Cradle cap

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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

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)

 

About the authors

  • Dilshad Marikar is a paediatric registrar based in England with an interest in high dependency care and clinical informatics

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