Don’t treat cradle cap

The Crowning Treatment for Cradle Cap

“Oh you have to get rid of that, it looks awful,” said a pharmacist to a mother as she wheeled her baby into the pharmacy. The baby had cradle cap.

Who had the problem? The mother hadn’t. The child hadn’t. So who had? The pharmacist, of course, and her problem wasn’t with the child’s health but what was and was not aesthetically pleasing to her!

I once suggested to a doctor who worked with children that it’s dangerous to treat cradle cap (seborrheic dermatitis). She returned a month later to inform me she had attended a dermatology conference in Galway and the lecturer had warned them not to treat cradle cap. Why was this the first time in her career she had heard this? If medicine is a science then why isn’t this the standard approach in medicine?

It’s not as if this is a revelation to medicine. Many years ago, myself and Dr Sebastiaan van Eynatten (Cork) presented a skin conference at the Society’s AGM. In doing research for it, I came across a photo (which now I can’t locate but was linked to John Hopkins’ University Medical School) of a baby with eczema subsequent to having cradle cap suppressed – according to the medical school’s own website.

If cradle cap is a minor, common and harmless skin eruption, why am I raising it? My concern about the external treatment of cradle cap – which is suppressive and therefore harmful – was triggered by a case history I read in Dr N.M. Chouhuri’s materia medica and subsequent cases of my own. Here’s one of Choudhuri’s Medorrhinum† cases:

Case 3 – A child of six, since infancy, was horribly disfigured with tinea capitis [cradle cap, milk crust, crusta lactea, seborrheic dermatitis, scald-head]. The scalp was a mass of dense crusts exuding a fetid ichor and the only semblance of hair were a few distorted stumps ending in withered roots. One dose cured in a few months, and at the time of writing, the patient was a healthy and extremely talented young lady, and the possessor of a luxuriant head of chestnut hair.

Her hair was now healthy because she had been restored to health. The case prior to this, a case of Dr Wildes, was similar but more extreme and perhaps not a typical cradle cap as it extended down the back to the genitalia. This case is informative and worth noting:

Case 2 – Girl of eleven had been treated by many physicians with salves and ointments to the general impairment of her health. Face mottled with a profusion of red scurfy sores; eyelids involved and nearly denuded of lashes; hairy scalp one diffuse mass of thick yellow scabs, from beneath which oozed a highly offensive mixture of ichor and sebum. Passing down neck, back, perineum and involving genitals and pubes was a fiery red band as broad as a child’s hand, oozing a pale yellow serum, which caused the clothing to stick to the body. Told the mother he could cure the case but it would certainly get worse the first three months. Medorrhinum cm. was given, one dose dry on the tongue. The external appearance grew rapidly worse, but appetite, sleep and general health steadily improved, and in nine months she was completely cured. – ­Dr Thomas Wildes

Suppressing any skin eruption can be harmful and cradle cap is no exception because, since it’s classified under the umbrella of eczema, it is broader and deeper than a scalp problem. After all, if the child is healthy, they wouldn’t produce an eruption at all. If the child was healthy, such infections wouldn’t find a home on the child’s scalp. And treating from the outside doesn’t remove the inner reason they produced the eruption in the first place. Only internal treatment can do so.

Often after cradle cap is treated, eczema will ensue or worse; recurring ear, nose and throat infections set in and finally, as the child is made more susceptible, asthma. “When did your child start getting all these sore throats and glands?,” you can ask a mother. “Last October,” she can reply. You dig a bit more and find the child had cradle cap until October when her mother couldn’t bear to look at it any longer, “So I combed it out with some olive oil” or “I washed it with shampoo from the pharmacy.”

Even that simple “brushing it out with olive oil” is enough to do harm. That brushing or picking the crusts off is suppressive, as much as using medicated shampoo is. Sometimes less is more.

Here’s another example, a famous case of deafness cured by Caroll Dunham, which shows the importance of past history in treating the present symptoms. The eruption, if not cradle cap had many similarities:

A Youth, 17, deaf since four, and incapacitated thereby, secludes himself and broods over his trouble. Membranes thickened.

At the age of three he had an eruption of thick, whitish scabs, hard, almost horny, covering the whole scalp. There were fissures through which exuded on pressure a thick, yellowish pus, often very offensive. Much itching and disposition to tear off the scabs with the finger-nails, < at night.

The treatment (allopathic) was vigorous: A tar cap was placed on the head, and when firmly adherent to the scabs was violently torn off, scabs and all, leaving the whole scalp raw. This was painted with a saturated solution of Arg. nit. The eruption did not reappear, but from that time the child was deaf.

The eruption was the very counterpart of an eruption observed in a proving by Wehle.

Mez. 30, three globules in a powder of sugar of milk, was given on each of these dates – February 3, March 1, and September 28, 1857, and January 26, 1858. Improvement set in slowly after the first dose, which was only repeated when the effect of each preceding dose seemed to be exhausted. Finally the hearing was for all practical purposes completely restored. (Carroll Dunham, Science of Therapeutics, p.462, free to view here)

Further Reading
A Study on Materia Medica by N.M. Choudhuri: Click here (or scroll down here to page 640 or click here)

Photo Credit: LepoRello (Wikipedia link)