diaper rash


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Diaper Rash

 

Definition

Dermatitis of the buttocks, genitals, lower abdomen, or thigh folds of an infant or toddler is commonly referred to as diaper rash.

Description

The outside layer of skin normally forms a protective barrier that prevents infection. One of the primary causes of dermatitis in the diaper area is prolonged skin contact with wetness. Under these circumstances, natural oils are stripped away, the outer layer of skin is damaged, and there is increased susceptibility to infection by bacteria or yeast.
Diaper rash is a term that covers a broad variety of skin conditions that occur on the same area of the body. Some babies are more prone to diaper rash than others.

Causes and symptoms

Frequently a flat, red rash is caused by simple chafing of the diaper against tender skin, initiating a friction rash. This type of rash is not seen in the skin folds. It may be more pronounced around the edges of the diaper, at the waist and leg bands. The baby generally doesn't appear to experience much discomfort. Sometimes the chemicals or detergents in the diaper are contributing factors and may result in contact dermatitis. These rashes should clear up easily with proper attention. Ignoring the condition may lead to a secondary infection that is more difficult to resolve.
Friction of skin against itself can cause a rash in the baby's skin folds, called intertrigo. This rash appears as reddened areas that may ooze and is often uncomfortable when the diaper is wet. Intertrigo can also be found on other areas of the body where there are deep skin folds that tend to trap moisture.
Seborrheic dermatitis is the diaper area equivalent of cradle cap. It is scaly and greasy in appearance and may be worse in the folds of the skin.
Yeast, or candidal dermatitis, is the most common infectious cause of diaper rash. The affected areas are raised and quite red with distinct borders, and satellite lesions may occur around the edges. Yeast is part of the normal skin flora, and is often an opportunistic invader when simple diaper rash is untreated. It is particularly common after treatment with antibiotics, which kill the good bacteria that normally keep the yeast population in check. Usual treatments for diaper rash will not clear it up. Repeated or difficult to resolve episodes of yeast infection may warrant further medical attention, since this is sometimes associated with diabetes or immune problems.
Another infectious cause of diaper rash is impetigo. This bacterial infection is characterized by blisters that ooze and crust.

Diagnosis

The presence of skin lesions in the diaper area means that the baby has diaper rash. However, there are several types of rash that may require specific treatment in order to heal. It is useful to be able to distinguish them by appearance as described above.
A baby with a rash that does not clear up within two to three days or a rash with blisters or bleeding should be seen by a healthcare professional for further evaluation.

Treatment

Antibiotics are generally prescribed for rashes caused by bacteria, particularly impetigo. This may be a topical or oral formulation, depending on the size of the area involved and the severity of the infection.
Over-the-counter antifungal creams, such as Lotrimin, are often recommended to treat a rash resulting from yeast. If topical treatment is not effective, an oral antifungal may be prescribed.
Mild steroid creams, such as 0.5-1% hydrocortisone, can be used for seborrheic dermatitis and sometimes intertrigo. Prescription strength creams may be needed for short-term treatment of more stubborn cases.

Alternative treatment

Good diaper hygiene will prevent or clear up many simple cases of diaper rash. Diapers should be checked very frequently and changed as soon as they are wet or soiled. Good air circulation is also important for healthy skin. Babies should have some time without wearing a diaper, and a waterproof pad can be used to protect the bed or other surface. Rubber pants, or other occlusive fabrics, should not be used over the diaper area. Some cloth-like disposable diapers promote better air circulation than plastic-type diapers. It may be necessary for mothers to experiment with diaper types to see if the baby's skin reacts better to cloth or disposable ones. If disposable diapers are used, the baby's skin may react differently to various brands. If the baby is wearing cloth diapers, they should be washed in a mild detergent and double rinsed.
The diaper area should be cleaned with something mild, even plain water. Some wipes contain alcohol or chemicals that can be irritating for some babies. Plain water may be the best cleansing substance when there is a rash. Using warm water in a spray bottle (or giving a quick bath) and then lightly patting the skin dry can produce less skin trauma than using wipes. In the event of suspected yeast, a tablespoon of cider vinegar can be added to a cup of warm water and used as a cleansing solution. This is dilute enough that it should not burn, but acidifies the skin pH enough to hamper the yeast growth.
Barrier ointments can be valuable to treat rashes. Those that contain zinc oxide are especially effective. These creams and ointments protect already irritated skin from the additional insult of urine and stool, particularly if the baby has diarrhea. Cornstarch powder may be used on rashes that are moist, such as impetigo.

Nutrition

What the baby eats can make a difference in stool frequency and acidity. Typically, breast-fed babies will have fewer problems with rashes. When adding a new food to the diet, the baby should be observed closely to see whether rashes are produced around the baby's mouth or anus. If this occurs, the new food should be discontinued.
Babies who are taking antibiotics are more likely to get rashes due to yeast. To help bring the good bacterial counts back to normal, Lactobacillus bifidus can be added to the diet. It is available in powder form from most health food stores.

Herbal treatment

Some herbal preparations can be useful for diaper rash. Calendula reduces inflammation, tightens tissues, and disinfects. It has been recommended for seborrheic dermatitis as well as for general inflammation of the skin. The ointment should be applied at each diaper change. Chickweed ointment can also be soothing for irritated skin and may be applied once or twice daily.

