Cradle cap

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Cradle cap
Other namesinfantile or neonatal seborrhoeic dermatitis, crusta lactea, milk crust, honeycomb disease, scurf cap
Baby With Cradle Cap.jpg
An infant with characteristic scaly scalp of cradle cap
Specialty Dermatology

Cradle cap causes crusty or oily scaly patches on a baby's scalp. The condition is not painful or itchy, but it can cause thick white or yellow scales that are not easy to remove. [1] Cradle cap most commonly begins sometime in the first three months but can occur in later years. Similar symptoms in older children are more likely to be dandruff than cradle cap. The rash is often prominent around the ear, the eyebrows or the eyelids. It may appear in other locations as well, where it is called infantile seborrhoeic dermatitis. Cradle cap is just a special—and more benign—case of this condition. The exact cause of cradle cap is not known. Cradle cap is not spread from person to person (contagious). It is also not caused by poor hygiene. It is not an allergy, and it is not dangerous. Cradle cap often lasts a few months. In some children, the condition can last until age 2 or 3. [2]

Contents

Signs and symptoms

Close up image of cradle cap Cradle Cap Detail.jpg
Close up image of cradle cap

Cradle cap is seborrheic dermatitis that affects infants. It presents on the scalp as greasy patches of scaling, [3] which appear thick, crusty, yellow, white or brown. [4] The affected regions are not usually itchy and do not bother the child. [3] [5] Other affected areas can include the eyelids, ear, around the nose, and in the groin. Hair loss can also occur. [4]

Causes

Cradle cap is not caused by bacterial infection, allergy or poor hygiene. [4] Cradle cap is also not contagious. [4] Doctors do not agree on what causes cradle cap, but the two most common hypotheses are fungal infection and overactive sebaceous glands. Cradle cap is an inflammatory condition. [4]

Possibly it has to do with overactive sebaceous glands in the skin of newborn babies, due to the mother's hormones still in the baby's circulation. The glands release a greasy substance that makes old skin cells attach to the scalp instead of falling off as they dry. There is a relationship with skin yeasts ( Pityrosporum ovale , newly renamed Malassezia furfur ). [6]

Warning signs

If the condition thickens, turns red and irritated, starts spreading, appears on other body parts, or if the baby develops thrush (fungal mouth infection), fungal ear infection (an ear infection that does not respond to antibiotics) or a persistent diaper rash, medical intervention is recommended.

Severe cases of cradle cap, especially with cracked or bleeding skin, can provide a place for bacteria to grow. If the cradle cap is caused by a fungal infection which has worsened significantly over days or weeks to allow bacterial growth (impetigo, most commonly), a combination treatment of antibiotics and antifungals may be necessary. Since it is difficult for a layperson to distinguish the difference between sebaceous gland cradle cap, fungal cradle cap, or either of these combined with a bacterial infection, medical advice should be sought if the condition appears to worsen.

Cradle cap is occasionally linked to immune disorders. If the baby is not thriving and has other problems (e.g. diarrhea), a doctor should be consulted.

Treatment

To help with cradle cap, parents can gently massage their baby's scalp with their fingers or a soft brush to loosen the scales. They may want to shampoo the baby's hair more frequently (no more than once a day), and after shampooing gently brush the baby's scalp with a soft brush or a terrycloth towel. Oil remedies can be used by rubbing a small amount of pure, plant-derived oil (coconut oil, pure olive oil, almond oil) on the baby's scalp and leaving it on for 15 minutes. After 15 minutes, gently comb out the flakes with a fine tooth comb or brush. Be sure to wash out all of the oil to avoid making the cradle cap worse. [7]

In cases that are related to fungal infection, such as tinea capitis, doctors may recommend a treatment application of clotrimazole (commonly prescribed for jock itch or athlete's foot) or miconazole (commonly prescribed for vaginal candidiasis).

