Cradle cap: how to treat it, causes and how long it lasts

Cradle cap often needs little treatment. The NHS says there are some things you can do that can help remove it, and your baby's hair may come away with the scales. Do not worry if this happens as it will soon grow back.

NICE Clinical Knowledge Summaries (CKS) describes the same approach for infants: massage a topical emollient onto the scalp to loosen scales and remove them with an infant brush, and, if other areas of the body are affected, bathe the infant every day using an emollient as a soap substitute. CKS says a topical imidazole cream or a short course of a mild topical corticosteroid may be considered if appropriate, which is a decision for a clinician.

Cradle cap is the common name for seborrhoeic dermatitis of the scalp in babies. CKS says seborrhoeic dermatitis is a common inflammatory skin condition occurring in areas rich in sebaceous (oil) glands, and that in infants the scalp is most commonly affected, which is called cradle cap. It typically presents as red patches with greasy-looking yellowish scales.

The British Association of Dermatologists (BAD) says babies can get a short-lived type of seborrhoeic dermatitis on the scalp, commonly called cradle cap, or in the nappy area. These usually clear after a few months and, if there are no symptoms, may not require treatment. It should not be confused with the condition in adults, and when it affects the nappy area it is entirely separate from nappy rash caused by prolonged contact with soiled nappies.

The NHS says the main symptom is patches of greasy, scaly skin. It is usually found on the scalp and face, but sometimes affects the nappy area and areas where the skin creases. It can look like patches of white or yellow greasy scales on the scalp and face that form a crust which might flake off, or small, dry flakes of skin on the nappy area.

The scales look similar on all skin tones. The skin under and around the scales may look pink or red on white skin, or lighter or darker than the surrounding skin on brown or black skin. The NHS says it is not itchy or painful.

The NHS says cradle cap usually goes away on its own within a few months. CKS says infantile seborrhoeic dermatitis is usually self-limiting and lesions normally resolve at around 8 to 12 months. BAD says babies' seborrhoeic dermatitis usually clears after a few months.

The NHS says to see a GP if cradle cap does not get better after a few weeks of treatment.

The NHS says the cause of cradle cap is not clear, but it cannot be caught from other babies. CKS says the exact cause of seborrhoeic dermatitis is not fully understood, and many factors, including the presence of Malassezia yeasts and the host immune response, have been associated with it.

BAD says a harmless yeast, Malassezia, is present on normal skin but found in higher amounts in seborrhoeic dermatitis, and that this yeast is not the same as the yeasts that cause thrush. It describes the cause as involving many factors and still being researched.

The NHS says bleeding, leaking fluid and swelling could be signs of an infection or another condition such as atopic eczema or scabies, and that a GP should see these. CKS says that investigations are appropriate if an underlying cause or an alternative diagnosis such as tinea is suspected.

The NHS says you can ask a pharmacist about an emollient you can use on your baby's scalp, unperfumed baby shampoos, and barrier creams to use on your baby's nappy area if it is also affected.

The NHS says to see a GP if your baby's cradle cap does not get better after a few weeks of treatment, your baby has cradle cap all over their body, the crusts bleed or leak fluid, or the affected areas look swollen. These could be signs of an infection or another condition.

See a doctor promptly if your baby also seems unwell, has a fever, is feeding poorly or is very unsettled, rather than assuming it is cradle cap.

On the NHS cradle cap is usually looked after at home with advice from a pharmacist or health visitor, and a GP if it is widespread, infected or slow to improve. Specialist referral is rarely needed.

Some parents choose to see a private paediatrician or dermatologist for reassurance. In general terms the same advice applies, and it is worth being cautious about products that are scented, contain peanut oil or are marketed as cures. Ask a pharmacist or health visitor if you are unsure about a product.