Prognosis

Treated appropriately, diaper rash will resolve fairly quickly if there is no underlying health problem or skin disease.

Prevention

Frequent diaper changes are important to keep the skin dry and healthy. Application of powders and ointments is not necessary when there is no rash. Finding the best combination of cleansing and diapering products for the individual baby will also help to prevent diaper rash.

Resources

Other

Greene, Alan. "Diaper Rash." Dr. Greene's House Calls. 1996. http://drgreene.com/960430.asp.

Key terms

Dermatitis — Inflammation of the skin.

rash

 [rash]
a temporary eruption on the skin.
butterfly rash a skin eruption across the nose and adjacent areas of the cheeks in the pattern of a butterfly, as in lupus erythematosus and seborrheic dermatitis. (See Atlas 2, Part B).
diaper rash irritant dermatitis in the area in contact with the diaper in infants, often sparing the genitocrural folds, occurring as a reaction to prolonged contact with urine and feces, retained soaps and topical preparations, and friction and maceration, and commonly associated with secondary bacterial and yeast infections, especially with Candida albicans. Some consider irritation by the ammoniac decomposition products of urine to be a contributing factor. Called also diaper dermatitis.
drug rash drug eruption.
heat rash miliaria.

di·a·per der·ma·ti·tis

colloquially referred to as diaper rash; dermatitis of thighs and buttocks resulting from exposure to urine and feces in infants' diapers. Formerly attributed to ammonia formation; moisture, bacterial growth, and alkalinity may all induce lesions.
See also: intertrigo.
Synonym(s): diaper rash, nappy rash

diaper rash

Diaper dermatitis Pediatrics A dermatopathy of infancy caused by prolonged contact with soiled diapers, soaps, or topical lotions, resulting in maceration of a skin that is scaly and erythematous with papulovesicules or bullae; DD may be extensive, but often spares crural folds; 2º bacterial and yeast–especially Candida spp, infections may complicate recalcitrant cases; chronic DD may undergo papular induration
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DIAPER RASH: (A) mild diaper rash, (B) severe yeast infection in diaper area
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DIAPER RASH

diaper rash

Irritant contact dermatitis as a reaction to friction, maceration, and prolonged contact with urine, feces, soap retained in diapers, and topical preparations. A persistent diaper rash may be colonized by yeast or bacteria. Synonym: diaper dermatitis See: illustration

Treatment

Treatment is symptomatic. Diapers should be changed frequently. If washable cloth diapers are used, they should be thoroughly washed and rinsed; occlusive plastic pants should not be used over diapers; the perianal and genital areas should be washed with warm water and mild, nonperfumed soap. If these measures and the application of a bland protective agent (such as zinc oxide paste) do not promote healing, then a small amount of 0.5% to 1% topical hydrocortisone cream should be applied to the area after each diaper change until the rash has completely resolved.

illustration
See also: rash

Patient discussion about diaper rash

Q. What do I do with this horrible Diaper Rash?? I have no idea what is up with my daughters diaper rash, she is a year old and I do everything to keep this rash from coming, but it comes back! All week I have let her run without a diaper on trying to let it air out as much as possible, (thank god for carpet shampooers).Is there any secret that someone has to getting rid of this rash?

A. My own daughter was yeasty from whatever they do to newborns in the hospital and I battled it ever day until I started taking garlic gel tabs. Because I breasfed her she got all the benefits of it and her bottom cleared right up.
Probiotics can help, yogurt, kefir and the like. Super Salve from supersalve.com is amazing in its healing abilities. Avoid processed foods and especially sugars.

More discussions about diaper rash
References in periodicals archive ?
Conveniently available at all food, drug and mass merchandisers nationwide, Aquaphor Baby Fast Relief Diaper Rash Paste is hypoallergenic and is made with provitamin B5 and Shea Butter to help repair skin's natural barrier and keep baby's skin moisturized and smooth.
Diaper rash is a normal skin condition in babies and young children due to the skin staying wet, rubbing from the diaper and contact with chemicals in urine and stool.
Skin care for patients who develop skin conditions that are acute rather than chronic--that is, for example, a child with a sunburn or diaper rash rather than AD--requires temporary short-term changes to the general principles of well skin care discussed by McLeod et al.
The evidence also showed that Nelson twice prescribed the steroid-containing cream Lotrisone to treat the child's diaper rash over a 13-month period - a dosage that experts testified was reasonable.
I mean, how can one go wrong with a hurricane and diaper rash?
There's Diaper Rash Ointment, Gentle Cleansing Milk, Nurturing Baby Cream for Face and Body, Gentle Foaming Hair and Body Wash, and Baby Lip Balm.
There are many alternatives and products available in the management of diaper rash (DR).
From diaper rash to chicken pox itches to ache, children experience a whole host of skin issues all their own.
The remainder of the physical examination was normal except for the severe eczematous diaper rash and the similar rash on the scalp.
New Scientist magazine reported: ``Vernix might also yield the winning formula for new diaper rash creams and medicated lotions for people with skin problems such as eczema and psoriasis.
Selan+ products are indicated for the prevention and treatment of diaper rash and other rashes caused by moisture, Stage I pressure ulcers, and amputee tissue trauma, as well as the itch associated with end-stage renal disease.
To play it safe, avoid treating diaper rash, eczema, or other rashes with skin lotions that contain peanut oil.