Doctors may recommend a treatment with a mild dandruff shampoo such as Selsun Blue even though the treatment may cause initial additional scalp irritation. A doctor may instead prescribe an antifungal soap such as ketoconazole (2%) shampoo, which can work in a single treatment and shows significantly less irritation than over-the-counter shampoos such as selenium disulfide shampoos. [8]

There are only a limited number of studies regarding the efficacy and safety of treatments for cradle cap and infantile seborrheic dermatitis. Several treatments including Promiseb, lactamide MEA gel, hydrocortisone 1% lotion, licochalcone 0.025%, flumethasone pivalate 0.02% ointment, and eosin 2% aqueous solution have been studied, however there is uncertainty regarding the efficacy and safety of these treatments. [9]

For adults: see the article on seborrheic dermatitis (the adult version of cradle cap).

Scalp, behind ears, eyebrows

If the cradle cap is not severe, it could simply be combed out gently after bathing. The softened scales can then be brushed away with a soft brush, comb or cloth, but if not done very gently, this could worsen the condition and bring about temporary hair loss. Applying petroleum jelly (e.g., Vaseline) liberally overnight is another popular treatment. The softened scales either fall off during the night, or can be brushed off in the morning. [10]

There is broad disagreement regarding the role of shampoos. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, but the exact denotation of the label "mild" in this context is not quite clear. Baby shampoos often contain detergent surfactants, perfumes, quaternium-15 and other eczematogenic irritants. No studies have been performed on non-prescription shampoos.[ vague ]

In stubborn cases some doctors may recommend keratolytic (dandruff) shampoos (e.g. with sulfur, selenium, zinc pyrithione, or salicylic acid) while others warn against the use of medicated shampoos in newborns due to systemic absorption. Dandruff shampoos often contain sodium dodecyl sulfate, a noted skin irritant. [11]

Steroid and tar preparations have also been used but may have drawbacks.[ clarification needed ] The immunomodulators tacrolimus/Protopic and pimecrolimus/Elidel have not been approved for children under two years. [12] [13]

Ketoconazole shampoos and creams are currently shown to be the most effective medical treatment of moderate to serious cradle cap. [3] There appears to be little to no absorption of topical ketoconazole into the bloodstream. [14] [15]

Eyelids

Typical medical advice is to use baby shampoo, diluted with warm water, on a cotton swab to cleanse the eyelid. There is no agreement on the dilution, which ranges from as high as a 1:1 mix to as low as a few drops of shampoo per half-cup of water.

Prognosis/differential diagnosis

Assurances that this condition will clear as the baby matures are very common. However, the condition occasionally persists into the toddler years, and less commonly into later childhood. It tends to recur in adolescence and persists into adulthood. In an Australian study, about 15 percent of previously diagnosed children still had eczema 10 years later. It is common that people mistake cradle cap for atopic dermatitis due to the similar symptoms. Unlike some signs and symptoms of cradle cap, atopic dermatitis affect infants' sleep and feeding habits with moderate to severe itching. In addition, one of the physical diagnosis of atopic dermatitis is poor crusted lesions on certain surfaces of the baby, such as scalp and cheek. [16] Rarely, it turns out to be misdiagnosed psoriasis.[ citation needed ]

Related Research Articles

<span class="mw-page-title-main">Dermatitis</span> Inflammation of the skin

Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is often called eczema, and the difference between those terms is not standardized.

<span class="mw-page-title-main">Dandruff</span> Skin condition of the scalp

Dandruff is a skin condition that mainly affects the scalp. Symptoms include flaking and sometimes mild itchiness. It can result in social or self-esteem problems. A more severe form of the condition, which includes inflammation of the skin, is known as seborrhoeic dermatitis.

<span class="mw-page-title-main">Tinea cruris</span> Medical condition

Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates.

<span class="mw-page-title-main">Tinea versicolor</span> Skin disease

Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

<span class="mw-page-title-main">Irritant diaper dermatitis</span> Medical condition

Irritant diaper dermatitis is a generic term applied to skin rash in the diaper area that are caused by various skin disorders and/or irritants.

<span class="mw-page-title-main">Sebaceous gland</span> Gland to lubricate the hair and skin

A sebaceous gland, or oil gland, is a microscopic exocrine gland in the skin that opens into a hair follicle to secrete an oily or waxy matter, called sebum, which lubricates the hair and skin of mammals. In humans, sebaceous glands occur in the greatest number on the face and scalp, but also on all parts of the skin except the palms of the hands and soles of the feet. In the eyelids, meibomian glands, also called tarsal glands, are a type of sebaceous gland that secrete a special type of sebum into tears. Surrounding the female nipple, areolar glands are specialized sebaceous glands for lubricating the nipple. Fordyce spots are benign, visible, sebaceous glands found usually on the lips, gums and inner cheeks, and genitals.

