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Diaper Rash
Getting to the bottom of things
Babies cry for many reasons: they're hungry, tired, feeling uncomfortable, or just want to be held. They may also cry when their bottoms are sore from diaper rash. Almost every parent with an infant has witnessed the red, irritated skin under the baby's diaper. This irritation, usually caused by prolonged contact with urine or feces, is generally easy to cure and fairly simple to prevent.
Synonyms
- Contact dermatitis
- Candidiasis, or monilial diaper rash (if yeast infection is present)
- Atopic dermatitis (if caused by an allergic reaction)
Detailed Description
Diaper rash is the generic name for any type of skin irritation or inflammation that develops in the diaper area. Severity ranges from mild cases in which the skin is bright red to severe cases with open sores. Diaper rash often begins around the anus and can spread to the genital area, the skin folds of the thighs and buttocks, and the abdomen. Mild cases often respond quickly to treatment -- generally in three to four days. More severe cases that involve bacterial or yeast infections take longer to heal and may require a visit to the doctor.
The skin may appear moist, red, spotty and is often itchy, sore, and sensitive to touch. The skin may also be cracked, oozing, or scaly looking. Sometimes you may see small, white, or yellowish pustules or pimples.
How Common Is Diaper Rash?
Diaper rash is very common in the United States. It is mostly seen in infants, and affects equal numbers of males and females. More than half of babies between the ages of 4 and 15 months develop diaper rash at least once every two months.
Established Causes
The most common cause of diaper rash is prolonged exposure to urine or feces. Chemicals that form in the wet or soiled diaper irritate babies' thin, delicate skin and make it vulnerable to infection. Plastic-coated or tight diapers keep moisture close to the skin, making the rash worse.
Some cases are caused by bacterial growth in the excessive ammonia on the wet diaper. The risk increases when diapers aren't changed frequently. Other causes include sensitivity or allergies to baby wipers, soap, detergents, fabric softeners, some lotions, powders, and even diapers.
Diaper rash caused by yeast infections is also quite common. Yeasts thrive in the warm moist environment of the diaper area. Any infant may develop a yeast diaper rash since yeast lives on everyone's skin. However, infants taking antibiotics are even more susceptible to yeast-caused diaper rashes because the antibiotics kill friendly bacteria, allowing the yeasts that are normally found on the skin to multiply rapidly.
Risk Factors
Risk factors for diaper rash include:
- Prolonged contact with a wet or "poopy" diaper
- Chafing or rubbing
- Washing cloth diapers in a detergent not designed for baby's skin
- Diarrhea
- Hot, humid weather
- Bottle-fed babies and babies who have started solid food
- Plastic diaper covers or pants
- Family history of skin allergies
- Recent treatment with oral antibiotics
- Diseases of the immune system (a rare cause of chronic or severe diaper rashes)
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
Signs indicating that your infant may have diaper rash:
- Patchy red rash on the buttocks and pubic skin that may have blisters, pustules, or sores
- Skin may look chapped, scaly, or scalded
- Tip of penis may be red and raw
- Sticky membrane may form between vaginal lips
Conditions That May Be Mistaken for Diaper Rash
Diaper rash shares many symptoms with other diseases. The following may be confused with diaper rash:
- Heat rash or prickly heat caused by blockage of the sweat glands. Prickly heat rashes are usually smaller than diaper rash and go away untreated.
- Other skin conditions such as seborrheic eczema and psoriasis. A baby with either of these conditions will likely have rashes elsewhere.
How Is Diaper Rash Diagnosed?
The location of diaper rash and its common incidence make it easy for parents to recognize. For persistent cases that do not respond to at-home treatment, your doctor may need to examine your baby to verify the presence of a yeast or bacterial infection or another cause.
Goals of Treatment
The goal of treatment is to keep the affected area as dry as possible to help the rash heal and prevent recurrence. Diaper rash usually responds quickly to treatment, generally within four days.
Treatment Overview
Diaper rash thrives in a moist, warm environment. The best remedy requires changing diapers often, washing the affected area with warm water, thoroughly drying the skin, and constant monitoring. Treat diaper rash with a thick layer of protective ointment or cream that forms a barrier between the skin and the moisture in the diaper area. Recommended products include those that contain zinc oxide or petrolatum, such as Desitin, A & D medicated ointment, Vaseline, or Eucerin cream. In general, baby powder and cornstarch should be avoided because breathing in powder particles can irritate babies' lungs. If the rash persists, your pediatrician should check for infections such as yeast and other types of dermatitis. Sometimes a special prescription ointment will combat stubborn or secondary inflammations.
