Pediatrician’s Perspective: What are these crusty scales on my baby’s head?

Q. What is cradle cap, how can it be avoided and how do you treat it?

Cradle cap is a form of seborrheic dermatitis, a skin condition that causes yellow crusty scales to appear on the skin. In babies, it usually occurs on the scalp and behind the ears. Sometimes it can also involve the eyebrow and eyelid areas. Rarely, it can be an extensive rash on much of the body. When it just involves the head, it is usually mild, not life threatening, not scarring, and will usually resolve by about 1 year of age. The causes and cures of cradle cap are not well studied and not well understood, and for this reason, there are a multitude of conflicting recommendations and cautions about its management.

The causes:
There seems to be a certain fungus that either causes the cradle cap, or likes to grow in it. It has the rather silly sounding name Malassezia furfur. And cradle cap and seborrhea tend to run in families, so there is probably an inherited predisposition to get it. Since it is “outgrown” at about a year of age, there may be a component of immune insufficiency that resolves as the immune system of the skin matures.

Avoidance:
It is unlikely that it can be avoided by any maneuvers known to us.

Treatment:
It is a legitimate option to do nothing but wait for the cradle cap to go away. But if the skin condition worsens and causes breaks in the skin and which would allow super-infection, I think it is worthwhile to try to treat it.

Keeping in mind that most cradle cap treatments are products of our Culture, not of our Science, and thus have the status of folk remedies, there are some things to do that seem to work for many people and babies.

I usually recommend to those who have failed to improve by washing the scalp with baby shampoo that they try the following every other night:
1. Rub baby oil into the scalp and behind the ears and leave it there for about an hour.
2. Wash the baby’s scalp and behind the ears with Selsun Blue shampoo.
Be very careful not to get it into the baby’s eyes. Rinse well.
3. If irritation occurs, or if the scalp looks worse, stop whatever you are doing.

And my usual closing remark: If the cradle cap is very concerning to you, bring it up with your pediatrician. Every once in a while, seborrheic dermatitis is associated with serious conditions.