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What is Cradle Cap?

Baby With Cradle CapCradle cap is a term used to refer to any red scaly rash on the scalp of babies. Cradle cap is not a medical diagnosis, but simply a descriptive term, like the term diaper dermatitis.

There are a few causes of Cradle cap, including Seborrheic dermatitis, Atopic Dermatitis and Plaque Psoriasis. Seborrheic dermatitis is the most common cause of cradle cap. Before Cradle Cap can be treated, the specific cause of the Cradle cap must first be diagnosed. To diagnose the cause of the Cradle cap your doctor will have to examine the baby from head to toe.

A concomitant rash in the skin-folds and the nappy area might indicate Seborrheic dermatitis, whereas a generally dry skin might indicate Atopic Dermatitis as the cause of the Cradle cap. Nobody knows exactly why babies develop Seborrheic dermatitis or Atopic Dermatitis. The theory is that Seborrheic dermatitis is related to the overgrowth of the yeast Pityrosporum ovale which was recently renamed Malassezia furfur. The yeast overgrows because of overactive oil glands on the scalp. The oil glands become overactive because of genetic influences or perhaps because of hormones passed to the baby from the mother.  Seborrheic dermatitis is not due to bad hygiene or a bad diet! Perhaps as many as 50% of babies born in the developed world have some degree of cradle cap.

Once the diagnosis is made, treatment can be started. The following treatment options will apply especially to Cradle cap caused by Seborrheic dermatitis.

The are really 2 aspects of Cradle cap to treat; scaling and redness. The scaling develops from the areas of redness. Once the redness is resolved the scaling will cease. Initially however, treatment is targeted at both scaling and redness.

Redness can be treated with mild topical corticosteroids. Corticosteroids is not dangerous if used correctly and sparingly. Do not let anybody tell you different, because mild topical corticosteroids can rapidly improve the condition and make your baby feel better. Mild topical corticosteroids should be applied once of twice per day while there is redness. If there is no redness do not apply any corticosteroids.

Ketoconazole containing shampoos can also help. Ketoconazole is an anti-fungal that will help to eradicate yeasts. It is a good idea to dilute the Ketoconazole shampoo perhaps 50:50 or greater initially, to make sure the shampoo does not irritate the babies skin. Use the shampoo every second day initially. Ketoconazole creams can also be applied once or twice per day to the red areas.

Scaling is treated by moisturising the skin. Many different oil and creams can be used for this. Examples include Vaseline, over-the-counter moisturizers, olive oil, borage oil, tea-tree oil, aloe gel etc.

Cradle cap due to Seborrheic dermatitis will resolve spontaneously within a few months in the vast majority of babies.

How to treat nappy rash

The term nappy rash simply refers to a rash in the nappy area. Many conditions can cause a rash in the nappy area. The first step is to determine what the cause of the nappy rash is.

Conditions that can cause a rash in the nappy area:

  • Primary irritant dermatitis
  • Candida infection
  • Atopic dermatitis
  • Allergic Contact Dermatitis
  • Seborrheic dermatitis
  • Psoriasis
  • Acrodermatitis Enteropathica
  • Langerhans Cell Histiocytosis
  • Bullous Mastocytosis
  • Incontinentia pigmenti
  • Bullous Pemfigoid
  • Dermatitis Herpetiformis
  • Linear IgA disease
  • Epidermolysis Bullosa
  • Herpes Simplex virus infection
  • Bullous Impetigo
  • Tinea cruris
  • Scabies
  • Papular urticaria

See why is it essential to determine the cause first?!

The most common cause of nappy dermatitis is Primary irritant dermatitis. Primary irritant dermatitis is a result of urine and faeces irritating the skin. The irritation of the skin is due to wetness, the alkalinity of urine and faeces, irritating enzymes in urine and faeces and secondary infection with Candida and bacteria.

The initiating irritating factor is wetness. The most important part of the treatment of Primary irritant dermatitis is to keep the baby’s bottom DRY. Regular nappy changes, frequently enough to prevent too much wetness, is the most important part of the treatment. Nappy changes can be reduced by using more absorbent nappies. After every nappy change apply a nourishing moisturiser to help repair the skin.

