Cradle cap

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Cradle cap in babies is the first manifestation of the onset of neurodermatitis (atopic eczema) - a chronic inflammatory skin disease. The term refers to the flaky, yellow-brownish crusts on the scalp, forehead and cheeks of the person affected. This is associated with an itchy rash that can spread to other parts of the baby's body. Read everything you need to know about cradle cap here!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. L21L20

Cradle cap: description

The term cradle cap describes yellow-brownish crusted skin on the head and face of many babies. The appearance of the crusts is reminiscent of burnt milk - hence the name "cradle cap". Other than that, the inflammatory lesions on the skin have nothing to do with milk.

Cradle cap is the first manifestation of the onset of neurodermatitis (atopic eczema). It usually occurs in babies between three and six months of age. In individual cases the rash can develop earlier; In most cases, however, it is not a cradle cap, but seborrheic eczema (head gneiss) or another skin disease. If the cause of the eczema in the infant is not entirely clear, it is called eczema infantum.

Cradle cap as a symptom of eczema

More than half of children with eczema had cradle cap as their first symptom when they were babies. Sometimes, however, the first signs of atopic dermatitis do not develop until school age. Around 10 to 15 percent of preschool children are at least temporarily affected by atopic eczema. This makes neurodermatitis one of the most common skin diseases in children. The number of children with cradle cap and neurodermatitis has increased significantly in the past few decades. For many, the disease heals over the course of school, while for some it persists into adulthood. Depending on the climate, up to 25 percent of people in sunny northern Europe are affected by neurodermatitis, while only around 1 percent suffer from it on the coasts of southern Europe.

The frequent connection between neurodermatitis, hay fever (allergic rhinitis) and allergic asthma is striking. These three diseases are also summarized under the term atopic form circle. Not infrequently, cradle cap appears in babies as the first harbinger from which other allergic diseases later develop. The atopic diseases can also occur individually.

Cradle cap: symptoms

Babies with cradle cap often develop typical symptoms: First, a reddish skin rash (exanthema) forms on the child's head, which can be accompanied by nodules and small blisters on the skin. Mostly the hairy scalp, forehead and cheeks are affected. Here small, dry flakes initially peel off. Cradle cap is the yellowish to brown crust that forms on the rash. In many infants, eczema spreads to the arms, legs, and upper body. In most cases, the diaper area is not affected.

Like neurodermatitis itself, cradle cap also causes severe itching. In very young babies, this initially manifests itself in frequent crying and very restless nights. Once the baby begins to scratch, the development of cradle cap increases. Scratching the skin creates entry portals for bacteria, which not infrequently leads to larger foci of inflammation.

Cradle cap: causes and risk factors

The causes of cradle cap (and neurodermatitis) have not yet been conclusively clarified; However, there are indications of a genetic predisposition as well as external risk factors. Doctors assume that several factors are jointly responsible for the development of the disease (multifactorial genesis).

The hereditary predisposition to neurodermatitis and cradle cap is passed on to the offspring via several different genes. If both parents suffer from neurodermatitis, the child has a 60 to 80 percent chance of developing it.However, not every child with this predisposition develops cradle cap and eczema.

Rashes, itching and cradle cap crusts in atopic dermatitis patients are caused by various complex processes in the skin. Usually there is a combination of three factors:

• Barrier Disorders: Babies with cradle cap are predisposed to dry skin. More moisture is lost through the upper layer of the skin (epidermis) than in healthy babies; the skin is more permeable and can store less water. On the one hand dry skin leads to itching, on the other hand it is more susceptible to harmful influences and allergens.
• Immunological causes: Many people with neurodermatitis have increased levels of immunoglobulin E (IgE) in their blood. This class of antibodies plays a major role in the development of allergies. Babies with cradle cap, for example, are often allergic to hen's eggs or cow's milk. The defense reactions take place on the skin and lead to inflammatory processes.
• Neurovegetative causes: The nervous system of those affected reacts more sensitively to various external stimuli such as cold and dry climates, skin irritations (e.g. from woolen fabrics), but also psychological factors such as stress, grief or fear. These factors aggravate atopic dermatitis in many patients.

Cradle cap: examinations and diagnosis

The most important clue for diagnosing cradle cap and neurodermatitis provides the doctor with the baby's skin:

• red nodules and blisters
• yellowish cradle cap crusts
• fine flaking of the skin
• characteristic places where the eczema occurs (especially the face, scalp, arms and legs)

In addition, the doctor pays attention to so-called stigmata - characteristics that occur quite often (if not always) in cradle cap or neurodermatitis and other atopic diseases. This includes, for example, stronger lines on the palms and soles of the feet, a double lower eyelid fold (Dennie Morgan sign) and torn ear lobes. In some people with neurodermatitis, the eyebrows become very thin towards the sides (Hertoghe sign) or the lips are more furrowed and quickly dry and crack. Eczema on the fingertips and toes is also quite common in children and is sometimes mistaken for fungal infections.

The medical history of the patient and the family - the (family) anamnesis - also helps the doctor to assess whether there is a cradle cap behind eczema in the baby. In the anamnesis interview, the doctor asks, for example, whether the infant's parents or siblings suffer from neurodermatitis or another atopic disease. Pre-existing illnesses and complications in the baby's first months of life can also provide valuable information for the diagnosis.

Further examinations are usually not necessary to diagnose cradle cap and neurodermatitis. In unclear cases, a histological examination of the skin can rule out other skin diseases. In many cases, blood tests show increased IgE levels.

Cradle cap: treatment

Whether you should remove cradle cap from the baby's scalp and how you can treat it, read the article Remove cradle cap?

Cradle cap: disease course and prognosis

Cradle cap rarely appears before the age of three months, but can last for several months and up to two years. Typically, the symptoms of neurodermatitis shift in the course of the disease: After the first year of life, the eczema occurs more frequently in the arms and knees, on the neck and in the groin area.

In some cases, a chronic form of neurodermatitis then develops. In many children, however, it heals within the first two years of life, so that the other symptoms subside along with the cradle cap.

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