From the Guidelines
Cradle cap should be treated with gentle massage and mild baby shampoo, with consideration of over-the-counter dandruff shampoos for more persistent cases. Cradle cap is a common, harmless skin condition in infants characterized by yellowish, greasy, scaly patches on the scalp. The exact mechanism of action is unclear, but it is likely related to overactive oil-producing glands in the baby's skin due to maternal hormones still circulating in the baby's bloodstream after birth 1. To manage symptoms, gently massage baby oil, mineral oil, or petroleum jelly into your baby's scalp about an hour before bathing to soften the scales. Then wash your baby's hair with a mild baby shampoo, using a soft brush to gently remove the loosened scales. Some key points to consider when treating cradle cap include:
- For more persistent cases, try an over-the-counter dandruff shampoo containing 1% selenium sulfide or 2% ketoconazole, but use these only once or twice a week and be careful to keep them out of your baby's eyes.
- If the condition spreads beyond the scalp or becomes red and irritated, consult your pediatrician, as a mild hydrocortisone cream (0.5-1%) or antifungal cream may be needed.
- Most cases resolve on their own by 6-12 months of age, but regular gentle washing can help manage symptoms until then. It's also important to note that while coal tar is used in the treatment of psoriasis, atopic dermatitis, and seborrheic dermatitis as an antiproliferative and anti-inflammatory agent 1, its use in cradle cap is not recommended due to potential adverse effects such as folliculitis, irritation, contact dermatitis, and photosensitivity/phototoxicity.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition and Symptoms of Cradle Cap
- Cradle cap is a benign and self-limiting variant of seborrheic dermatitis (SD) that can be distressing for parents 2.
- The characteristic symptoms of seborrheic dermatitis, including scaling, erythema, and itching, occur most often on the scalp, face, chest, back, axilla, and groin 3.
- Cradle cap is a clinical diagnosis based on the location and appearance of the lesions 3.
Causes of Cradle Cap
- The skin changes in cradle cap are thought to result from an inflammatory response to a common skin organism, Malassezia yeast 3.
- A significant colony-forming unit (CFU) count for Malassezia furfur and Staphylococcus aureus was detected in infants with cradle cap 2.
Treatment of Cradle Cap
- Treatment with antifungal agents such as topical ketoconazole is the mainstay of therapy for seborrheic dermatitis of the face and body 3.
- Several over-the-counter shampoos are available for treatment of seborrheic dermatitis of the scalp, and patients should be directed to initiate therapy with one of these agents 3.
- A gel cream containing piroctone olamine, biosaccharide gum-2, stearyl glycyrrhetinate, and zinc l-pyrrolidone carboxylate may be a valid option to treat mild-to-moderate forms of cradle cap 2.
- Topical corticosteroids can be used as second-line agents for treatment of scalp seborrheic dermatitis, but should be used only for short durations due to possible adverse effects 3.
Effectiveness of Treatments
- The effectiveness of commonly promoted treatments for cradle cap is unclear, and further research is needed to determine the best course of treatment 4.
- A systematic review of topical ketoconazole found that it is clinically effective for the treatment of Malassezia-related conditions, including seborrheic dermatitis, with a reported efficacy of 63-90% 5.