<span class="mw-page-title-main">Seborrhoeic dermatitis</span> Skin disease

Seborrhoeic dermatitis is a long-term skin disorder. Symptoms include flaky, scaly, greasy, and occasionally itchy and inflamed skin. Areas of the skin rich in oil-producing glands are often affected including the scalp, face, and chest. It can result in social or self-esteem problems. In babies, when the scalp is primarily involved, it is called cradle cap. Seborrhoeic dermatitis of the scalp may be described in lay terms as dandruff due to the dry, flaky character of the skin. However, as dandruff may refer to any dryness or scaling of the scalp, not all dandruff is seborrhoeic dermatitis. Seborrhoeic dermatitis is sometimes inaccurately referred to as seborrhoea.

<span class="mw-page-title-main">Zinc pyrithione</span> Chemical compound

Zinc pyrithione is a coordination complex of zinc. It has fungistatic and bacteriostatic properties and is used in the treatment of seborrhoeic dermatitis and dandruff.

<span class="mw-page-title-main">Blepharitis</span> Medical condition of the eyelid

Blepharitis, sometimes known as "granulated eyelids," is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

<span class="mw-page-title-main">Ketoconazole</span> Antifungal chemical compound

Ketoconazole, sold under the brand name Nizoral among others, is an antiandrogen, antifungal, and antiglucocorticoid medication used to treat a number of fungal infections. Applied to the skin it is used for fungal skin infections such as tinea, cutaneous candidiasis, pityriasis versicolor, dandruff, and seborrheic dermatitis. Taken by mouth it is a less preferred option and only recommended for severe infections when other agents cannot be used. Other uses include treatment of excessive male-patterned hair growth in women and Cushing's syndrome.

<span class="mw-page-title-main">Tinea capitis</span> Cutaneous fungal infection of the scalp

Tinea capitis is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the genera Trichophyton and Microsporum that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern, that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls.

<span class="mw-page-title-main">Ciclopirox</span> Antifungal medication

Ciclopirox is a synthetic antifungal agent for topical dermatologic treatment of superficial mycoses. It is most useful against tinea versicolor. It is sold under many brand names worldwide.

Selenium disulfide, also known as selenium sulfide, is a chemical compound and medication used to treat seborrheic dermatitis, dandruff, and pityriasis versicolor. It is applied to the affected area as a lotion or shampoo. Symptoms frequently return if treatment is stopped.

<span class="mw-page-title-main">Hair care</span> Hygiene and cosmetology involving human hair

Hair care or haircare is an overall term for hygiene and cosmetology involving the hair which grows from the human scalp, and to a lesser extent facial, pubic and other body hair. Hair care routines differ according to an individual's culture and the physical characteristics of one's hair. Hair may be colored, trimmed, shaved, plucked or otherwise removed with treatments such as waxing, sugaring and threading. Hair care services are offered in salons, barbershops and day spas, and products are available commercially for home use. Laser hair removal and electrolysis are also available, though these are provided by licensed professionals in medical offices or speciality spas.

<span class="mw-page-title-main">Neonatal acne</span> Medical condition

Neonatal acne, also known as acne neonatorum, is an acneiform eruption that occurs in newborns or infants within the first 4-6 weeks of life, and presents with open and closed comedones on the cheeks, chin and forehead.

<span class="mw-page-title-main">Pityriasis amiantacea</span> Medical condition

Pityriasis amiantacea is an eczematous condition of the scalp in which thick tenaciously adherent scale infiltrates and surrounds the base of a group of scalp hairs. It does not result in scarring or alopecia.

<i>Malassezia globosa</i> Species of fungus

Malassezia globosa is a species of yeast-like fungus.

<span class="mw-page-title-main">Climbazole</span> Chemical compound

Climbazole is a topical antifungal agent commonly used in the treatment of human fungal skin infections such as dandruff, seborrhoeic dermatitis and eczema. Climbazole has shown a high in vitro and in vivo efficacy against Malassezia spp. that appear to play an important role in the pathogenesis of dandruff. Its chemical structure and properties are similar to other fungicides such as ketoconazole and miconazole.

