Diaper Rash

• Diaper rash is inflammation of the skin that appears on the skin under a diaper. Diaper rash typically occurs in infants and children younger than 2 years of age, but the rash can also be seen in people who are incontinent or paralyzed.
• Diaper rash is medically referred to as diaper dermatitis.
• Almost every baby will get diaper rash at least once during the first three years of life, with the majority of these babies 9-12 months of age.
• This is the time when the baby is still sitting most of the time and is also eating solid foods, which may change the acidity of the bowel movements.

• Friction: Most diaper rash is caused by friction that develops when sensitive baby skin is rubbed by wet diapers. This results in a red, shiny rash on exposed areas.
• Irritation: The skin under the diaper gets red from irritants such as feces, urine, or cleaning agents. Irritation can be caused by the diaper or by the acid in urine and bowel movements. This rash appears red in the area where the diaper has rubbed and is normally not seen in the folds of the skin.
• Candidal infection: The rash of a candidal infection, also known as fungal or yeast infection, usually has a bright, beefy red appearance and is very common after the use of antibiotics. Candida is a fungal microorganism that is typically found in warm, moist places such as in the mouth. In fact, Candida is the same organism that causes thrush.
• Allergic reaction: The rash may be a reaction to diaper wipes, diapers, laundry detergent, soap, lotion, or the elastic in plastic pants. Children who have a previous history of eczema may be more susceptible to diaper rashes.
• Seborrhea: This is an oily, yellow-colored rash that may also be seen in other areas of the body, such as the face, head, and neck.

Identifying a diaper rash is usually fairly easy. The rash is located on areas of skin immediately underneath the diaper area.

The skin is red and irritated. It may appear all over your baby's bottom or genital area, or only in certain places. It may or may not involve the folds of the skin.

It is usually not necessary to call the doctor for a simple diaper rash. Keeping the diaper area clean and dry should prevent most diaper rashes. However, even the best prevention is sometimes not enough.

• Call your doctor if these conditions develop:
  • The rash does not get better despite treatment in four to seven days.
  • The rash is getting significantly worse or has spread to other parts of the body.
  • The rash appears also to have a bacterial infection, with symptoms such as a pus-like drainage or yellowish colored crusting. This is called impetigo and may need to be treated with antibiotics.
  • You are not certain what may be causing the rash.
  • You suspect the rash could be from an allergy. The doctor can help you pinpoint the possible allergen.
  • The rash is accompanied by diarrhea continuing for more than 48 hours.

It is very rare to need to go to the hospital for diaper rash. However, should your child appear to be in severe pain, or if you notice rapid spread of the rash with fever, you should seek medical attention.

Diagnosis is typically based on a history and physical examination of the rash. It is usually not necessary to perform lab testing. If the rash appears to be caused by an allergic response, your doctor may perform skin testing to determine the specific allergy-causing agent.

Proper skin care is one of the most important treatments for diaper rash. The following techniques may help alleviate or shorten the duration of diaper rash.

• Diapers should be changed more often than normal.
• Skin should be washed with a very mild soap and air dried or lightly patted dry.
• The skin should be cleaned, but avoid any rough scrubbing, which could lead to further skin irritation. After cleaning, the skin should be exposed to air, leaving the diaper off for several hours if possible.
• Avoid using plastic pants during this time.
• Certain foods may seem to worsen the rash. If this is the case, avoid these foods until the rash has cleared.
• If the rash is caused by a contact or allergic dermatitis, stop using any new soaps or detergents that may be causing the rash.
• If the rash appears to be caused by a candidal infection, it may be treated with topical, over-the-counter antifungal creams.
• Topical steroids can be used for diaper rash caused by allergic, atopic, or seborrheic causes but should not be used for fungal infections and should not be started unless recommended by a medical professional.
• Zinc oxide or some other barrier creams or ointments may also be effective.

• If the child (or adult) appears to have a candidal infection, the doctor may recommend antifungal creams or medicines.
• If the child has impetigo (a bacterial infection), antibiotics may be prescribed.
• Your doctor may recommend a short course of mild topical steroid cream or ointment if the rash does not appear to be a fungal infection.

Prevention is the most effective way to treat diaper rash.

• Diapers today are highly absorbent and can wick away excess moisture from the skin. However, it is still a good idea to change the diapers every few hours to prevent urine or feces from coming into contact with skin.
• Before putting on a new diaper, be sure that the skin is dry and clean.
• When applying the diaper, avoid tape adhering to the skin, because this can also lead to breakdown and irritate the skin.
• Good hand washing is a must to help prevent infections.
• Try to air out the diaper area as much as possible.

Diaper rash usually goes away on its own. In addition, a child will stop having episodes of diaper rash once potty-training has been successfully completed and the child no longer wears a diaper.