Activity & Diet Recommendations
Sometimes the introduction of new foods will cause diarrhea and diaper rash. Breastfed babies are less prone to this condition than those fed on formula.
Possible Complications
Untreated diaper rash can lead to severe skin irritation, inflammation, and infection -- and a very uncomfortable baby. When the skin becomes severely irritated, complications in the form of bacterial and yeast infections may arise from diaper rash.
Call your pediatrician if you notice any of the following:
- Blisters, pus, or open sores
- Rash seems to be getting worse
- Rash doesn't start to respond to treatment within 72 hours
Diet
If your baby suffers frequent, recurring diaper rash, consider a diet change. Decrease foods containing yeast (breads and pastas); avoid tomatoes and acidic fruits, whose high acid content tends to make stools more irritating; and try giving the baby some fresh live-culture yogurt. If the baby has more than one or two bowel movements a day, try rice, bananas, and applesauce to decrease stool frequency.
Herbs
- Calendula: Creams made with extracts of calendula (marigold) flowers can soothe diaper rash and promote healing.
- Chamomile: Wipe the rashy area with lukewarm chamomile tea. Chamomile, which has some anti-inflammatory action, is a traditional remedy for irritated skin.
- Aloe vera: Best known as a treatment for burns, its cool gel can soothe rashy skin. (However, some babies maybe sensitive to it. If irritation appears to increase after applying aloe, stop using it.)
Supplements
- Lanolin: pure lanolin ointment can be helpful for cracked or irritated skin.
- Vitamin E: Try applying vitamin E oil or using a skin cream containing vitamin E.
Preventing Diaper Rash
- The longer a baby sits in a wet or soiled diaper, the greater the risk of a rash developing. Change diapers frequently -- if possible, immediately after urination or defecation.
- Keep the baby's diaper dry as much as possible.
- Don't wash the baby's bottom with alcohol wipes or soaps. They dry skin, increasing susceptibility to rash. Some brands of diaper wipes can also be irritating, when the baby already has a rash. Use warm water and gently pat dry.
- Dust the baby's bottom with cornstarch or powder to keep it dry. The American Academy of Pediatrics does not recommend using talcum because these products can cause breathing problems in infants. Some doctors recommend against use of any powders for this reason.
- Once the baby soils the diaper, clean the diaper area and leave it open to air for a while. Air exposure helps keep skin rash-free.
- Don't use plastic diaper covers. They trap moisture, increasing the risk of rash.
- Soaps can contribute to diaper rash. After bathing the baby, thoroughly rinse off all soap.
Caring for Diaper Rash
- Allow the rashy area to air-dry. After changing, place the baby on soft towels and allow him or her to remain naked for 10 or 15 minutes.
- Consider switching diaper methods. If you use disposables, try a diaper service. The superabsorbent materials and plastic at the waist and legs in today's disposables can irritate some babies' skin. If you use cloth, try disposables or change to a detergent especially made for washing diapers.
- If the baby's skin seems raw, apply a thin coat of zinc oxide or other ointment after thoroughly air-drying the area. To remove the ointment, use a cotton ball dipped in baby oil or lotion.
- Consider using a blow dryer -- at a very low setting -- at diaper changes to dry baby's skin, especially creases, more completely. Some doctors, concerned about the heat of a dryer,
Websites & Organizations
American Academy of Dermatology
P.O. Box 401
Schaumburg, IL 60168
Phone: 708-330-0230
American Dermatologic Society of Allergy and Immunology
Mayo Clinic
Rochester, MN 55905
Phone: 507-284-2555
Dermatology Foundation
1653 Maple Ave
Evanston, IL 60201
Phone: 312-328-2256
ERIC Clearinghouse on Elementary and Early Childhood Education
University of Illinois
805 West Pennsylvania Avenue
Urbana, IL 61801
Phone: 217-333-1396
Fax: 217-333-3767
Email: ericeece@ux1.cso.uiuc.edu
QuickCare
Society for Pediatric Dermatology
5422 North Bernard
Chicago, IL 60625
Phone: 773-583-9780
Fax: 773-583-9765
Sources for This Article
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Tierney, L.M., McPhee, S.J., and Papadakis, M.A. Current Medical Diagnosis and Treatment eds. Stamford, CT: Appleton & Lange, 1998.
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