Cradle Cap (Seborrheic Dermatitis)
Why does my child have cradle cap?
Cradle cap is very common in babies and often runs in families. It’s closely related to dandruff (seborrheic dermatitis) and tends to be worse in the winter. While it rarely hurts or bothers the baby, the yellowish flakes of dead skin (dandruff) on the scalp can worry or bother parents.
Cradle cap doesn’t just affect the scalp. Similar redness and flaky patches can appear behind the ears, inside the ears, in the eyebrows, on the sides of the nostrils
How do I fix cradle cap?
The most effective treatments for cradle cap are medicated dandruff shampoos, but these can sting if they get in the eyes. That’s why I usually recommend starting gently with mineral oil or baby oil for babies.
For mild cradle cap:
Massage mineral oil or baby oil into your baby’s scalp and leave it on for 10-15 minutes.
Rinse the scalp and wash with a gentle, tear-free baby shampoo (I prefer CeraVe, but Johnson & Johnson is also common).
For severe cradle cap:
Every day, massage mineral oil or baby oil into your baby’s scalp and leave it on for 10-15 minutes.
Rinse the scalp and massage a medicated dandruff shampoo into the affected areas (see below).
If redness or scaling is present behind the ears, in or between the eyebrows, or around the nostrils, apply the dandruff shampoo there as well.
Important tips:
ALL dandruff shampoos burn if they get in the eyes. To avoid this, apply the shampoo like a lotion to the eyebrows (or other areas) 10 minutes before the bath, then rinse off during the bath.
Leave the dandruff shampoo on for 5–10 minutes (longer is better) so the active ingredient has time to work.
After rinsing, you may follow with a gentle, tear-free baby shampoo if you’d like (again, I prefer CeraVe).
For red or itchy spots:
Apply an over-the-counter hydrocortisone ointment in a thin layer to scalp.
Which medicated dandruff shampoo works best?
Different shampoos work in different ways because they have different active ingredients, so if one doesn’t help, try another.
Remember: More expensive doesn’t mean better results.
For a long time, I used store-brand Head & Shoulders. Recently, I tried CeraVe’s new dandruff shampoo—and it is amazing.
Shampoos with Active Ingredients:
Zinc pyrithione:
CeraVe shampoo (1%) and conditioner (0.5%)
Head and Shoulders (1%)
Vanicream (2%, good for sensitive skin)
Amazon brand (1%)
Selenium sulfide: Selsun Blue
Salicylic acid: T/Sal
Coal Tar (0.5%): DHS or Amazon brand
NOTE: Coal tar shampoos often have a strong smell, but they work well for cradle cap. To get rid of the odor, use a conditioner after shampooing.
Ketoconazole: Nizoral
How long do I have to use dandruff shampoo for cradle cap?
Cradle cap is a chronic condition. It often requires long-term use of medicated dandruff shampoos, at least occasionally, to keep it under control. The good news is that most babies eventually grow out of cradle cap.
Should I buy an expensive dry scalp shampoo?
No! Don’t waste your time or money on pricey “dry scalp” shampoos. Always check the back label — it needs to list an Active Ingredient at the top to actually work. Expensive tea tree oil shampoos may help some people, but there’s no solid data to support them. Save your money and stick with proven medicated dandruff shampoos.
What if the cradle cap isn’t getting better?
Usually, the steps above clear cradle cap. Sometimes, though, another condition such as contact allergy or eczema may be causing the scalp rash. If over-the-counter shampoos aren’t working, stronger prescription topical steroids or antifungals may be needed. Look for a board-certified dermatologist in your area. If you are in or near Utah, see one of my excellent colleagues at the University of Utah or me virtually with Honeydew.
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