EXTRACT VIRGIN OLIVE OIL (EVOO) AS A NATURAL REMEDY IN REMOVING

CRADLE CAP IN INFANTS

Kholilah Lubis, Faculty of Midwifery, Prima Nusantara Bukittinggi Health Institute, West
Sumatera, 26122, Indonesia
Nofri Wardianti, Siulak Mukai Public Medical Centre, Kerinci Regency, Jambi, 37169,
Indonesia
Abstract
Cradle cap (Infantile Seborrhoeic Dermatitis) is a form of dermatitis that manifested as patches
of scale severity on the scalp of infants and causes stress to the parents. Some investigations can
be correlated with the dominant fungus like Malassezia. Extract Virgin Olive Oil (EVOO), a
natural product comes from the fruits of Olea europaea trees. EVOO is safe for consumption, it
has an anti-inflammatory effect, antioxidant effect, wound healing, skin aging, and reduces the
incidence of skin cancer. Effect of EVOO to removing cradle cap in infants unknown. The
control group was not administration (n=5) and the intervention group was given four drops of
EVOO (n=5). This study was conducted in the Siulak Mukai Public Medical Centre area, Kerinci
Regency, Jambi. Infants aged 1-4 months, cradle cap/ ISD confirmed in the head with a low
degree (less than 10%) from the frontal area and parietal areas of the infant’s head. EVOO used
is “Casa di Oliva”. Before giving the treatment, the first infant’s head is cleaned of plaque with a
tight comb. No difference in characteristics (p = 0.879). There were significant difference
between the control group and the intervention group in the duration of recovered the cradle cap
(p = 0.000). Further analysis demonstrated a favorable effect of the intervention group with
duration time to recovered 10.20 days than the control group is 27.60 days. EVOO is
recommended to removing cradle cap in infant and also nourish hair with making the infant's
scalp moist by preventing oxidative damage.

Keyword : EVOO, Cradle cap, Infants

1. Introduction
Cradle cap (Infantile Seborrhoeic Dermatitis) is a form of dermatitis that manifested as
patches of scale severity on the scalp of infants. The scalp scale can be white or yellow [1]. In
Indonesia, cradle cap is called “Kerak Topi” because the plaque is hard, thickness and tightly
scale accompanied by red inflammation resembling as a hat. Generally, the rash occurs in babies
aged 2 weeks to 6 months and does not cause itching in the baby but causes stress to the parents
and usually resolves on its own at 8 months of age [2][3].
The prevalence rate of cradle cap is 3.5% with a worldwide distribution, and occurs in various
ethnicities and races. Cradle cap affects approximately 11.6-11.6% of the general population and
up to 70% of infants in the first three months. Cradle cap is more common in men than women
because there are differences in the sebaceous glands, hormones and the number of hair follicles.
Male hormones are androgens that cause hair to grow on the skin and contain more sweat glands.
Androgen hormones also stimulate the glands to produce oil so they tend to cause dry plaque [4]
[5][6].
Some investigations are still controversial but can be correlated with the dominant fungus
like Malassezia [7]. Malassezia (p.ovale) is group of fungus which is a normal flora in our head.
In certain circumstances such as temperature, humidity, high oil content and decreased levels of
immune factors can trigger the growth of this fungus [5]. Malassezia density in the head is an
important role in the severity of cradle cap. Other factors such as environmental humidity,
weather changes or trauma can also cause the cradle cap [6][8]. Other studies show that
deficiency of essential fatty acid in the scalp area is causing cradle cap. Then commonly this
effect produces plaque. This plaque is called as dandruff [1].
Alternative therapies have also been used such as coconut oil, aloe vera, mud, tea tree,
quassia amara, and the others. The efficacy, side effects, usage and age of the patient need to be
considered before deciding which type of treatment to use. Several nutritional mediators such as
essential fatty acids, vitamins A, E and D, vitamins B1, B2, B6, niacin and biotin, vitamin C
selenium, zinc, and iron can play a role in cradle cap treatment [9].
The National Center for Complementary and Integrative Health defines complementary
medicine as a nonmainstream practice used in conjunction with conventional medicine. In
contrast, alternative medicine is used in place of conventional medicine. Natural products are
commonly pursued, because consumers perceive them to be wholesome and devoid of irritating
or toxic chemicals, but “natural products” are not well defined [10].
Extract Virgin Olive Oil (EVOO), a natural product comes from the fruits of Olea
europaea trees. It consists mainly of oleic acid, with smaller quantities of other fatty acids such
as linoleic acid and palmitic acid. More than 200 different chemical compounds have been
detected in EVOO, including sterols, carotenoids, triterpenic alcohols, and phenolic compounds.
Hydrophilic phenols are the most abundant antioxidants of EVOO. The phenolic contents have
antioxidant properties higher than those of vitamin E and vitamin K. In fact, these phenolic
compounds and their antioxidant activity exhibit anti-inflammatory properties when EVOO is
included in regular diet [11][12]. Unsurprisingly, EVOO has been used as a skin product and hair
cosmetic for a long time in several cultures. EVOO is safe for consumption, it has an anti-
inflammatory effect, antioxidant effect, wound healing, skin aging, and reduces the incidence of
skin cancer. With all the benefits of EVOO, We hoped that it can be removing cradle cap in
infants [13][14].

