Causes and Treatment of Diaper Rash

"Over half of all babies suffer from a diaper rash once every two months. It is caused by prolonged wetness and non exposure to air on a babies bottom. Common causes range from diarrhea, infrequent diaper change, skin rubbing and chaffing, allergic reaction to diaper or diaper rash ointment and even sweat. Symptoms of diaper dermatitis is a red rash that can either be mild to severe. Treatment involves frequent changing of the diaper and treatment of the skin with over the counter or in chronic cases a prescription ointment.  If a rash does not improve in 2 to 3 days using no treatment or over the counter ointments, or if it is accompanied by symptoms such as lethargy, fever, or puss filled pimples, see a Doctor for a prescription ointment or cream."  

Overview

Another name for this condition is dermatitis and nappy dermatitis. It is a form of inflamed skin that develops in the region covered by diapers. It’s a commonly reported symptom in infants. But it can also occur in elderly individuals who suffer from urinary incontinence or are paralyzed. The rash likely develops due to a combination of factors, including, urine, feces, friction, moisture and microorganisms.

Symptoms and Diagnosis

This problem is commonly seen in the area covered by diapers. However, it can also be present on the thighs and on the abdomen. Depending on the infants’ sensitivity, the rash can range from slight skin reddening to open, blistering sores. The problem may be seen covering the entire diaper area or only in certain areas.

With the most common form of diaper dermatitis, contact or irritant, skin folds are rarely involved. Skin infections, the second most common form, the skin folds are involved.  The affected area may be puffy and tender.

The problem may be due to bacterial (strep and staph), skin infections, which can cause multiple elevated lesions like vesicles (blisters) and pustules (pus-filled). Skin conditions due to yeast or fungal (Candida) skin infection causes bright red skin lesions with multiple small surrounding lesions called the satellite lesions. 

Care givers might notice changes in the baby’s disposition. Infants may cry or fuss during diaper changes or if the affected area is touched.  This problem is commonly seen in babies less than 15 months of age.

Causes

There are several causes and specific types of diaper dermatitis:

  • Irritant dermatitis is the most common cause of this problem.  Rashes occur due the skins prolonged contact with wet diapers (urine and, or stool). In this type of rash, the skin folds are not involved. Causation can also be due to ill-fitting diapers which rub the skin.

    bad diaper rash
    Irritant dermatitis type of Baby Diaper Rash Picture
  • Skin infection is the second most common cause of this type of rash. Both bacterial and fungal infections can be the primary cause of the problem.   Bacterial infections that are commonly associated with diaper rash are streptococcal and staphylococcal infections. Candida infection is the most common fungal infection that is associated with this baby skin condition.
  • A rash due to infection occurs when the skin layer under the diaper is not intact and is disrupted. Skin folds are often involved with infections and rashes due to Candida.  The infection can be mainly seen in the skin folds and around the anus.

    diaper rash
    Picture Diaper Rash Candida
  • Allergy is not a common cause of this rash. The components of diapers or wipes may sensitize the skin causing rashes. Fragrances, laundry detergents and changes in diet can also be causes. Dietary changes include the introduction of table food, using formula when the child has been breast-fed.
  • Baby heat rash can effect the groin and other areas.  This occurs in hot and humid environments when an infants immature or obstructed sweat glands cannot keep up with the cooling needs of the body.  If caught early the condition resolves itself on its own after the baby is kept out of the heat.  Loose fitting cotton clothes, corn start powder or just wearing a diaper can also help.
  • Less common causes include seborrhoeic dermatitis( overproduction of sebum, a secretion of the sebaceous glands, made up of fat, keratin and cellular material), congenital syphilis(syphilis acquired in utero), acrodermatitis enteropathica which occurs due to zinc deficiency and immunological disorders like histiocytosis( abnormal multiplication of white blood cells, which are found in the bloodstream and connective tissue) and Wiskott Aldrich syndrome( a rare genetic disorder).

 Medical Treatments

Treatment depends on the underlying cause. The most common cause  is prolonged wetness. Since this type of rash occurs due to prolonged contact of wet nappies with the skin, barrier cream can be applied to the skin which will prevent this contact. The barrier creams or ointments that can be applied are Zinc oxide cream (e.g; Desitin, petroleum jelly, A&D ointment and Burows solution.

Other treatment options include::

  • If the diaper rash is due to bacterial skin infections, then a course of antibiotics should be given.
  • If the diaper rash is due to Candida infection then anti fungal cream should be used
  • If the diaper rash is due to allergy, then hydrocortisone cream should be used
  • If it is due to acrodermatitis enteropathica, then zinc supplements should be given.
  • If it is due to congenital syphilis, then a course of penicillin should be given.

Natural Treatments

A rash usually goes away within 2 to 3 days with home care. Natural treatments or home remedies for diaper rash include:

  • Removing the wet diaper and allowing the affected skin to dry. It is the wetness that initiates the development of rashes.
  • Homeopathic remedies such as Diaper Distress Cream are formulated with 100% natural herbs and other ingredients (tea tree oil, marigold, lavender oil, comfrey)  to soothe and heal the skin.
  • Promptly change soiled nappies.
  • Increase airflow to area.
  • Naked time, you can use a chuck underneath.
  • Gently clean area with water and pat dry with soft cloth. Soap should only be used if stool doesn’t come off easily. Try a squirt bottle with luke warm water and rinse without rubbing.
  • Avoiding rubbing of the diaper area.
  • Diaper liners and breathable diapers allow the skin to remain dry and prevent the development of diaper rash.
  • Avoiding tight fitting or plastic nappies
  • Certain types of food can cause diaper rash and these should be avoided.
  • If the rash is due to allergy, using new soaps should be avoided.

References:

1. Kids Health

2.MedicineNet

3. eMedicine

4. eHow

5. Mayo Clinic

 




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