What should you know about dark cradle cap?

Cradle cap often creates greasy or dry scale on the scalp. On deeper skin tones, the surrounding skin may look brown, purple, or darker rather than obviously red. Mild flaking can occur without discomfort, but scratching, cracking, or an inflamed edge suggests irritation or another condition. It is not caused by poor hygiene, and the color does not by itself show how severe the problem is. A clinician can check whether the scalp pattern fits cradle cap.

Wash the scalp with a mild baby cleanser, then loosen softened scale gently with a soft brush or cloth. Do not pick, scrape, or pull attached flakes, because broken skin can become sore or infected. A clinician may recommend emollient therapy to soften thick scale. If the scalp is inflamed or the rash extends beyond it, medical advice may be needed about a topical antifungal treatment or another medicine. Keep products away from the eyes and stop anything that causes irritation.

Contact a clinician if the scalp is painful, wet, bleeding, swollen, strongly odorous, or producing pus, or if the baby seems unwell. Arrange an assessment when the rash spreads widely, causes marked itching, involves the face or body, or does not improve with gentle care. Urgent help is needed for fever with a rapidly worsening skin infection or a baby who is unusually difficult to wake or feed.

Does the scale and color fit cradle cap, or could this be eczema or infection? How should we soften the flakes? Is an emollient or topical antifungal treatment suitable, and which warning signs mean we should return?