Brief overview
- Symptoms: Scaled skin, red nodules and vesicles, yellow crust, especially on the scalp.
- Causes and risk factors: Hereditary predisposition and external factors
- Diagnosis: Physical examination, whether characteristic features exist, family history
- Treatment: Special creams and ointments that inhibit inflammation and relieve itching
- Course and prognosis: duration up to two years, possible transition to other symptoms of neurodermatitis
- Prevention: Breastfeeding may be one method of prevention. Good skin care helps prevent worsening of milk scabs.
What is cradle cap?
The term cradle cap refers to yellow-brownish crusted areas of skin on the head and face of many infants. The crusts resemble burnt milk in appearance – hence the name “milk crust”. Apart from the name, however, the inflammatory skin changes have nothing to do with milk.
Cradle cap as a harbinger of neurodermatitis
More than half of children with atopic dermatitis had cradle cap as their first symptom when they were babies. Sometimes, however, the first signs of neurodermatitis do not develop until school age. About 10 to 15 percent of preschool children are at least temporarily affected by atopic eczema. This makes atopic eczema in children one of the most widespread skin diseases.
The frequent combination of neurodermatitis, hay fever (allergic rhinitis) and allergic asthma is striking. Doctors summarize these three diseases under the term “atopic group of forms”. It is not uncommon for cradle cap to appear in babies as the first harbinger, from which other allergic diseases develop in adulthood. However, the atopic diseases also occur individually.
How does cradle cap manifest itself?
Cradle cap is the name given to the yellowish to brown crusts that form on the rash. In many infants, the eczema spreads to the arms, legs and upper body. The diaper area is rarely affected.
Like atopic dermatitis itself, cradle cap causes intense itching. In very young babies, this initially manifests itself in frequent crying and very restless nights. As soon as the baby starts scratching, cradle cap development intensifies. Scratching the skin creates entry points for bacteria, which often leads to larger foci of inflammation.
Head urticaria or cradle cap: what’s the difference?
What is the cause of cradle cap?
The causes of cradle cap – just as for neurodermatitis – have not yet been conclusively clarified. However, there are indications of both a genetic predisposition and external risk factors. Doctors assume that several factors are jointly responsible for the development of the disease and speak of a multifactorial genesis.
The hereditary predisposition to atopic dermatitis and cradle cap is passed on to the offspring via several different genes. If both parents suffer from neurodermatitis, the child is 60 to 80 percent likely to develop the disease. However, not every child with a corresponding predisposition develops cradle cap and neurodermatitis.
The rash, itching and cradle cap crusts in atopic dermatitis patients are caused by various complex processes in the skin. Usually there is a combination of three factors:
- Immunological causes: In many people with atopic dermatitis, elevated levels of immunoglobulin E (IgE) are found in the blood. This class of antibodies plays a major role in the development of allergies. Babies with cradle cap, for example, are often allergic to hen’s egg or cow’s milk. The defensive reactions take place on the skin and lead to inflammatory processes.
- Neurovegetative causes: The nervous system of those affected reacts more sensitively to various external stimuli such as cold and dry climates, skin irritation, for example, from woolen fabrics, but also to psychological factors such as stress, grief or fear. These factors aggravate atopic dermatitis in many patients.
How is cradle cap diagnosed?
The most important clue for the diagnosis of cradle cap and neurodermatitis is provided to the doctor by the baby’s skin condition. In the case of cradle cap, there are:
- Red nodules and blisters
- Yellowish crusts typical of cradle cap
- A fine scaling of the skin
In addition, the doctor looks for so-called stigmata. These are features that occur quite often in cradle cap or neurodermatitis and other atopic diseases. These include, for example, more pronounced line formation on the palms of the hands and soles of the feet, a double lower eyelid crease (Dennie-Morgan sign) and torn earlobes.
In some neurodermatitis sufferers, the eyebrows also become very thin towards the sides (Hertoghe’s sign) or the lips are more furrowed and quickly become dry and cracked. Children also quite often have eczema on the fingertips and toes, which is sometimes confused with fungal diseases.
Further examinations are usually not necessary for the diagnosis of cradle cap and neurodermatitis. In unclear cases, a histological examination of the skin excludes other skin diseases. In blood tests, elevated IgE levels are found in many cases.
What to do in case of cradle cap?
You can read about whether you should remove cradle cap from the baby’s scalp and how to treat it in the article Removing cradle cap.
What is the course of cradle cap?
Cradle cap appears on the skin for several months and up to two years. Typically, the symptoms of atopic dermatitis shift in the course of the disease: After the first year of life, eczema appears more frequently on the arms and knees, on the neck and in the groin area.
In some cases, a chronic form of neurodermatitis subsequently develops. In many children, however, it heals within the first two years of life, so that the other symptoms disappear at the same time as the cradle cap.
Prevention
Babies who have only mild cradle cap benefit from careful skin care that prevents the child from scratching and inflaming the affected areas. Special ointments help prevent cradle cap from worsening. Discuss with your treating pediatrician which ointments are best for your child.