Anti-seborrheics are drugs effective in seborrheic dermatitis. Selenium sulfide, zinc pyrithione, corticosteroids, imidazole antifungals, and salicylic acid are common anti-seborrheics.

Topical antifungaldrugs are used to treat fungal infections on the skin, scalp, nails, vagina or inside the mouth. These medications come as creams, gels, lotions, ointments, powders, shampoos, tinctures and sprays. Most antifungal drugs induce fungal cell death by destroying the cell wall of the fungus. These drugs inhibit the production of ergosterol, which is a fundamental component of the fungal cell membrane and wall.

References

  1. "Cradle Cap". Mayo Clinic. Retrieved November 20, 2019.
  2. "MedlinePlus Medical Encyclopedia - Cradle Cap". Medline Plus. Retrieved November 20, 2019.
  3. 1 2 3 Sheffield RC, Crawford P, Wright ST, King VJ (March 2007). "Clinical inquiries. What's the best treatment for cradle cap?". The Journal of Family Practice. 56 (3): 232–233. PMID   17343816.
  4. 1 2 3 4 5 "Seborrheic dermatitis". National Center for Biotechnology Information. Retrieved 26 August 2012.
  5. Ro BI, Dawson TL (December 2005). "The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff". The Journal of Investigative Dermatology. Symposium Proceedings. 10 (3): 194–197. doi: 10.1111/j.1087-0024.2005.10104.x . PMID   16382662.
  6. Victoire A, Magin P, Coughlan J, van Driel ML (March 2019). "Interventions for infantile seborrhoeic dermatitis (including cradle cap)". The Cochrane Database of Systematic Reviews. 2019 (3): CD011380. doi:10.1002/14651858.CD011380.pub2. PMC   6397947 . PMID   30828791.
  7. "Cradle Cap". Baby Center. Retrieved 17 June 2015.
  8. Danby FW, Maddin WS, Margesson LJ, Rosenthal D (December 1993). "A randomized, double-blind, placebo-controlled trial of ketoconazole 2% shampoo versus selenium sulfide 2.5% shampoo in the treatment of moderate to severe dandruff". Journal of the American Academy of Dermatology. 29 (6): 1008–12. doi:10.1016/0190-9622(93)70282-x. PMID   8245236.
  9. Victoire A, Magin P, Coughlan J, van Driel ML (March 2019). "Interventions for infantile seborrhoeic dermatitis (including cradle cap)". The Cochrane Database of Systematic Reviews. 2019 (3): CD011380. doi:10.1002/14651858.CD011380.pub2. PMC   6397947 . PMID   30828791.
  10. Nobles, T.; Harberger, S.; Krishnamurthy, K. (2022). "Cradle Cap - StatPearls". NBCI Bookshelf. PMID   30285358 . Retrieved November 20, 2019.
  11. "Fact Sheet: Cradle cap". Better Health Channel. Victorian Government, Australia. April 2006. Archived from the original on 2006-06-18. Retrieved 2006-07-14.
  12. "Tacrolimus Topical: MedlinePlus Drug Information". medlineplus.gov.
  13. "Pimecrolimus Topical: MedlinePlus Drug Information". medlineplus.gov.
  14. Kucers' the use of antibiotics : a clinical review of antibacterial, antifungal, antiparasitic and antiviral drugs (6th ed.). CRC Press. 2010. ISBN   978-1444147520 . Retrieved 20 November 2019.
  15. Wang K, Wu Y, Chi Z, Shu C, Li L, Wei J, et al. (September 2016). "A highly sensitive LC-MS/MS method for determination of ketoconazole in human plasma: Application to a clinical study of the exposure to ketoconazole in patients after topical administration". Journal of Pharmaceutical and Biomedical Analysis. 128: 504–509. doi:10.1016/j.jpba.2016.06.025. PMID   27379747.
  16. Nobles T, Krishnamurthy K (2019). "Cradle Cap". StatPearls. StatPearls Publishing. PMID   30285358 . Retrieved 2019-08-02.