Rough, scaly patches of skin on their newborn's scalp can be alarming to new parents, but usually are nothing to worry about. Most likely, they're due to a harmless condition many babies develop called cradle cap.
About Cradle Cap
Cradle cap is the common term for seborrheic dermatitis, or seborrhea, which is also called dandruff in older kids and adults.
It's a relatively common condition in newborns and children as old as 3 and causes thick white or yellow scales on the scalp. Some kids just get scales in a small patch; others have scales all over their heads. Sometimes, cradle cap can even occur on the eyebrows, eyelids, ears, crease of the nose, back of the neck, diaper area, or armpits. In rare cases, such as in babies who have eczema or dry skin, cradle cap can cause cracked skin that itches and oozes a small amount of clear yellow drainage.
Cradle cap is not contagious and it isn't an indication of poor hygiene. Most of the time, it just goes away on its own. In severe or persistent cases, though, a doctor may recommend a medicated shampoo or lotion. Washing your baby's scalp daily with mild shampoo can also help to loosen and remove the scales caused by cradle cap.
Though it might look to be uncomfortable or irritating to the skin, cradle cap generally doesn't bother kids.
The exact cause of cradle cap isn't known, although some researchers believe it can be caused by an overproduction of skin oil (sebum) in the oil glands and hair follicles. A type of yeast (fungus) called malassezia can grow in the sebum along with bacteria, and this may be another factor in the development of cradle cap.
Seborrhea often runs in families, meaning the conditions that lead to cradle cap can be passed from mother to baby before birth. Certain factors — such as weather extremes, oily skin, infrequent skin cleaning, lotions that contain alcohol, obesity, and other skin disorders — can increase a child's risk of developing cradle cap.
Cradle cap looks different on every baby. It can be grouped together in bunches, or crops, or it can be spread far apart on the body. Affected areas will usually have one or more of these symptoms:
thick plaques or crusts (especially on the scalp, but sometimes on the ears, eyelids, eyebrows, nose, neck, groin, or armpits)
greasy or oily patches of skin, often covered with white or yellow scales
skin flakes (dandruff)
Rarely, babies with cradle cap will have skin that is mildly red or itchy, and some might even experience hair loss, though the hair usually grows back after the cradle cap is gone.
In most cases, cradle cap will be easy to diagnose at home based solely on its appearance. However, call your child's doctor if:
you are treating cradle cap for the first time
your child has seborrhea in places where he or she doesn't have hair
you've tried home treatments without success
the seborrhea gets worse or covers large parts of the body
the seborrhea is causing hair loss or becomes itchy
the affected skin becomes firm and red, starts to drain fluid, or feels warm, which could be indications of an infection
your child has a weakened immune system and develops seborrhea
Curing Cradle Cap
While most cases of cradle cap won't require any treatment, you may want to loosen and remove the scales on your baby's scalp. This usually can be done by gently massaging your baby's scalp with your fingers or a washcloth and washing your baby's hair once a day with mild baby shampoo while scales are present.
After the scales have disappeared, shampooing can be reduced to twice a week to help control symptoms. Brush your child's hair with a clean, soft brush before rinsing off the shampoo to loosen the scales.
If the scales don't loosen easily, consider rubbing a small amount of mineral oil onto your baby's scalp. Allow the oil to soak into the scales for a few minutes, and then brush and shampoo your baby's hair as usual. Be sure to wash the oil away each time, as excess oil may cause scales to accumulate and make cradle cap worse.
If your baby's cradle cap doesn't respond well to regular shampooing, ask your doctor about medicated or dandruff shampoos. These shampoos, many of which are available over the counter, contain ingredients such as salicylic acid, coal tar, zinc, selenium, and ketoconazole (which usually requires a prescription) that can help treat dryness and flaking.
Rub a little shampoo into your child's scalp and let it soak in for at least 2 minutes. Then wash the shampoo out and repeat the process one more time. You might need to do this daily or twice weekly at first, but after the cradle cap is controlled, you may only have to use medicated shampoos once a month.
For seborrhea on other parts of the body, or if your child has irritated skin, hydrocortisone creams can help. Be sure to consult with your baby's doctor before using hydrocortisone, however.
Cradle cap may disappear for months at a time and then suddenly reappear, but by following the steps above, you should be able to control it.