Cradle cap
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224866533
2008-07-10T19:33:35Z
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nl: (cradle cap mentioned within the article)
{{DiseaseDisorder infobox |
Name = Cradle Cap |
ICD10 = {{ICD10|L|21|0|l|20}} |
ICD9 = {{ICD9|690.11}} |
}}
[[Image:Baby With Cradle Cap.jpg|thumb|200px|right|An infant with Cradle Cap]]
[[Image:Cradle Cap Detail.jpg|thumb|200px|right|Close up image of Cradle Cap]]
'''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.
==Causes==
The cause of cradle cap is not clearly defined but it is not caused by an infection, allergy nor from poor hygiene. Possibly it has to do with overactive [[sebaceous gland]]s in the skin of newborn babies, due to the mother's hormones still in the baby's circulation. The glands release a greasy substance that makes old skin cells attach to the scalp as they try to dry and fall off. There may be a relationship with skin yeasts (''[[Pityrosporum ovale]]'', newly renamed ''[[Malassezia furfur]]''). Nutritionally oriented practitioners have speculated that the disorder is caused by the baby's immature digestive system being unable to absorb sufficient [[biotin]] and other vitamins of the B-complex.
==Warning signs==
Home remedies are appropriate with mild cases. If the condition thickens, turns red and irritated, starts spreading, appears on other body parts, or if the baby develops a persistent [[diaper rash]], medical intervention is recommended. Fungal infection ([[ringworm|tinea capitis]]) and [[scabies]] can mimic cradle cap.
Cradle cap is occasionally linked to immune disorders. If the baby is not thriving and has other problems (e.g. [[diarrhoea]]), consult a doctor.
==Prognosis==
Assurances that this condition will clear as the baby matures are very common. However, studies have shown that the condition not infrequently persists into the toddler years, and less commonly into later childhood. It tends to recur in adolescence and persists into adulthood. In an Australian study, about 15% percent of previously diagnosed children still had eczema 10 years later. Sometimes, cradle cap turns into [[atopic dermatitis]]. Rarely, it turns out to be misdiagnosed [[psoriasis]].
==Treatment==
===Scalp, behind ears, eyebrows===
The common advice of applying ([[vegetable oil|vegetable]] or [[mineral oil|mineral]]) oil liberally to the scalp and letting it soak in overnight or for lesser periods of time seems to conflict with the fact that Malassezia yeasts thrive in oily environments. The softened scales can then be brushed away with a soft brush, comb or cloth, but if not done very gently, this can worsen the condition and bring about temporary hair loss. There has been no study done on these recommendations.
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 [[shampoo]]s. Some sources warn against frequent shampooing, others recommend it. Mild baby shampoo is often recommended, while never specifying what "mild" actually means. [[Baby shampoo]]s 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.<ref>{{cite web|url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Cradle_cap?OpenDocument|title=Fact Sheet: Cradle cap|accessdate=2006-07-14|year=2006|month=April|work=Better Health Channel|publisher=Victorian Government, Australia}}</ref>
[[Glucocorticoid|Steroid]] and [[tar]] preparations have also been used but have significant drawbacks. [[Immunosuppressive drugs|Immunomodulators]] ([[tacrolimus]]/Protopic, [[pimecrolimus]]/Elidel) have not been approved for babies under two years.
[[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.{{Fact|date=April 2007}} In one study,{{Fact|date=April 2007}} 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,{{Fact|date=April 2007}} 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{{Fact|date=April 2007}} found good results from massaging the scalp with small amounts of [[Borage seed oil|borage oil]] twice a day.
Other home remedies recommended in various alternative sources and parent forums are herbal washes (e.g [[burdock]] or [[German chamomile|chamomile]]), [[aloe]] gel, and [[Tea tree oil|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.{{Fact|date=September 2007}}
===Eyelids===
Typical medical advice is to use diluted baby shampoo on a cotton swab to cleanse the eyelid. There is no agreement on the dilution, which ranges from a few drops to a half cup warm water, to a 50/50 mix. No studies have been performed on the efficacy or safety of this treatment. (Please note the problems with baby shampoo noted above.) In adults, a study comparing soap and baby shampoo to commercial eyelid scrubs found that patients strongly preferred not to put soap or shampoo on their eyelids. Baking soda has also been recommended (a teaspoonful in a cup of boiled water) and is well accepted by adults. Boiled warm water wash may help.
==References==
<references />
==External links==
* {{DermNet|dermatitis/cradle-cap}}
* [http://www.nlm.nih.gov/medlineplus/ency/article/000963.htm NIH/Medline]
* [http://www.bbc.co.uk/health/conditions/cradlecap2.shtml BBC]
* [http://www.emedicine.com/DERM/topic396.htm eMedicine]
* [http://www.mothernature.com/Library/Bookshelf/Books/50/33.cfm Doctors' Book of Home Remedies for Children]
==Personal views==
* [http://www.slashhair.net/cradlecap.html infantile seborrhoeic dermatitis - a hairdressers view]
{{Diseases of the skin and subcutaneous tissue}}
[[Category:Dermatology]]
[[Category:Eczema]]
[[Category:Seborrheic dermatitis]]
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