From the Guidelines
For severe cradle cap, the most effective treatment approach is to use topical coal tar as an antiproliferative and anti-inflammatory agent, as it has been shown to be effective in treating seborrheic dermatitis, although its use in pediatric patients is mostly studied in the context of psoriasis treatment 1. When considering treatment options for severe cradle cap, it's essential to weigh the potential benefits and risks of each approach. Topical coal tar, available in over-the-counter and prescription-strength formulations, can be used as a shampoo for scalp involvement or in combination with topical corticosteroids.
- The exact mechanism of action of coal tar is unclear, but it has been identified as an aryl hydrocarbon receptor agonist, which contributes to its anti-inflammatory properties.
- While there is limited literature on the use of coal tar in pediatric seborrheic dermatitis, studies on its use in pediatric psoriasis have shown significant improvement in patients treated with a combination of coal tar and phototherapy, with 85% experiencing a prolonged remission 1.
- However, it's crucial to consider the potential adverse effects of coal tar application, including folliculitis, irritation, contact dermatitis, and photosensitivity/phototoxicity, as well as the theoretical increased risk of carcinogenicity with prolonged use.
- Given the potential risks and benefits, topical coal tar should be considered as a treatment option for severe cradle cap, but its use should be carefully monitored and individualized, with regular follow-up appointments to assess treatment response and potential side effects 1.
From the FDA Drug Label
Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing. The best treatment for severe seborrhoeic dermatitis (cradle cap) is applying Ketoconazole Cream 2% to the affected area twice daily for four weeks or until clinical clearing, as stated in the drug label 2.
- Key points:
- Apply Ketoconazole Cream 2% twice daily
- Treat for four weeks or until clinical clearing
- If no clinical improvement after the treatment period, the diagnosis should be redetermined 2
From the Research
Treatment Options for Severe Seborrhoeic Dermatitis (Cradle Cap)
- The treatment of severe seborrhoeic dermatitis, also known as cradle cap, typically involves the use of antifungal agents, anti-inflammatory agents, and keratolytic agents 3, 4, 5.
- Topical antifungals such as ketoconazole and ciclopirox have been shown to be effective in reducing symptoms of seborrhoeic dermatitis, including erythema, scaling, and itching 5.
- A study published in 2021 found that a gel cream containing piroctone olamine, biosaccharide gum-2, stearyl glycyrrhetinate, and zinc l-pyrrolidone carboxylate was effective in reducing symptoms of mild to moderate cradle cap in infants 6.
- Another study published in 2013 found that a nonsteroidal cream was effective in reducing disease severity in pediatric subjects with cradle cap, with 96% of subjects achieving success in the nonsteroidal cream group 7.
Recommended Treatment Approaches
- For mild to moderate forms of cradle cap, topical antifungals such as ketoconazole or ciclopirox may be recommended 3, 4, 5.
- For severe forms of cradle cap, systemic antifungal drugs such as terbinafine or itraconazole may be considered, as well as UVB phototherapy 4.
- In infants, cradle cap can often be managed with baby shampoos enriched with emollient agents and vegetable oils, or with medical device shampoos containing anti-inflammatory and antifungal properties 4.
Efficacy of Treatment Options
- Ketoconazole has been shown to be effective in reducing symptoms of seborrhoeic dermatitis, with a 31% lower risk of failed clearance of rashes compared to placebo 5.
- Ciclopirox has also been shown to be effective, with a lower failed remission rate than placebo at four weeks of follow-up 5.
- The efficacy of other antifungals, such as clotrimazole and miconazole, is less clear, with limited evidence available 5.