Cradle Cap (infantile or neonatal seborrhoeic dermatitis, also known as crusta lactea, milk crust, honeycomb disease) is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. It is usually not itchy, and does not bother the baby. Cradle cap most commonly begins sometime in the first 3 months. 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 seborrhoeic dermatitis rather than cradle cap. Some countries use the term pityriasis capitis for cradle cap. It is extremely common, with about half of all babies affected. Most of them have a mild version of the disorder. Severe cradle cap is rare.
Cradle cap is occasionally linked to immune disorders. If the baby is not thriving and has other problems (e.g. diarrhoea), consult a doctor.
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.
Making a paste from sodium bicarbonate (baking soda) and leaving it on the affected area for 10 minutes can also help lift the scales.
There is broad disagreement regarding the role of shampoos. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, while never specifying what "mild" actually means. Baby shampoos often contain detergent surfactants, perfumes, quaternium-15 and other eczemagenic irritants. Again, no studies have been performed.
Keratolytic (dandruff) shampoos (e.g with sulfur, selenium, zinc pyrithione, or salicylic acid) are generally not recommended as they sting eyes and may worsen the dermatitis. In stubborn cases some doctors do recommend them 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.
Ketoconazole shampoos and creams are taking first place in medical treatment of moderate to serious cradle cap. Research so far indicates that this anti-fungal medication is not absorbed into the bloodstream. Ketoconazole shampoo is currently made with a number of problematic irritants and allergens.
There have been several studies where cradle cap cleared swiftly and completely followed by the injection of biotin, either to the baby or the breastfeeding mother. In one study, injection of B-complex worked well also. Injection directly into the vein (rather than into the muscle) is recommended. Small amounts of oral biotin have not shown efficacy in a more recent trial, and many cradle cap compendia have since said that biotin supplementation is ineffective. However, oral supplementation with liquid biotin is favoured by some physicians, but a well-designed study is needed to ascertain the effective dosage in oral supplementation (if there is one) or the effect of injected biotin/B-complex in a larger sample.
A Swedish study found good results from massaging the scalp with small amounts of borage oil twice a day.
Other home remedies recommended in various alternative sources and parent forums are herbal washes (e.g burdock or chamomile), aloe gel, and tea tree oil (Melaleuca oil) shampoo. Tea tree oil and aloe can be sensitizers; any worsening should be an occasion to discontinue the remedy in question. Both remedies have been tested in medical trials and found useful.
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