ANSWER:
Hello,

I am sure the Pediatrician is right, but there are several different types of eczema, even in infants. I mean that the Pediatrician has been maybe slightly vague. Also, it would be useful to know exactly how old your daughter is.

“Cradle cap eczema” in infants is medically called “seborrheic eczema, (or dermatitis),” and if this is the sort that the Pediatrician means, then a yeast infection of the scalp skin, with a yeast called “P. ovale” (pronounced Pee oh – VAHL” -ee) may be implicated.

Here is a “cradle cap eczema” clickable picture reference, http://www.eczema.com/wp-content/uploads/2010/01/CradleCap-196×300.jpg – is this like your baby has? Or this one, … http://www.thegaybump.com/wordpress/wp-content/uploads/2010/11/cradle-cap.jpg The scalp and forehead are involved more than the cheeks, – the opposite, usually, to Atopic eczema, – which many times starts on the cheeks between 2 and 3 months of age.

If I may I will quote on this from Thomas Habif’s huge book, “Clinical Dermatology 3rd edition,” page 214, on “cradle-cap eczema,” –

” Infants commonly develop a greasy, adherent scale on the vertex [top] of the scalp. Minor amounts of scale are easily removed by frequent shampooing with products containing sulfur and salicylic acid, (e.g. Sebulex shampoo).

” [Otherwise] scale may accumulate and become thick and adherent over much of the scalp, and may be accompanied by inflammation. Secondary infection can occur.

” Treatment. Patients with serum and crust are treated with oral anti-staphylocococcal antibiotics. Once infection is controlled, erythema and scaling can be suppressed with Group VI or VII topical steroid creams, or lotions. Dense, thick adherent scale is removed by applying warm mineral or olive oil to the scalp, and washing several hours later with detergents, such a Dawn dishwashing liquid. Remissions can possibly be prolonged with frequent use of salicylic acid or tar shampoos.”

I am not sure how much better informed this will leave you, as it is substantially in medical jargon. I will try to de-code it for you.

There are 4 elements to cradle cap,

(1) High production of natural skin-oils by the scalp, in excess of those levels strictly needed to keep the skin waterproof,

(2) A mild yeast infection, by a yeast which actually feeds on this excess natural skin oil, and breaks it down to produce energy (for itself) and irritant waste-products. The irritant waste-products cause the skin to react in an “eczematous” way. That is to say, by producing protective scales and by becoming sore. Cradle cap is not an allergic skin reaction, it is a irritant reaction to the yeast’s “poo.”

(3) The scales accumulate and tend to make the eczema worse. Removal of the scales is part of the treatment.

(4) If the skin becomes eroded in depth, then other germs can jump in and cause a bacterial skin infection, described as “secondary.”

It seems to me that your treatment so far has essentially been the copious application of moisturizing creams and lotions. Excellent, but you don’t seem to have addressed yet, the full range of treatment which includes –

(a ) using a mild acid-containing shampoo to dissolve the scales, and a mild sulfur shampoo to help kill off the yeast infection. In think Sebulex shampoo must be an American preparation, here is a clickable link about it, – http://www.drugs.com/cdi/sebulex-shampoo.html

(b) using a detergent shampoo to help remove the excess natural skin-oil, the yeast’s “food.” Habif recommends Dawn dishwashing liquid, I think this is also an American product. The essential action is purely detergent, – no medication is involved. If there is no excess of natural skin-oil, the yeast dies off for want of its “food.”

(c) it is possible to treat the inflammation, – the redness you describe, – with 1% hydrocortisone cream, and this may well be beneficial to the infant, and will be without ill-effect. Hydrocortisone is the weakest strength of steroid cream and is fine for babies’ skin. The ultra-cautious use the half-percent, instead of the 1% strength.

I suggest you float these ideas past your Pediatrician next time you see her or him. Although I believe the ideas to be helpful, (and harmless). Obviously keep the shampoos out of baby’s eyes, though.

Obviously if your Pediatrician means that your baby has “Atopic Eczema,” (see below), – then I will have to do this answer all over again,

I hope this is of some use,

Best wishes,

Belliger
retired uk gp