Seborrhoeic dermatitis & cradle cap in infants

Infantile seborrhoeic dermatitis (also known as ‘seborrhoeic eczema’) is a common skin condition seen in infants, which appears before the age of 3 months and usually resolves by 6-12 months.

The condition is not serious or contagious, and is not usually itchy. Your baby should feed, play and sleep without any problems. It generally resolves spontaneously within a few weeks to a few months. If the condition does not resolve by itself, some simple treatment measures can be taken.

Symptoms

Cradle cap starts with the scalp becoming thickly coated with greasy, yellowish, waxy scales that stick to the head, making it look crusted.

The eyebrows may be scaly, and the forehead, temples, neck folds and behind the ears can also be affected, if the condition is more severe.

The baby’s bottom may look flaky and inflamed (showing as red on white skin and darker patches on skin of colour). There may be small skin scales (these may be white or grey in colour), which tend to rub off easily, especially if the nappy is tight, giving the skin a shiny appearance.

The red or darker patches may extend into the skin folds at the tops of the legs, around the genitals and between the buttocks. They can then spread quite rapidly and widely.

On other areas of the body, such as the face, skin folds and torso, there may be small, dry, salmon-pink or darker patches that join up to cover larger areas.

Cradle cap is not usually itchy and causes no discomfort to the baby.

Triggers

Many environmental factors can trigger an eczema flare-up, but dry skin and exposure to soaps and detergents can worsen cradle cap. Learn more about these triggers and how to prevent them.

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Treatments

If the cradle cap does not clear by itself within a few months, or if your baby has symptoms other than those associated with seborrhoeic dermatitis, consult your health visitor or GP. If your baby is itchy or the cradle cap persists, it is more likely that your baby has developed childhood atopic eczema, which often starts on the face and the scalp. Although there is no need to treat cradle cap, the following suggestions may be helpful:

Cradle cap shampoos - Use tepid water and a shampoo designed to treat cradle cap (such as Dentinox Cradle Cap Treatment Shampoo or Mustela Foam Shampoo for Newborns) to wash the scalp every few days. Gently massage the scalp with fingertips to remove crusts and excess scale, but do not rub vigorously.
Gentle brushing - Gentle brushing with a soft brush will help to loosen the scales.
Soaking the scales - Do not pick the scales as this can leave raw areas of skin and may increase the risk of infection. If you are not able to remove the scales with the simple measures described above, soften them prior to hair-washing by applying an emollient or unperfumed oil the night before to soak into the scales. Unperfumed mineral oil or vegetable oil, such as coconut or sunseed oil, is fine to use. Olive oil is no longer recommended as it has been found to damage the skin barrier. If any hair comes out with the scales, do not worry as it will grow back.
Emollients - Use a medical emollient rather than cosmetic baby products to bathe your baby and apply to dry skin (including those described as ‘natural’ or ‘for sensitive skin’), which may contain fragrance and other ingredients that can irritate the skin.
Topical steroids - If the skin looks sore, your GP or health visitor may prescribe a mild topical steroid cream or ointment. Apply it thinly once a day, or as prescribed, to the sore areas of skin only, for a short treatment burst.

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FAQ’s

Bath your baby every day with a medical emollient as a soap substitute, or add an emollient bath oil to the water, which will help loosen scales and moisturise dry skin. Take extra care when lifting your baby out of the bath as their skin will be slippery!

After gently patting the skin dry with a soft towel, apply the emollient. After applying the emollient, leave a gap of ideally 20-30 minutes before applying a topical steroid. It’s important to leave a gap between the two treatments to avoid diluting the topical steroid and/or spreading it to areas unaffected by eczema.

Also apply a water-repellent emollient during each nappy change, as a barrier to help protect the skin (ask your pharmacist for a suggestion). Do not use plastic pants over cloth nappies as these can make the problem worse.

The exact cause of infantile seborrhoeic dermatitis is unknown. It is believed to be caused by the overproduction of oil-producing sebaceous glands, found on the baby’s scalp, face and under arms – oily areas of the skin. Hormones passed from the mother can make oil glands more active. Oil secreting glands also activate at birth and are very active for the first six months of life.

Malassezia yeasts are also indicated in this condition, although their exact role is not clear. These are not the same yeasts as those found in foods, or which cause thrush. A family history of eczema or other skin conditions does not seem to be of great significance, although some babies with seborrhoeic dermatitis will also develop atopic eczema, especially if seborrhoeic dermatitis is more severe and extensive.

It can sometimes be difficult for a healthcare professional to determine whether a baby has seborrhoeic dermatitis or another skin condition, such as psoriasis or nappy rash, because they all look similar. However, if the skin creases are unaffected, it is probably nappy rash. Fortunately, treatments for these different conditions in the nappy area are often the same. Infantile seborrhoeic dermatitis is a temporary condition that typically resolves within the first six months and, at the latest, by the child’s first birthday. It does not reoccur during childhood.

Mild infantile seborrhoeic dermatitis is unlikely to become infected if the skin remains intact. However, if the skin becomes sore and raw, especially in the nappy area, it may then become infected by a yeast called Candida, which normally lives on the skin in this part of the body and can cause thrush. Special creams are available to treat this if your healthcare professional thinks they are necessary. Sometimes, seborrhoeic dermatitis can become infected by bacteria if areas of skin are severely affected, particularly the creases. If your baby’s skin feels hot, smells odd or weeps, consult your GP.

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Seborrhoeic dermatitis & cradle cap in infants factsheet