Diagnosis | Cradle cap on the baby

Diagnosis

The diagnosis of milk crust can be made on the basis of the clinical appearance. The name cradle cap already indicates that the skin lesions have a similarity to “milk burnt and crusty in a pot”. Relevant for the diagnosis are highly itchy skin redness with blister formation and later on yellow crusts that are difficult to loosen.

The typical itching in milk crust allows a diagnostic distinction to be made from head gneiss, which causes similar skin symptoms but does not cause itching. Typical predilection sites affected by milk crust are the face and the hairy head. It is also possible for the stretched sides of the arms to be affected. The diaper region, which is for example affected by diaper dermatitis, remains free in the milk crust.

The difference to head gneiss

The milk crust is to be separated from the so-called head gneiss. This demarcation is often very difficult and can be made by a pediatrician. In both clinical pictures, scaly skin areas form mainly on the baby’s head.

Colloquially, the term milk crust, i.e. atopic eczema, is often used, although the much more harmless appearance of the head gneiss is meant. When we speak of head gneiss, we mean the so-called seborrheic eczema (inflammation of the skin due to increased sebum production). Head gneiss manifests itself, similar to milk crust, in the form of scaly spots on the scalp.

However, these usually appear in the first month of the baby’s life and not only after the third month. In contrast to the hard scales of milk crust, the scales of head gneiss are soft and do not cause the baby any discomfort. They do not itch or hurt.

Head gneiss typically disappears by itself within the first year of life and does not affect the baby. It is therefore not an indication of a chronic skin disease such as neurodermatitis. Another difference is that head gneiss is usually restricted to the head and neck region, whereas cradle cap can also occur in other parts of the body.

The dandruff of head gneiss can often be removed by applying baby oil or washing the hair, whereas the dandruff of milk crust is firmly attached to the head. The classic age peak for the appearance of milk crust is rarely before the third month of life. However, unlike head gneiss, the skin changes can last for months to years. Usually the expansion to the extremities occurs during this time. After about two years, most forms of milk crust heal, but a transition to a chronic form that lasts a lifetime is also possible.