications, as it generally resolves on its own without any harm. However, secondary bacterial infections can occur if the skin cracks or bleeds, often following a fungal infection. Therefore, it is crucial to avoid scratching the scales to prevent bleeding.

Prevention

Preventing cradle cap involves washing infants’ hair regularly with baby shampoo and gently brushing the hair with a soft brush. Consult a pediatrician or dermatologist for advice on hair care post-cradle cap recovery. They may suggest using anti-inflammatory creams, certain lotions, or other treatments to maintain scalp health after the cradle cap has healed.

When to See a Doctor?

Seek medical advice if:

• Cradle cap does not improve within a few weeks despite routine treatment.
• The condition spreads across the body of infants.
• The scales bleed or ooze fluid.
• There is swelling in the affected area.

These symptoms could indicate an infection or other skin conditions, such as atopic dermatitis or scabies.

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