2. Methods
This study was a quasy experiment with the control group and the intervention group. The
control group was not administration (n=5) and the intervention group given EVOO (n=5). This
study was conducted in the Siulak Mukai Public Medical Centre area, Kerinci Regency, Jambi.
Inclusion criteria : Infants aged 1-4 months, cradle cap/ ISD confirmed in the head with a low
degree (less than 10%) from the frontal area and parietal areas of infant’s head. Exclusion criteria
: infants with the highest degree of cradle cap accompanied Dermatitis Atopic (DC). Infant’s
already undergoing treatment with EVOO but on the next day the infant not given treatment is
excluded as a sample.
EVOO used is “Casa di Oliva”. This brand is used because it’s available anywhere and safe for
consumption by infants in complementary feeding. Before giving the treatment, the first, infant’s
head is cleaned of plaque with a tight comb. Then four drops of EVOO are applied in the scalp of
infants. This treatment was carried out two times after the infants bathed in the morning and
afternoon. Monitoring is carried out with daily home visits until the infants have removed from
the cradle cap.
Summary statistics were expressed as means (mean of duration time to recovered) ±
Standard Deviation (SD) and 95% Confidence Intervals (CI) for comparing the two groups
(between the intervention group and the control group). Analyses were carried out using the
SPSS version 16.0 statistical package.
 3. Result and Discussion
Both groups were comparable regarding age and Infant’s sex (Table 1). No difference was found
between the control group and the intervention group (mean age was 2.30 vs. 2.20, p-value =
0.879). In the control groups, two infants were female and three infants were male but in the
intervention group all infants were male.

Table. 1 Characteristics of the study population

Characteristics Control group n = 5 Intervention group n= 5 P value
Age (Month), (SD) 2.30 (0.97) 2.20 (1.04) 0.879
Sex
Female 2 0
Male 3 5
In this study, cases of cradle cap occur in 80% of male infants and 20% of female infants.
It’s clear that male infants are more prevalent than female infants. This is related to the
production of more androgen hormones in male infants which tend to cause plaque on the scalp
in infants.

Based on table 2, there were significant difference between the control group and the
intervention group in the duration of recovered the cradle cap (p-value = 0.000). Further analysis
demonstrated a favorable effect of the intervention group with a duration time to recovered 10.20
days than the control group with a duration time to recovered 27.60 days.

Table 2. Effect of EVOO to removing the cradle cap in infants

Groups N Mean ± SD Min-Max p-value
Control 5 27.60 ± 1.82 25-30 0.000*
Intervention 5 10.20 ± 0.84 9-11
 Control group (Day 1) Control Group (Day 30)

Intervention group (Day 1) Intervention group (Day 11)

Figure 1. Difference scalp with cradle cap between the control group and the intervention group

The clinical assessment of scaling and redness was carried out using a five point scale
from 0 until 3 (0, 0.5, 1, 2, 3) as explained below scale 0 (none), there’s no plaque, debris and
redness in the target area. Scale 0,5 (very low) target area shows only a few soft plaque and little
redness. Scale 1 (mild) the target area shows single spots or full of soft plaque, clear plaque and
little redness. Scale 2 (moderate), target area shows single large spots or plaque filled, some
debris may be loose, the redness should be cleaned. Scale 3 (severe) target area shows the
plaque was thick, with no splinters and intensive redness [3].
Based on figure 1, In this study, the sample was scale 1 (mild) and duration time to
recovered for the control group at most 30 days, while in the intervention group only 11 days.
This’s because EVOO contains so many substances that it can speed up the healing process.
 Being an oil, EVOO acts as a natural moisturizer for both the scalp and hair. Vitamin E
and vitamin K found in EVOO have superb moisturizing properties that keep the scalp and hair
moisturized preventing an itchy, flaky scalp and encouraging stronger hair fibers. Its have also
been shown to reduce the loss of moisture from the hair, slowing down both absorption and
diffusion of water enabling the hair to retain its natural moisture. Applying EVOO to the scalp
helps moisturize dry areas where skin may be flaking off and can be absorbed into larger thick
scaly patches that cause cradle cap. Once these patches are hydrated enough they become
loosened and released in larger pieces instead of the usual smaller flakes. This puts an end to
dandruff and the scalp can heal over [15].
Using EVOO regularly can help boost the health of the scalp and hair by preventing
oxidative damage. Abundant in antioxidants, EVOO stops bacteria and microbes dead in tracks
like as Malassezia which live naturally on the scalp, EVOO stops the growth of this fungus and
reduces future flaky scalp [7]. Biologically active antioxidants called polyphenols can attack
more serious diseases like psoriasis or eczema which may be an underlying cause of an itchy
scalp or cradle cap. Microbial and antiviral properties can slow down the symptoms of many
serious diseases [16].
Vitamins A, E and K in EVOO, give nutrition to the scalp helping it to heal flaky scalp
like as cradle cap and restore the hair follicles. Polyphenols, water-soluble substances, in EVOO
naturally cleanse the scalp, removing dirt, dust and accumulated dead skin cells from the scalp
keeping it healthy. A clean scalp can be crucial in the fight against the cradle cap. Combined
with the antibacterial and antifungal properties, many common scalp issues like cradle cap, head
lice or seborrheic dermatitis can be avoided [13].
Massaging EVOO into the scalp will improve blood circulation in addition to cleansing
the scalp to enhance hair growth. Polyphenols also help with dry or frizzy hair, making it
smoother without a buildup of greasiness that often accompanies many shampoos specially
formulated for dry hair. Inflammation of the scalp is often symptomatic of dandruff or a dry,
itchy scalp. Other conditions like psoriasis, eczema or dermatitis often cause chronic
inflammation. Massaging EVOO into the scalp will both soothe and moisturize while fighting
any inflammatory compounds. Oleocanthal, an antioxidant unique to EVOO, has been shown to
work much like the well known anti-inflammatory drug, ibuprofen [13][15].
 4. Conclusion
Extract Virgin Olive Oil (EVOO) demonstrated a favorable effect and recommended to
removing the cradle cap in infant and also nourishes hair with making the infant's scalp moist by
preventing oxidative damage.

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