Cradle cap (infantile seborrhoeic dermatitis) is a self-limiting greasy, scaly rash of unknown cause that most commonly affects the scalps of babies. Overactive sebaceous glands, maternal hormones and skin yeasts have been suggested as possible causes.
Presentation
- Can present in the first month of life (unlike atopic dermatitis which tends to present later)
- Typically the scalp is affected with greasy, scaly patches that may eventually affect the whole scalp
- The faces, ears, neck and nappy area may also be affected
- Unlike atopic dermatitis, the baby is usually not affected by the condition, although mild pruritus may occur
Cradle cap
Management
- Most cases will clear spontaneously between 8-12 months of age
- Tends to respond well to treatment but can be recurrent in nature
- Moisturisers and emollient bath oils can help soften scales for removal with gentle brushing
- Mild shampoos help
- Ketoconazole 2%
- Selenium sulphide shampoo
- Tar containing shampoo
Some authors have suggested avoiding olive oil to treat this condition, on the basis that it can encourage the proliferation of Malassezia yeasts, a suggested virulence factor. However, there is no evidence that use of olive oil worsens cradle cap.
Differential Diagnosis
- Atopic dermatitis
- Consider immunodeficiency in children with extensive disease and failure to thrive (eg Wiskott-Aldrich syndrome, HIV infection)
