Diaper Rash – A Pain In The Butt

Diaper Rash – A Pain In The Butt

Diaper Rash and Babies

 

Diaper Rash is found on most babies have at least once before they are toilet trained. It is the most common of rashes on babies. The majority of these are caused by irritation of the sensitive skin that comes in contact with urine and stool. Yeast infections are also very common. Bacterial infections of the diaper area are uncommon.

 

Types of diaper rash (most common to least)

 

Contact dermatitis

Newborn diaper rash is usually contact dermatitis. When urine and stool comes in contact with the skin it can become irritated and inflamed. This is very common in infants. You’ll notice redness where the skin touches the diaper, with sparing of the skin in the creases that do not come in contact with the diaper. Sometimes children will also develop ulcerations.

 

Severe diaper rash treatment – for simple contact dermatitis, I suggest applying thick layers of zinc oxide cream (like icing on a cake), with the highest percentage of zinc you can find. When the baby stools, gently wash away the stool and apply more cream. The goal is to avoid seeing the irritation on the bum as it should be generously coated. I also avoid using diaper wipes, which often have alcohol in them, as these can be irritating to the skin as well. When the contact dermatitis is present, I suggest using water and a face cloth to clean the diaper area instead.

 

I don’t like using cornstarch for diaper rash as this may lead to yeast growth (see below).  Similarly, I don’t recommend using baby powder on diaper rashes as this can be inhaled into the baby’s lungs, causing irritation.

 

My favorite diaper rash home remedy:  airing the area out. Sometimes all you need is a little diaper free time. Allowing the area to get dry with air can work wonders.

 

Yeast infection (candida)

When there is a breakdown of the skin as with contact dermatitis, yeast, which lives all over our bodies, can cause infection. Yeast loves warm moist regions of the body, such as the diaper area. Recent antibiotic use can also increase the risk for yeast infection. These rashes typically look like red dots that are scattered away from the periphery of the rash.  This rash usually involves the skin creases.  You may notice that this rash is not responding to treatment for contact dermatitis, as listed above. Seeing your doctor can help with the diagnosis.

 

How to treat a yeast infection – Follow the same instructions as for contact dermatitis, with the addition of an antifungal topical preparation, such as Canestan. Sometimes an added topical steroid cream can decrease the discomfort associated with the rash.

 

Seborheic dermatitis

Some children will develop a cradle cap type rash. In the diaper area this looks like yellow, greasy scales that may affect the scalp and face as well.

 

Treating diaper rash from seborheic dermatitis– Petroleum or non-petroleum jelly may alleviate this rash. Your doctor may also prescribe a low dose steroid cream.

 

Bacterial infection

As our skin has natural bacteria on it, a break in the skin, such as with contact dermatitis, can lead to bacterial infection. These rashes look like small pimple-like lesions with lots of redness and sometimes blisters. If you suspect a bacterial infection, please see your doctor.

Treatment – a topical or oral antibiotic may be necessary.

 

Prevention

baby-diaper-1The best method to avoid diaper rashes is to change your baby’s diaper regularly. This is especially true when they are stooling frequently or lying in the same diaper for long stretches (such as at night). Applying a petroleum or non-petroleum jelly or zinc oxide cream as a barrier can prevent the contact of stool and urine with the skin.  Leaving the diaper off at times, allowing the skin to dry can also be helpful in preventing and treating irritation. Some evidence shows that babies who wear cloth diapers, which are less absorbent than disposable diapers, are more likely to get diaper rashes. These babies may avoid rashes by wearing disposable diapers, particularly when sleeping for long periods of time. If your baby has a persistent or worsening diaper rash, please see your doctor to ensure no other medications are required.

 

For how to treat other baby rashes like eczema, please see here.

Dina M. Kulik, MD, FRCPC, PEM

About Dina M. Kulik, MD, FRCPC, PEM

Dina is a wife, mother and adrenaline junky. She loves to share children’s health information from her professional and personal experience. More About Dr Dina.

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