Cradle cap is the collective term for infantile seborrheic dermatitis, which causes scaly patches on the scalp of infants. Thick crusts and scales may form, yet cradle cap is not considered a serious condition and disappears within a few months.
What is cradle cap?
Cradle cap is a yellowish oily and scaly rash that appears on the scalp within the first 3 months after birth. The inflammatory, noncontagious rash is usually itchy and not dangerous for a baby. In the most common cases, cradle cap is located directly on the top of the skull, and also often around the ear, eyebrows, or on the eyelids. Worldwide, cradle cap affects about half of all babies, most of whom suffer from a mild variant of the condition. Cradle cap is sometimes confused with another skin condition, infantile eczema. However, the main difference is that eczema usually causes considerable more severe itching. As a rule, cradle cap will not show up later in life, although recent studies suggest that about 15 percent of affected children are still prone to eczema 10 years later.
Causes
The exact cause of cradle cap cannot be clearly designated; in no case is lack of hygiene or allergies the decisive factor. On the one hand, it is believed that hormones transferred from the mother to the baby before birth create an excessive production of sebum, which clogs the sebaceous glands and hair follicles. A deficient intake of biotin seems to be closely related to this. Since biotin influences fatty acid biosynthesis, overactive sebaceous gland production in the skin of newborns may result in the increased output of an oily substance that binds old skin cells on the scalp instead of shedding them. Another cause of cradle cap is thought to be a yeast fungus (Malassezia) that multiplies in the sebum together with bacteria. This hypothesis is supported by the fact that antifungal treatment with ketoconazole is often effective.
Symptoms, complaints, and signs
The first sign of the presence of cradle cap is changes in the skin, primarily in hairy areas on the head and face. The appearance is strongly reminiscent of burnt milk and also smells similar. By means of these initial signs, cradle cap can be easily distinguished from harmless skin changes in babies, such as “gneiss”. The symptoms of cradle cap appear immediately after its onset – the skin itches and shows scaly encrustations in the affected areas. Cradle cap appears around 4 months of age – babies at this age cannot be permanently prevented from scratching the affected areas of skin. Scratching the individual areas sometimes causes the skin areas to become inflamed and begin to fester. Such inflamed sores are uncomfortable and painful, and affected babies are often cranky and tearful. Some babies suffer from sleep disorders, the permanent itching – which is usually stronger in the evening than in the morning – does not allow them to rest. In the affected skin areas, hair usually falls out. In order for the hair to grow back normally after the cradle cap subsides, too much scarring due to scratching must be avoided. Cradle cap is not infrequently a harbinger of neurodermatitis.
Diagnosis and course
Cradle cap appears as mild white or yellowish scaling or thick greasy crusts on the scalp. Similar symptoms may also appear on the ears, eyelids, nose, and skin folds. Only when cradle cap reddens, spreads to the mouth and ears, or diaper rash develops is medical intervention recommended. Severe cases of cradle cap, especially cracking or bleeding of the skin, can provide a nourishing place for bacterial buildup. Occasionally, cradle cap may also be associated with immune system disorders. Therefore, a doctor should be consulted if developmental problems or diarrhea occur. When consulting a physician, parents should provide information about the duration of the cradle cap, care products used, and countermeasures begun to facilitate diagnosis.
Complications
Cradle cap primarily causes various discomforts that occur on the scalp. These discomforts are very unpleasant for those affected and can also lead to a feeling of shame or inferiority complexes in the process.The quality of life is significantly reduced by the discomfort. Redness and itching occur on the scalp. Furthermore, blisters can form, which can also affect the face. Especially in the face, the symptoms lead to reduced aesthetics of the patient. Even small children can suffer from this disease and often have to scratch themselves due to the itching. The itching itself is usually only intensified and the constant scratching can further lead to bleeding on the skin. Due to the bleeding, it is not uncommon for infections or inflammations to occur. Furthermore, diarrhea or developmental disorders may also occur. The treatment of this disease is mostly done with the help of shampoos or by other care products. There are no particular complications and the symptoms can be resolved relatively quickly and easily. The life expectancy of the child is not affected by the discomfort.
When should you go to the doctor?
