"Over half of all babies suffer from a diaper rash (diaper dermatitis) once every two months. It can cause stress and pain for the infant. Diaper dermatitis is caused by prolonged wetness and a lack of exposure to air on a babies bottom. Between 7% and 35% of all babies suffer from the condition 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 (5 stages). 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."
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Another name for diaper rash is dermatitis and nappy dermatitis. It is a form of inflamed skin that develops in the region covered by diapers. It is 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.
Diaper rash occurs more often in babies who are:
- 8 to 10 months of age
- If babies are not dry and clean
- During bouts of diarrhea
- When starting solid food
- When taking antibiotics
Infant skin is less developed than adult skin, particularly in premature babies. Without full barrier protection, the skin is subject to dehydration and electrolyte imbalances. The full barrier forms between age 30 and 32 weeks. Without the full barrier, an infant is more susceptible to microbes and irritants. The outer skin barrier, stratum corneus breaks down when exposed to outside elements, causing the inflammation known as diaper rash.
There are several causes and specific types of diaper dermatitis:
Irritant dermatitis is the most common cause of this
problem. Rashes occur due to the skins prolonged contact with
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. Primarily found in the upper leg crease, upper thighs, pubic area, anal area, and buttocks.
- Chaffing dermatitis (also called frictional dermatitis) refers to friction on the skin. t affects areas such as the genitals, abdomen, buttocks and thighs.
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- Diaper candidiasis (yeast diaper rash): A rash due to a yeast (Candida albicans) infection occurs when the skin layer under the diaper is not intact and is disrupted. Skin folds or creases are often involved with infections and rashes due to Candida. The infection can be mainly seen in the skin folds and around the anus. It causes symptoms such as a raised-edge skin rash with multiple skin lesions. The condition thrush may be present at the same time (oral candidiasis) requiring an oral medication.
You may also see little satellite lesions just near the edge of the rash area. Some rashes are resistant to anti-fungal creams so you may need to get two different products such as the type used for athlete's foot. You can alternate the two creams.
Allergic Contact Dermatitis (Allergy)
Allergy is not a common cause of this rash. The components of diapers or wipes may sensitize the skin causing rashes such as elastic, preservatives and dyes. 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 breastfed.
Allergy is treated by identifying and removing the underlying cause.
Baby Heat Rash
Baby heat rash can affect the groin and other areas. This occurs in hot and humid environments when 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.
Bacterial Infection (Staph and Strep Diaper Rash)
Bacterial (Streptococcal and staphylococcal) and fungal infections (see candida above) can be the primary cause of the problem (referred to as Staph Diaper Rash and Strep Diaper Rash).
If a bacterial infection is suspected the Doctor will sample a culture. The physician determine the patient's sensitivity to antibiotics and then pursue antibiotics along with any topical treatment.
HSV (herpes simplex virus) look like skin crusts or blisters and can occur in the diaper area. This is a serious infection that needs to be immediately treated. This is particularly dangerous for infants under age 4 weeks.
Intertrigo is a bright red rash located in skin creases or folds. It is the result of sweat retention, moisture, and heat, particularly when it is warm outside. No treatment is needed. The rash will heal when exposed to the air.
Psoriasis also creases a clearly demarcated bright red rash. The condition does not have scaling and is commonly seen in the skin folds. It can be found in other parts of the body such as the scalp. It is frequently seen in families where others have the condition. Psoriasis is treated with prescription corticosteroid creams.
Scabies is a condition caused by a small mite which burrows under human skin. It can occur in any location on the body, particularly between the toes, fingers, wrists, face, palms, soles and ankles. Creams are used to treat the condition. Patient age will dictate the type of product used (if older than 2 months then permethrin, an insecticide is used).
Seborrheic dermatitis occurs when an infant is between age 3 and 4 weeks. It has a well defined red rash along with salmon-colored lesions (called plaques) and some yellow skin scaling. The dermatitis is found in the diaper area, body creases, chest, cheeks and scalp.
- Nutritional deficiency can cause symptoms that mimic diaper dermatitis such as deficiency in Zinc. The condition Acrodermatitis enteropathica causes the zinc malabsorption problem.
- Congenital syphilis (syphilis acquired in utero)
- Langerhans cell histiocytosis causes papules and crusts to form in the diaper area. Lesions can be brown or reddish along with deep skin ulceration. It is an immunological disorder where there is an abnormal multiplication of white blood cells, which are found in the bloodstream and connective tissue.
- Wiskott Aldrich syndrome which is a rare genetic disorder).
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.
Caregivers 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.
Diaper dermatitis is diagnosed by rash appearance and by eliminating other possible reasons for the rash. The Doctor will ask about:
- cleaning habits
- Defecation and urination habits (frequency, consistency)
- products used on the skin
- medications (antibiotics etc.)
- rash duration
- symptoms such as itch and pain
- diaper type (disposable, cloth)
- skin injury
- diet (new foods, breastfeeding)
- recent medical conditions and history
Diaper Rash Treatment
Treatment depends on the underlying cause. Doctors encourage parents to follow the ABCDE approach when treating diaper rash:
- Air: expose skin area to air by removing the diaper. Without the diaper pressed against the skin, the skin is exposed to fewer irritants.
- Barrier: The use of a barrier diaper rash cream is used to protect the skin. Most products contain petrolatum or zinc oxide. Both are considered to be effective. Popular products include Desitin® (Zinc Oxide) and A&D ointment (petrolatum). There are no best diaper rash creams as all products with these core ingredients are equally effective. For more see our guide to barrier diaper rash creams and ointments. Creams are applied every time the diaper is changed.
- Cleansing: Keeping the diaper area clean using water and a light touch when washing the skin. Note that wipes or a washcloth and water can be used. Both are equally effective. To remove any feces, a mild cleaner is needed. Wipes made out of soft cloth that contain moisturizers can help to improve the function of the skin barrier such as Huggies Natural Wipes. Avoid wipes with alcohol or perfumes if they are causing skin irritation. Wipe the genitals from front to back (gently).
- Diaper: Switch to a superabsorbent diaper. Change diapers frequently (every 1 to 3 hours) and 1x at night. Wash your hands after every change.
- Education: Getting smart about the condition and how to treat it.
DO NOT use cornstarch or baby powder for diaper rash. Both can lead to candida and bacterial growth in the diaper area. It can also worsen the diaper dermatitis.
Other treatment options used by a Doctor 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 antifungal 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.
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 Soothing Diaper Cream that is formulated with 100% natural herbs and
other ingredients (tea
tree oil, marigold, lavender oil, comfrey) to soothe and heal
- Promptly change soiled nappies.
- Increase airflow to the area which reduces the yeast infection risk.
- 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 of 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
- Avoid wipes that have alcohol
by: American Academy of Pediatrics
by: Lisa Merrill
by: International Journal of Pharmaceutical Compounding