Cradle cap is one of the most common causes for consult among babies during their first few months. The condition is very common. It occurs in two out of a hundred infants born in the United States, and 70% of babies in Australia. [1, 2]
What is Cradle Cap?
This is also known as Infantile Seborrheic Dermatitis, Pityriasis capitis, Milk Crust, Crusta Lacteal, and Honeycomb Disease. It is a skin lesion characterized as greasy, crusty, yellow, scale-like patches, usually located at the scalp of babies during their first few months of life. [3, 4]
Image 1 : This image shows the white and yellowish flakes seen at the scalp of a baby with cradle cap.
Image 2 : Scaly scalp: a skin lesion characteristic of cradle cap
Who Can Get Cradle Cap?
Cradle cap usually occurs among babies, from birth to three months of age. It is rare and uncommon among children 6 to 12 months old. 
What Causes Cradle Cap?
- The specific cause of cradle cap is still unknown. However, some things are certain: it is harmless, and is neither from allergy, bacteria or poor hygienic practices. Two theories have been believed: it can be from either fungi or from hyperactivity of sebaceous glands. [3, 6]
- It is thought to be of fungal origin, particularly Malassezia, associated to maternal antibiotic use just before delivery, or that given to the babies during the early newborn period. These antibiotics are said to eradicate both bad bacteria-causing harmful diseases, and good bacteria preventing yeast growth. With the good bacteria gone, fungi flourish, causing skin lesions in the diaper area, ear, mouth, and scalp, hence, the cradle cap. [4, 7]
- The other theory of cradle cap origin involves excessive release of greasy substances from the sebaceous glands. This is believed to be influenced not only by the maternal hormones present on the infants’ circulation, but also associated with biotin deficiency. This grease-like element appears to cause old skin cells to attack and remain in the scalp, instead of falling off. [8, 9]
Clinical Manifestations of Cradle Cap
- Usually among newborns, cradle cap is harmless and not bothersome. It is not pruritic nor does it cause irritability among infants. Common physical examination findings of which may include thickened crusts and scaly patches of the scalp, skin covered with grease, white flakes or yellowish scales, and skin erythema.
- They usually start as large, greasy scales, either yellow or brown, often found in the scalp. In time, these scales begin to flake, leaving the affected skin not just red in hue, but also with loss of hair. [10, 11]
- In more severe cases, the skin lesions may appear thickened and more erythematous in character. They may even spread on the other body parts. Aside from the scalp, these skin lesions may also be noted in the mouth as thrush, on the ears as fungal ear infections, and the inguinal region, as jock itch or diaper rash. Cradle cap appearing in other areas of the body is termed as seborrheic dermatitis.  Also see : Fungal Rash Symptoms.
- Complicated cases of cradle cap may start from the presence of bleeding and cracked integuments. These areas tend to allow bacteria to grow as inhabitants. In a few days time, impetigo may ensue. During these cases, consult with a physician is warranted. 
How is Cradle Cap Diagnosed?
- Physical examination is of high importance in diagnosing this skin condition. When there is persistence of symptoms even after one year of age, or if condition has not improved with simple treatment measures, other diagnostic examinations may be performed to rule out other pathologic conditions. 
How to get rid of cradle cap : Remedies
- This particular condition may spontaneously resolve in a few weeks time, even without medical management. The following must be remembered in its management: [4, 10, 11, 13, 14]
- In mild cases of cradle cap, gentle washing of the scalp can be done using a mild hypoallergenic product. After bathing, the scalp can be gently brushed to loosen the scales off.
- After the scales have gone, gentle washing should be repeated every few days to prevent recurrences.
Image 3 : Gentle washing of the scalp should be done using a mild shampoo. This should be repeated regularly.
- Petroleum jelly or mineral oil, in minimal amount, may loosen the scales on the baby’s scalp. These should be soaked and left into the scales for a few minutes, then brushed off of the scalp and hair. Thorough rinsing of the hair is done thereafter. If left, the oil may accumulate and worsen the cradle cap.
- If the scales would still recur, application of a stronger shampoo, oil or lotion may soften the thickened scaly patches. This should be done as prescribed by a physician.
- If the areas of infection or inflammation are noted, consultation is warranted. The specialist may then prescribe an antibiotic, an antifungal shampoo or a mild steroidal cream.
- Use of over the counter antifungal and steroidal medication are not advisable without the physician’s consent.
- A number of these products are toxic if absorbed by the baby’s sensitive skin.
- Unprescribed anti-dandruff shampoos should not also be utilized. They may contain salicylic acid, which is also toxic to the baby’s delicate skin.
- Shampoos and hair product containing peanut oil should be avoided, especially among children younger than 5 years.
- A sodium bicarbonate paste, or baking soda, can be applied to the scalp before the baby’s bath. This should be rinsed thoroughly afterwards. Aside from oil, this can also help remove the scales of cradle cap.
- Washing of the baby’s skin and scalp using tea, particularly those containing chamomile, comfrey root and burdock can also be done.
- Cocoa butter can also soften the scaling, crusted dead skin cells. This will make brushing off and removal of the scales possible with less effort.
- Application of undiluted apple cider vinegar can also be used to manage scales of cradle cap. This should be applied ten minutes prior to bathing and should be rinsed meticulously.
- Picking off of the scales should not be allowed. This may lead to bacterial infection as complication.
How to Prevent Cradle Cap?
This particular skin condition can be prevented by washing the baby’s hair, using mild hypoallergenic shampoo every few days. This will prevent the buildup and attachment of dried skin cells on the scalp. 
- Seborrheic Dermatitis. National Center for Biotechnology Information. August 2012.
- Sheffield, R, et al. Clinical Inquiries. What’s the Best Treatment for Cradle Cap? The Journal of Family Practice. March 2009. 56(3): 232-3.