About seborrhoeic dermatitis/cradle cap in infants

Infantile seborrhoeic dermatitis (also known as ‘seborrhoeic eczema’) is a common skin condition is seen in infants, which appears before the age of 3 months and usually resolves by 6-12 months. It commonly affects the scalp as cradle cap or the baby’s bottom as napkin dermatitis, but sometimes the eyebrows, forehead, temples, folds around the nose and the area behind the ears are affected.

What causes infantile seborrhoeic dermatitis/cradle cap?

The exact cause is not known, but it is believed to be linked to the development of sebaceous glands. It usually appears around birth or in the first couple of months of life, and is thought to be caused by hyperactivity of sebaceous glands responsive to residual circulating maternal hormones shortly after birth. This is why the condition usually resolves by one year of age and does not return. Malassezia yeasts are also indicated in this condition, although their exact role is not clear. 

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.

Is it serious? Or contagious?

The condition is neither serious nor contagious and is not usually itchy. Your baby should feed, play and sleep as usual, without any problems. It will usually spontaneously resolve within a few weeks to a few months. For infants for whom the condition does not resolve by itself, some simple treatment measures can be taken.

How is cradle cap treated?

Although there is no need to treat cradle cap, the following suggestions may be helpful: 

  • Use mild, unperfumed baby shampoo and tepid water 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 with a soft brush will help to loosen the scales. 
  • Do not pick the scales as this may increase the risk of infection. If you are not able to remove the scales with the simple measures recommended above, soften them prior to washing with an emollient (medical moisturiser) or unperfumed mineral oil or vegetable oil, such as coconut or sunseed oil. Olive oil is no longer recommended as it has been found to damage the skin barrier.
  • If any hair comes out with the scales, don’t worry as it will grow back. 
  • Shampoo is not recommended for babies under one year with atopic eczema.

 

How is it treated on other parts of the body?

  • Bathe 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!

  • Use a medical emollient rather than cosmetic baby products (including those described as ‘natural’ or for sensitive skin), which may contain fragrance and other ingredients that can irritate the skin. Moisturising the skin with an emollient will help prevent further skin flaking and infection.

  • If the skin looks sore, your doctor or health visitor may prescribe a mild topical steroid cream – apply it very thinly once or twice a day, as prescribed, to the sore areas of skin only.

  • A good time to apply emollient is after bathing. After applying the emollient, wait at least 10 minutes (ideally 20-30 minutes if you have time) before applying a topical steroid. It is important to leave a gap between the two treatments to avoid diluting the topical steroid and/or spreading it to areas unaffected by eczema.

  • Keep the nappy area clean and dry. Check nappies frequently while the skin is sore and change as soon as they become wet or soiled.

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

For more information on infantile seborrhoeic dermatitis/cradle cap, please see our Seborrhoeic dermatitis and cradle cap in infants factsheet