Cradle Cap (Seborrheic Dermatitis)
Why does my child have cradle cap?
Cradle cap is very common in babies. It tends to run in families and is very similar to the rash that causes dandruff (seborrheic dermatitis). It is worse in the winter. It rarely hurts or bothers the baby, but the visible yellowish flakes of dandruff (dead skin) are concerning to most parents.
The same redness or scaly spots on the scalp can also happen behind the ears, inside the ears, in the eyebrows, and on the sides of the nostrils.
How do I fix cradle cap?
The best treatments for cradle cap are medicated dandruff shampoos, but all of them burn if they get in the eyes. So, I usually start gently with babies using mineral oil or baby oil.
For mild cradle cap:
Every day, massage mineral oil or baby oil into your baby’s scalp and leave for 10 minutes.
Rinse your baby’s scalp and wash with gentle, tear-free baby shampoo. (I prefer Cetaphil or CeraVe, but Johnson & Johnson is popular.)
For severe cradle cap:
Every day, massage mineral oil or baby oil into your baby’s scalp and leave for 10 minutes.
Rinse the scalp and massage a medicated dandruff shampoo into your baby’s scalp.
If your’s baby has red or scaly spots in or behind the ears, in or between the eyebrows, or around the nostrils, massage the dandruff shampoo in these places too.
NOTE: ALL dandruff shampoos burn the eyes. To avoid burning, put the shampoo on the eyebrows like a lotion 10 minutes before your baby’s bath, then rinse off in the bath.
LEAVE ON FOR 5-10 MINUTES (LONGER IS BETTER)! The active ingredient needs TIME to soak into your skin to be able to work.
Rinse out the dandruff shampoo. You can use a gentle, tear-free baby shampoo if you like at the end of the bath. (I prefer Cetaphil or CeraVe, but Johnson & Johnson is popular.)
For red or itchy spots, you can use an over-the-counter hydrocortisone ointment.
Which medicated dandruff shampoo works best?
There are several options, and each active ingredient is different. Just because one dandruff shampoo didn’t work doesn’t mean that others will not work. So if one shampoo isn’t working, switch to a different active ingredient. Also, remember higher price ≠ better results. I often use the store-brand version of Head and Shoulders myself.
Shampoos with Active Ingredients:
Zinc pyrithione:
Head and Shoulders (1%)
Free & Clear (2%, for sensitive skin)
Amazon brand (1%)
Selenium sulfide: Selsun Blue
Salicylic acid: T/Sal
Coal Tar (0.5% or 1%): T/Gel
NOTE: Coal tar stinks, so it is less popular, but it is a great active ingredient. Also, if you use a conditioner at the end of the shower, your hair won’t smell like tar.
Ketoconazole: Nizoral
How long do I have to use dandruff shampoo?
Cradle cap is a chronic issue. It will often require long-term use (as least occasionally) of a medicated dandruff shampoo. Most babies grow out of cradle cap.
Should I buy an expensive dry scalp shampoo?
NO! Don’t waste your time or money on an expensive “dry scalp” shampoo. Check the label on the back. It needs to have an Active Ingredient listed at the top. Expensive tea tree oil shampoos may help, but they haven’t been tested to actually show that they help. Save your money.
What if my dandruff isn’t getting better?
Usually, the steps above help most people clear their dandruff. Sometimes people have a contact allergy or psoriasis or another condition that makes their scalp itch. If over-the-counter shampoos are not working, there are stronger prescription topical steroids that can be used to get your dandruff/itchy scalp under control. 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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