Cradle cap

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)