Inflammation (redness) can be treated with mild corticosteroid ointments.

Small sores and ulcers can be covered with Vaseline / White soft paraffin or Zinc oxide ointment.

Infections can be treated with antifungal creams and antibacterial creams.

How to treat dandruff

Dandruff is a non-medical term for a scaly scalp. Many different conditions can cause a scaly scalp. The most common skin condition that causes dandruff is Seborrheic Dermatitis, followed closely by Atopic Dermatitis. Seborrheic Dermatitis tends to flare during  stressful periods.

The first step in treating dandruff is to decide which condition is causing the dandruff.

If the cause is Seborrheic Dermatitis the treatment is as follows:

Step 1:

Shampoos containing ketoconazole, e.g. Nizshampoo.
The shampoo is used 3-4 x per week and left on for a few minutes before rinsing off. Some people need to continue this process for years. If ketoconazole shampoo is not sufficient to control the dandruff the treatment in Step 2 is added.

Step 2:

Scalp lotions containing corticosteroids, e.g. Advantan scalp lotion, Synalar gel and Dermovate scalp lotion.
These lotions are best applied after washing the hair, while the scalp is still moist.

Step 3:

Shampoos containing corticosteroids, e.g. Clobex shampoo. Clobex shampoo is applied on dry hair. The Clobex shampoo can be washed off with the Ketoconazole containing shampoo.

Step 4:

Oral medications containing antifungals, e.g. Nizoral tablets or Sporonox tablets.
Most often, step 1, the ketoconazole containing shampoo, is all that is required

Treatment of psoriasis

Psoriasis-on-backThe treatment of psoriasis depends on the severity of the psoriasis. Think of the treatment of psoriasis as a flight of stairs. Each step represents a treatment of greater potency, but with more potential side effects. The treatment of psoriasis always starts at the bottom step, i.e. the least potent treatment with the least potential side effects. If the treatment at this level does not work, the treatment can progress to the next level. This stepwise approach allows for control of the psoriasis with the least potent and safest medication possible.

The treatment levels for psoriasis are as follows:

LEVEL 1:

  • Moisturisers containing Urea or Salicylic Acid.  Moisturisers help to remove the white scaling of psoriasis lesions.
  • Sun exposure. Sun exposure should not be overdone, because a sun burn can also worsen psoriasis. The time spent in the sun should be just enough to feel you have been in the sun the day before.
  • Rest and relaxation

LEVEL 2:

  • Diluted corticosteroid creams.  Corticosteroid creams suppress the redness and inflammation of psoriasis lesions.

LEVEL 3:

  • Undiluted corticosteroid creams, corticosteroid ointments, corticosteroid lotions and corticosteroid shampoos. The most reliably effective ointment is Dovobet™ ointment. Dovobet™ is actually a combination of a topical corticosteroid and a Vitamin D derived ingredient.

LEVEL 4:Alternate Text

  • Vitamin D derived creams like Calcipotriol (Dovonex™)
  • Vitamin A derived creams like Tazarotene (Zorac™)
  • Anthralin or Dithranol containing ointments Level one to four treatments are often used in combination and additively. So, if you progress to a level 4 treatment it is very likely that you will be using all the treatments from level one to four.

LEVEL 5:

  • Ultraviolet light therapy. Narrow band Ultraviolet B treatment is the most effective of the ultraviolet treatment options. Ultraviolet treatments can be combined with level 1-4 treatments, but corticosteroid medications should be gradually stopped during Ultraviolet treatment.

LEVEL 6:

  • Methotrexate tablets
  • Acitretin containing tablets, like Neotigason™. Acitretin is derived from Vitamin A and is especially useful in Pustular Psoriasis

LEVEL 7:

  • Cyclosporin tablets (Sandimmun Neoral™)

LEVEL 8:

  • Various injections. These medications are also known as the Biologic Response Modifiers