Cradle cap is one of the natural phenomena after a person is born. Normally, comprehensive medical examinations of the newborn take place immediately after delivery. Abnormalities and disorders are noticed and documented during this process. In the first weeks and months, there are further routine examinations by a pediatrician. If irregularities exist or special features develop, these can be discussed during the initial examinations. Cradle cap is a crusting of the skin. If the incrustations do not regress on their own within the first six months of life, a visit to the doctor should be made. The accompanying symptoms of cradle cap include unpleasant itching. Infants in particular are helplessly exposed to the situation. If this is very strong or triggers an increase in discomfort, a doctor should therefore be consulted. If open wounds occur on the body, sterile wound care of the affected areas is necessary. If parents are unable to provide sterile care, a visit to the doctor is recommended to avoid side effects. In severe cases, sepsis is an alternative threat. Blood poisoning can lead to premature death and should therefore be treated medically as soon as possible. If pustules, poplars, swellings form or redness occurs on the skin, a doctor is needed.
Treatment and therapy
Cradle cap usually does not require medical treatment and disappears within a few weeks to months. For many mild cases of cradle cap, the use of virgin olive oil has proven effective. The oil is rubbed into the scalp and should be left on for 15-20 minutes. Then the head is washed with a mild baby shampoo and the dandruff is combed out with a very fine comb. The scalp can also be gently massaged with a washcloth or soft brush to loosen the dandruff. If frequent hair washing does not produce a change, the use of a stronger shampoo with added tar or an antifungal soap with ketoconazole (2%) may be indicated. Anti-dandruff shampoos containing salicylic acid are not recommended for use on babies because the toxic substances can be absorbed through the skin. In severe cases, hydrocortisone cream may be postponed to reduce redness and inflammation. As a home remedy, massaging the scalp with small amounts of borage oil, aloe gel and tea tree oil twice a day have proven effective.
Outlook and prognosis
Cradle cap is mostly the sign of chronic atopic skin eczema and also therefore not treatable causally. Although the itching and intensity of the condition may subside in the meantime, more severe episodes can be expected until around the child’s second birthday. In rare cases, cradle cap may simply heal after a few months. If there is no transition to atopic eczema, it can be assumed that the disease will not be reactivated and that there will be no associated skin complaints afterwards. If the condition transitions to chronic atopic eczema, the prognosis is unfavorable: these conditions are lifelong and possible therapies and successes must always be judged on a case-by-case basis. The exact cause of these chronic skin conditions is unknown, and they can be difficult to manage.Various factors determine the further prognosis, including above all psychosomatic factors and the ability of the affected person to deal with the disease and himself properly. In many cases, very good therapeutic successes can be achieved and major cuts in the quality of life are not necessarily to be expected.
Prevention
Daily hair washing seems to be the simplest and most effective way to avert cradle cap. At the same time, it is recommended to pay attention to a balanced vitamin balance and especially an adequate intake of vitamin B already during pregnancy.
Aftercare
Cradle cap initially causes discomfort to the scalp. The child experiences constant itching and redness, which can greatly reduce the quality of life. Aftercare is primarily concerned with alleviating the discomfort. This is because if the cradle cap is repeatedly scratched open, scars and pigmentation disorders may remain. Rubbing with skin-friendly oil can help to gently rub off the loose layers of scales. This can also avert skin irritation and allergic reactions. If cradle cap is removed improperly, bleeding and inflammation can occur. Since cradle cap usually disappears on its own, aftercare therefore involves permanent monitoring of its development, which can be contained with the help of skin care products.
What you can do yourself
If the child suffers from cradle cap, various self-help measures and some household and natural remedies will help. For mild symptoms, herbal remedies and preparations from homeopathy help against cradle cap. Effective are, for example, the herbs brownroot, clubmoss and chamomile as well as globules with the active ingredients calcium carbonicum, graphites or viola tricolor. Pansy tea, which is applied to the dandruff and quickly helps against itching and inflammation, has also proven effective. Against weeping spots helps a saline solution, which can be easily prepared yourself. Dry crusts can be solved by rubbing the head with oil in the evening before going to bed. Both classic olive oil and burdock root and calendula oil are effective. Parents should take care that the child does not scrape off the dandruff itself. This can irritate the skin and in the worst case lead to inflammation. Gentle baby shampoo or an application from medicinal plants is better. If the symptoms do not subside despite all measures, it is best to talk to the pediatrician again. If there are signs of neurodermatitis, further precautionary measures should be taken in consultation with the medical professional.
