CRADLE CAP

Your beautiful 1-month-old baby has developed scaliness and redness on his scalp. You're concerned and think maybe you shouldn't shampoo as usual. You also notice some redness in the creases of his neck and armpits and behind his ears.

When this rash occurs on the scalp alone, it's known as cradle cap. Although it may start as scaling and redness of the scalp, it also can be found later in the other areas mentioned above. It can extend to the face and diaper area, too, and when it does, pediatricians call it seborrheic dermatitis (because it occurs where there are the greatest number of oil-producing sebaceous glands). Seborrheic dermatitis is a noninfectious skin condition and is a form of eczema that's very common in infants, usually beginning in the first weeks of life and slowly disappearing over a period of weeks or months. Unlike atopic or contact eczema, it's rarely uncomfortable or itchy.

No one knows the exact cause of this rash; however, it certainly is influenced by the hormonal changes of pregnancy, which stimulate the oil glands. This overproduction of oil may have some relationship to the scales and redness of the skin.

Treatment of Cradle Cap

If your baby's seborrheic dermatitis is confined to his scalp (and is, therefore, just cradle cap), you can treat it yourself. Don't be afraid to shampoo the hair. In fact, you should wash it (with a mild baby shampoo) more frequently than before. This, along with soft brushing, will help remove the scales.

As for baby oil, it's not very helpful or necessary. Many parents tend to use the unperfumed baby oil or mineral oil and do nothing else. But this allows scales to build up on the scalp, particularly over the rear soft spot, or fontanelle. If you decide to use oil, use only a little, rub it into the scales, and then shampoo and brush it out. Stronger medicated shampoos (antiseborrhea shampoos containing sulfur and 2 percent salicylic acid) may loosen the scales more quickly, but since they also can be irritating, use them only after consulting your pediatrician. The doctor may prescribe some additional medication to treat the scales and redness.

If frequent shampooing doesn't improve the cradle cap, or if the rash spreads to your baby's face, neck and crease areas, call your pediatrician who will probably suggest a stronger scale-dissolving shampoo and also might prescribe a cortisone cream or lotion. One percent hydrocortisone cream is a commonly used preparation.

Preventing Cradle Cap

Once the condition has improved, how can you prevent cradle cap from recurring? In most cases, just by frequent hair washing with a mild baby shampoo. Occasionally, a stronger medicated shampoo may be needed, but let your pediatrician make the decision. Also, after the child's first birthday, the condition will not come back until puberty.

Sometimes, yeast infections will become superimposed on the affected skin, most likely in the crease areas rather than on the scalp. If this occurs, the area will become extremely reddened and quite itchy. In this case, your pediatrician might prescribe some specific anti-yeast cream containing the medicine nystatin. If this is necessary, apply a small amount to the area three or four times a day, and rub it in well.

Rest assured that seborrheic dermatitis is not a serious infection. Nor is it an allergy to something you're using or due to poor hygiene. It will go away without any scars, and your baby will be beautiful again.