From the Guidelines
Severe cradle cap should be treated with a combination of home remedies and medicated options, prioritizing gentle and non-invasive approaches to minimize morbidity and improve quality of life. The treatment approach should focus on softening the scales, reducing inflammation, and preventing infection.
Initial Treatment
- Apply mineral oil, petroleum jelly, or baby oil to the scalp and let it soak for 15-20 minutes to soften the scales
- Gently brush with a soft brush or fine-tooth comb before shampooing with a mild baby shampoo
Medicated Options
- For persistent cases, try an over-the-counter dandruff shampoo containing 1% selenium sulfide, 1% ketoconazole, or 2% pyrithione zinc, diluted with baby shampoo and used twice weekly
- Leave the shampoo on for 3-5 minutes before rinsing thoroughly
- If inflammation is present, a low-potency hydrocortisone cream (0.5-1%) can be applied sparingly twice daily for up to 7 days The provided evidence 1 does not directly address cradle cap treatment, but emphasizes the importance of optimized skin care and cautious approach to dietary restrictions in managing eczema, which can be relevant in considering the overall skin health of infants. However, the primary approach to treating cradle cap remains focused on gentle removal of scales and management of associated inflammation. For severe cases that don't respond to these treatments, consulting a pediatrician is recommended, as they may prescribe stronger antifungal creams or shampoos. Cradle cap occurs due to the baby's oil glands being overactive from maternal hormones, creating an environment where yeast (Malassezia) can thrive, leading to inflammation and scaling. Most cases improve within weeks with proper treatment, though some may persist for several months.
From the FDA Drug Label
For treatment of dandruff and seborrheic dermatitis: Usually two applications each week for two weeks will afford control. Seborrheic dermatitis: Ketoconazole Cream 2% should be applied to the affected area twice daily for four weeks or until clinical clearing.
Severe cradle cap treatment options include:
- Selenium sulfide lotion: apply twice a week for two weeks 2
- Ketoconazole Cream 2%: apply twice daily for four weeks or until clinical clearing 3
From the Research
Severe Cradle Cap Treatment Options
Severe cradle cap, also known as seborrheic dermatitis, is a common skin condition that affects infants, adolescents, and adults. The following are some treatment options for severe cradle cap:
- Topical antifungal agents such as ketoconazole are the mainstay of therapy for seborrheic dermatitis of the face and body 4
- Antifungal shampoos, such as selenium disulfide, can be used as second-line agents for treatment of scalp seborrheic dermatitis 4, 5
- Topical corticosteroids can be used for short durations to reduce inflammation, but should be used with caution due to possible adverse effects 4, 6, 7
- Other treatment options include lithium gluconate/succinate, coal tar, salicylic acid, sodium sulfacetamide, glycerin, benzoyl peroxide, aloe vera, and mud treatment 8
- Alternative therapies such as tea tree oil, Quassia amara, and Solanum chrysotrichum have also been reported, but their effectiveness is not well established 8
- Systemic therapy is reserved for widespread lesions or cases that are refractory to topical treatment 8
Treatment Considerations
When treating severe cradle cap, it is essential to consider the following:
- The skin changes are thought to result from an inflammatory response to a common skin organism, Malassezia yeast 4, 6, 8
- Seborrheic dermatitis tends to relapse after treatment, so long-term therapy may be necessary to maintain remission 4, 6, 7
- The effectiveness and safety of different interventions, such as bifonazole, ciclopirox, ketoconazole, pyrithione zinc, selenium sulfide, tar shampoo, terbinafine, and topical corticosteroids, have been evaluated in various studies 6, 7