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Dermatitis Cradle Cap Treatment
Cradle cap treatment for when dermatitis is also present
Cradle cap treatment is usually a wait and see approach at first.
Seborrheic dermatitis in infants will eventually go away in several weeks—parents are often reminded of this by the pediatrician. If cradle doesn't go away in a few weeks, then further tests may be required to rule out other conditons that can cause the typical cradle cap symptoms. Most doctors will prescribe “watchful waiting” once a diagnosis of cradle cap is made. If the lesions are distressing to parents or baby, certain cradle cap treatments can be attempted. It is important to note that no one cradle cap treatment is always effective in all cases. Some cradle cap treatments may reduce the size of lesions or relieve itchiness but do not necessarily shorten the course of the condition.
When treating infants and toddlers with cradle cap, it is best to try conservative approaches at first before moving on to medications.1 The first thing to try is to gently break apart and loosen the baby cradle cap scales that have formed on the scalp. Remember, this is not a contagious condition so you can use your bare hands. In fact, this is probably the gentlest way of removing the scales and flakes. Otherwise a soft-bristled brush can be used to remove scales. If the scales are stubbornly stuck on, do not use too much force, rather use white petrolatum (petroleum jelly) to soften the scales. The petroleum jelly can be used daily to loosen scales. Vegetable oil can be used to soak the scalp overnight to soften the scales. Unfortunately children do not tolerate this approach very often.
If breaking loose the scales does not sufficiently remove them, even after softening, than a shampoo can be used as the next line of baby cradle cap treatment. Most parents start out with a baby shampoo and, in fact, cradle cap appears despite faithful washing with baby shampoo. The first shampoo that is usually tried as a treatment for cradle cap, is a shampoo containing tar (of all things). Even though tar shampoos are considered a “first line” treatment for cradle cap, tar can irritate and dry out the skin causing it to become red. It can be used several times a week and is a safe product, in general. However it should be rinsed thoroughly since it can stain clothing and bed linens, not to mention light colored hair. Tar can also make the skin more sensitive to sunlight (i.e. sunburns), which is another reason to rinse baby’s scalp thoroughly after using the cradle cap tar shampoo.
If the tar-containing shampoos do not work and the cradle cap still persists, products that contain selenium are probably safe as another type of cradle cap treatment. There is not much information available that shows whether selenium sulfide shampoos are harmful to infant scalps but it does not appear to be dangerous either.
Another baby cradle cap treatment option if tar products fail is to use an antifungal cream or shampoo. Ketoconazole can be used up to three times weekly without significant absorption across the scalp or accumulation in the body. The idea behind an antifungal is to remove the Malassezia fungus from the scalp so that the immune system stops reacting to it and causing the cradle cap. Another cradle cap treatment approach is to use a steroid cream like hydrocortisone 1% once every one to two days. This inhibits the immune system and also reduces itchiness, if itchiness is a symptom. Of the two treatments for cradle cap, ketoconazole may be better at preventing recurrences of cradle cap than corticosteroid creams.
While it may be safe and effective for adults with seborrheic dermatitis, salicylic acid should not be used to treat baby cradle cap. There is a concern that the chemical may absorb across the skin of the scalp and be harmful to the young child.2
In extreme cases there are more potent immunosuppressants that can be used to treat cradle cap, more precisely seborrheic dermatitis. Two such medications are Tacrolimus (Protopic) ointment and Pimecrolimus (Elidel) cream. These medications are only approved for use in those over the age of two years and would not likely be prescribed for cradle cap in infants and toddlers less than two years old. Despite the age restriction on their use, these immunosuppressants are safer than topical steroids if treatment is expected to last a long time.
Baby Cradle Cap Treatment - Seborrheic Dermatitis - Reference List
(1) O'Connor NR, McLaughlin MR, Ham P. Newborn skin: Part I. Common rashes. Am Fam Physician 2008;77:47-52.
(2) Janniger CK. Infantile seborrheic dermatitis: an approach to cradle cap. Cutis 1993;51:233-235.
ABOUT THE AUTHOR: Michael T. Spako is an M.D. who chose to pursue a medical writing career instead of a doctors practice. I am pleased to have him as the principal writer for this cradle cap treatment site, and look forward to his further contributions. Donald Urquhart, Psychologist, Editor.