Monday, April 28, 2014

Cradle Cap and Seborrheic Dermatitis

     Seborrheic dermatitis is a skin condition with red patches that can be divided into two types: cradle cap (infants) and seborrheic dermatitis (older children and adults). For infants, it will often start within the first month or two of birth and last until the infant is somewhere between 6-12 months of age. Older children that develop this find it happens late in or after puberty. There is a genetic component: it does tend to run in families.
     "Seborrheic" means "runny or seeping oil" and the rash is often accompanied by yellowish oily film or scaly crust. The rash in infants is most often just on the forehead, but there may be a rash in many other areas. This rash may be red and in splotchy areas or be many fine small "pimple" looking spots. There may be an oily or crusty appearance to the top of the smaller rashy areas. Seborrheic dermatitis can be itchy but is not always.
     What to do if your child has cradle cap? For infants where there is not much cradle cap and it does not cause your infant to scratch at the area, it is fine to just watch. The first step in treatment is to massage baby oil into the area 20-30 minutes before a bath. Then wash the hair with the usual baby shampoo that you use. After the bath, gently brush at the area with a soft-bristled brush. Do this regularly (2-3 times a week or more) until the cradle cap improves and the flakes are removed. Then repeat as needed in future weeks. Remember that the baby oil will not cure the cradle cap, just keep it calmed down until the cradle cap improves as the months go by.
     For those infants and children that the baby oil and brushing is not effective, we recommend trying using one of the over the counter medicated shampoos: Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel. Note: these are the same ones you and I would use. They do not make "infants" or "kids" forms of these. All of these can sting the eyes so be cautious about rinsing them out while keeping them out of the eyes (tilt the head back and pour the water front to back). These shampoos can be used daily or a couple times a week. If the cradle cap improves over a couple weeks, you may just need to use the medicated shampoo once a week. The baby oil can still help get the oily scales off the scalp.
     Most of the infants are not itchy with the cradle cap. However, for those infants that are itchy and the above measures are not helping, it can really help to use the over the counter 1/2-1% hydrocortisone cream (such as "Cortaid"). Apply a thin layer to the cradle cap once or twice a day. Ideally, this is only done when the itching is bad and for 3-7 days then off for the same amount of time.
     For older children with dandruff, itching, and seborrheic dermatitis, we recommend they use one of the three shampoos (Head 'n' Shoulders, Selsun Blue, or Neutragena T-Gel). If using that on a regular basis does not help, we can discuss here in the office -- there are prescription strength shampoos that can really help. If despite even the prescription medication your child's medication is no better, we would have them see a dermatologist.

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