Diaper Rash

(Diaper Dermatitis, Nappy Rash)

The Facts

A diaper rash is an area of inflamed skin found in the diaper area in infants and young children. It is usually caused by skin irritation from prolonged contact with urine and feces.

A diaper rash can sometimes lead to a bacterial or fungal infection. Diapers, whether reusable or disposable, create a hot moist environment that traps diaper contents (e.g., urine and feces) against the skin, which causes irritation and can promote infection.

Most babies will have a diaper rash at some point. Although the number of severe diaper rash cases has decreased over time, diaper rash is just as common now as it was 30 years ago.

The Causes

Diaper rash may be caused by a number of factors, including:

contact with urine and feces: Prolonged exposure to urine and feces can irritate the skin. Both urine and feces can cause moisture to come into contact with the skin, which makes it more prone to damage and irritation. Contact with digestive enzymes found in feces can also increase the risk of diaper rash. Although ammonia (the chemical that gives stale urine its smell) is irritating to the skin, the levels found in infant urine are not sufficient to cause a diaper rash. However, it can worsen skin that is already irritated and inflamed.
method of feeding: Breast-fed babies may experience fewer diaper rashes than bottle-fed babies because breast-fed babies tend to have stools of a smaller volume, which in turn are less irritating to the skin.
friction and rubbing: Tight-fitting diapers that chafe against the skin can lead to a diaper rash. This damage to the skin can be made worse if the skin is wet. Also, skin-to-skin contact within skin folds in the diaper area can promote a diaper rash.
preexisting skin conditions: Infants and children with preexisting skin conditions such as eczema and atopic dermatitis are more prone to developing a diaper rash.
contact with irritating chemicals: Your baby's bottom is very delicate. Some common chemicals that are found in fabric softeners, detergents, baby lotions, fragrances, soaps, and baby wipes can be very irritating to the skin and should be avoided. Talk to your child's doctor or pharmacist about which products to avoid.
antibiotic use: Using antibiotics can disrupt the normal balance of "good bacteria," which normally keep certain organisms such as yeast under control. Antibiotics taken by a breast-feeding mother can also affect the baby.
infections: The dark, damp, and moist environment created by a diaper is a perfect breeding ground for bacterial or yeast infections (e.g., Candida) on the skin. These types of infections are more common in babies who have a diaper rash. Blisters, pus, red bumps in the creases of the skin, "satellite" red areas outside the main redness, or severely swollen red areas may be signs of infection.
allergy to diaper elastic chemicals: A linear, red rash across the belly and in the skin creases can indicate an allergic reaction to chemicals in disposable diaper elastic. This is a common occurrence when you change to a different brand of diapers. If it persists or recurs, you should contact your child's doctor.
other conditions: Diaper rashes are not exclusive to infants and young children. They can also affect other people with conditions such as incontinence and paralysis.

Symptoms And Complications

Diaper rashes often appear as redness on the skin, with shiny patches and some pimply spots. The rash is usually found in the diaper area, which includes the buttocks, upper thighs, and genitalia. The affected skin may also be warm to the touch. The folds or creases of the skin are usually unaffected.

An infant or young child with a diaper rash may be more irritable and may complain or cry during diaper changes, especially when the skin in the diaper area is being cleaned or touched. An infection is usually indicated by red bumps that are present in the skin folds or creases. Blisters, pus, or red and severely swollen areas can also be signs of infection. "Satellite" red areas beyond the main rash are common with Candida yeast infection rashes.

Making A Diagnosis

The symptoms and location of the rash are usually the only necessary factors required to diagnose a diaper rash. Other information such as medication use and chemical exposure can help the doctor identify factors that may be making the rash worse.

In general, a mild case of diaper rash should clear up after a few days of proper treatment. It's important to understand that diaper rashes are very common and do not indicate poor child care.

Treatment And Prevention

Currently, the main treatment for diaper rash is to use a barrier cream or ointment containing ingredients such as zinc oxide and petroleum jelly,* which act both as a physical barrier between the skin and the irritant and as an absorbent to soak up moisture. Thicker barrier creams and ointments are usually recommended for treating a diaper rash. Some may contain vitamins A and D to promote healing.

Many common non-prescription diaper rash products contain zinc oxide. In general, the more zinc oxide a product contains, the thicker the product will be. Zinc oxide in concentrations up to 40% is suitable for treating a diaper rash. Lower concentrations (i.e., below 15%) can be used daily to prevent diaper rash.

Avoid using products with ingredients that may irritate the skin, such as certain fragrances or lanolin. Your child's doctor may recommend a topical antifungal product (such as clotrimazole, miconazole, or nystatin) to treat an infection on the skin caused by yeast (i.e., Candida). Avoid using topical steroid products (such as hydrocortisone) unless otherwise directed by your child's physician. Other measures you can take to help treat your child's diaper rash include:

changing the diaper often
cleaning the skin gently with mild soap and water and keeping it dry
avoiding products that may irritate the skin or cause pain (such as alcohol-containing wipes)

With an effective treatment, your child's diaper rash should clear up after several days. If it doesn't, or if your child has a fever or worsening symptoms (e.g., blistering, becoming inconsolable, or appearing lethargic), seek medical attention as soon as possible.

The following tips can be used to help prevent or reduce the chances of a diaper rash:

It has been shown that breast-fed babies tend to experience fewer diaper rashes than bottle-fed babies.
Use diapers that draw moisture away from the skin.
Expose the diaper area to air and apply barrier cream with the first signs of redness.
Avoid using products that expose your child's skin to irritating chemicals (e.g., diaper wipes with alcohol, fragrances, fabric softeners, detergents).
Change the diaper often, including throughout the night.
Avoid using powders such as talcum powder and cornstarch. Talcum powder may cause respiratory problems in your child, and cornstarch may promote a yeast infection.
Rinse your baby's bottom with warm water and a mild, unscented soap after each diaper change, and air- or pat-dry the area thoroughly. (Allow the area to air-dry for as long as possible.)
Avoid using tight-fitting diapers and rubber or plastic pants, since they retain more moisture.
Wash reusable diapers carefully to remove all the germs. Be sure to completely rinse out any soap or detergent.
Use a barrier cream or ointment such as petroleum jelly or zinc oxide to prevent skin irritation. Be sure to thoroughly dry your baby's bottom before you apply these products.
Wash your hands thoroughly after each diaper change.