Diaper dermatitis or diaper rash is an irritation of the skin covering the groin, lower stomach, upper thighs and buttocks. The term diaper rash includes a variety of disorders of the skin that occur in infants, young children and incontinent or paralyzed individuals.
Diaper rashes are common in babies between 4 and 15 months old. They may be noticed more when babies begin to eat solid foods.
Diaper rashes caused by infection with a yeast (fungus) called Candida are very common in children. Candida grows best in warm, moist places, such as under a diaper.
Candida diaper rash is more likely to occur in babies who:
- Are not kept clean and dry
- Are taking antibiotics or whose mothers are taking antibiotics while breast feeding
- Have more frequent stools
Other causes of diaper rash include:
- Acids in the stool (seen more often when the child has diarrhea)
- Ammonia (a chemical produced when bacteria break down urine)
- Diapers that are too tight or rub the skin
- Reactions to soaps and other products used to clean cloth diapers
This condition is seen more commonly in infants and early childhood prior to 2 years of age.
Diaper dermatitis usually occurs between one and two months of age and may continue until the child no longer wears diapers. Diaper dermatitis may become irritated or difficult to treat if the area becomes infected or the patient becomes allergic to one of the medications applied to the area.
Cause of Diaper dermatitis
Diaper dermatitis starts with irritation from prolonged contact with urine and feces. After the skin becomes red and inflamed, bacteria and yeast grow on the raw areas. This will inflame the already irritated skin, making the diaper rash worse.
Antibiotic treatment for throat and ear infections can cause yeast overgrowth making diaper dermatitis worse.
You may notice the following in your child’s diaper area:
- Bright red rash that gets bigger
- Very red and scaly areas on the scrotum and penis in boys
- Red or scaly areas on the labia and vagina in girls
- Pimples, blisters, ulcers, large bumps, or sores filled with pus
- Smaller red patches (called satellite lesions) that grow and blend in with the other patches
- Older infants may scratch when the diaper is removed.
Diaper rashes usually do not spread beyond the edge of the diaper.
Treatment for Diaper dermatitis
The best treatment for diaper dermatitis is to prevent it from starting. This is most easily done by using absorbent disposable diapers. These do not allow urine to come into contact with the skin.
Treatment for diaper dermatitis will vary based on the cause of the dermatitis. Specific treatment for diaper dermatitis will also be determined by your doctor based on:
Your child’s age, overall health, and medical history
Extent of the disease
Your child’s tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include:
- Removal of the diaper for a few days
- Medicated diaper cream (as prescribed by your child’s doctor)
- Anti-inflammatory creams
- Moisture-resistant diaper creams
- Proper skin care is also very important in preventing diaper dermatitis. This includes:
- Keeping the diaper area clean and dry
- Changing diapers frequently
- Allowing the diaper area to air dry at times
- Limiting the use of soap and other harsh cleaners in the diaper area
The rash should resolve in two to three days. Call your doctor if it does not improve, gets worse, you see open sores, or it appears extremely painful.
Modern absorbent disposable diapers can hold large amounts of urine and keep it away from the skin. For all practical purposes these diapers only need to be changed when they become soiled with feces or they get so heavy that they are down near the child’s ankles.
It is the mixture of urine and feces that causes the rash.
If one plans to use reusable cloth diapers, they must be changed each time after they become wet or every one to two hours. When using disposable diapers, it is important to prevent tape from adhering to the infant’s skin.
The adhesive can lead to skin break down. Contrary to popular belief, powder is not needed to keep the baby dry or to prevent diaper rash – in fact it may cause diaper rash to become inflamed particularly in the creases of the legs.
Desitin (and other zinc oxide containing pastes), applied at bedtime are often helpful. This helps prevent a rash from starting if there is a nighttime bowel movement.
How is diaper dermatitis diagnosed?
Diaper dermatitis is usually diagnosed based on the location and appearance of the rash during physical examination of your child. In addition, your child’s doctor may do skin scraping to aid in the diagnosis.
How to prevent diaper dermatitis?
Keep the diaper area as dry as possible by using absorbent disposable diapers or by frequent changes of conventional diapers. Triple paste is an ointment that can be applied to the diapered area with every diaper change.
A pharmacist usually makes this up by prescription. Lotrimin AF or Micatin creams can be used for diaper rash and can be purchased without a prescription. Avoid the use of Neosporin ointment, since this is a common product causing allergies.
A dermatologist can help clear a diaper rash that does not easily clear with these instructions.