Cradle Cap

Seborrheic Dermatitis of the Infant

Cradle cap is a form of seborrheic dermatitis, that presents in newborns approximately 1 week after birth.

Cradle Cap Skin

The skin looks greasy yellow and crusty, with scales and flakes found stuck onto the infants scalp. The involvement of the scalp can be very extensive at times, completely covering the scalp with redness and oozing discharge.

Body Cradle Cap

The entire body may be involved with smaller dermatitis-like lesions. These are much less extensive than on the scalp, and usually involve the face, neck, chest, abdomen and extremities. If the groin folds are involved, the inflammation and oozing may be severe.

What Causes Cradle Cap?

Cradle cap is caused by a type of fungus, which is normally found on the skin, and is the most common normal skin flora of the scalp, Malassezia. The Malassezia family, consists of approximately 7 different species, with Malassezia furfur being the most common cause of cradle cap. These fungi are all lipophilic and cause seborrheic dermatitis. In infants, sebum, which is produced from sebaceous glands and contains numerous lipids such as triglycerides and cholesterol which the Malassezia fungi grow on, is elevated. This elevated sebum is elevated in the first few weeks after birth as the infant still has circulating maternal androgens from the now removed placenta. These androgens subsequently become cleared and so does cradle cap through normal infant physiology (the liver breaksdown these steroids into fragments that then become cleared by the kidney).

Cradle Cap Treatments

Cradle Cap Skin Care

As mentioned in the causes of cradle cap, with time, the androgens disappear and so does the stimulus for cradle cap formation. Therefore, the best treatment for cradle cap is simple skin care. These include bathing with the use of emollients.

Cradle Cap Shampoo

Mild shampoos can be used to remove scales and crust. Do not use thick, highly irritant shampoos on an infants scalp. These may promote damage and inflammation and worsen the spread and involvement of the dermatitis.

Cradle Cap and Ketoconazole

Antifungals, such as 2% Ketoconazole cream are used for more severe, widespread seborrheic dermatitis. Low potency steroids can also be used for a very short period of time to decrease the inflammation. Steroids do not kill the fungus.

References:

Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology. (2004) Wolff Johnson, 5th edition.