Diaper Rash 101

New baby

 

Babies, newborns, and diaper rash

Most babies experience at least one diaper rash before they are out of diapers. Diaper rashes are the most common rashes we see in babies, and for a good reason.

Urine and stool can be very irritating to the delicate and sensitive skin of a baby’s bottom!

Luckily, most diaper rashes are simply caused by contact with moisture, pee, and poo, sometimes bacterial or yeast infections occur. Each type of rash is relatively easy to tell apart, so you know how to manage each cause.

 

Types of diaper rash (most common to least)

Contact dermatitis

Almost all newborn and baby diaper rash is from what we call contact dermatitis. ‘Contact’ refers to the fact that the rash is caused by being touched by something. ‘Dermatitis’ is ‘inflamed skin.’

When urine and stool directly touch the skin, it can lead to skin irritation and inflammation. This is very common in infants.

Babies are in wet diapers 24 hours a day!

Even if you change regularly, some skin elements may be damp, and the diaper can rub on the skin, leading to more irritation. Contact dermatitis looks red where the skin touches the diaper, with sparing of the skin in the creases that do not contact the diaper.

Sometimes children will also develop ulcerations if dermatitis becomes more severe and deep.

 

Contact dermatitis treatment

For uncomplicated contact dermatitis, I suggest applying a thick layer of zinc oxide cream to the skin. You want to use a cram with the highest percentage of zinc you can find. 40% is usually the highest zinc cream percentage. You want to apply like ‘icing on a cake’ – in thick amounts.

When the baby makes a poo, 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. When the contact dermatitis is present, I suggest using water and a face cloth to clean the diaper area instead.

I do not recommend applying baby powder to the baby’s diaper area, as the baby can inhale the powder and cause severe respiratory injury. I also do not recommend using cornstarch for diaper rash, which may lead to yeast growth (see below).

Some diaper-free time can also help. When the diaper is removed, the area has time to get dry, without being in contact with stool or urine, and without the diaper’s friction.

Sometimes all you need is a little diaper-free time. Allowing the area to get dry with air can work wonders.

 

Yeast infection (candida or thrush)

When there is a breakdown of the skin, as with contact dermatitis, yeast, which lives all over our bodies, can cause infection. Another name for yeast is candida. Yeast loves warm moist regions of the body, such as the diaper area. When yeast has led to an infection on the skin, we call this thrush. Recent antibiotic use can also increase the risk of yeast infection.

Yeast infection rash looks like red dots that are scattered away from the periphery of the rash. We call these ‘satellite lesions’ as these yeast spots are outside the central area of irritation. This rash usually involves skin creases where the skin may be moist and warm, allowing thrush to grow more quickly. You may notice that this rash is not responding to treatment for contact dermatitis, as listed above. Though keeping the diaper area dry and using zinc can minimize yeast growth, we often need to use a medication to kill off the yeast.

If you are unsure if your baby has a yeast infection, please see your doctor to confirm 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 clotrimazole. Sometimes an added topical steroid cream can decrease the discomfort associated with the rash. Many of us will prescribe a topical cream with equal parts hydrocortisone with antifungal medicine to apply two to three times a day. I then suggest using high percentage zinc for diaper changes in between.

 

Seborrheic dermatitis

Some babies develop a cradle cap type rash. Cradle Cap is often seen on the scalp, around the eyes, or the ears. The cradle cap looks like yellow, greasy scales that can be picked or rubbed off easily. It is not painful or itchy, and typically babies do not notice the rash.

 

Treating diaper rash from seborrheic dermatitis

Petroleum or non-petroleum jelly may alleviate this rash. Your doctor may also prescribe a low dose steroid cream if the inflammation is persistent or uncomfortable.

 

Bacterial diaper rash

Our skin has tons of bacterial on it. This is normal for us, and our bodies can tolerate it in most circumstances. However, if there is a break in the skin, such as with contact dermatitis, the bacteria that live on the skin can enter the skin barrier and lead to bacterial infection.

These rashes look like small pimple-like bumps with redness, yellow or clear discharge, and sometimes blisters.

If you suspect your baby has a bacterial infection, please see your doctor. In the case of bacterial diaper rash, your doctor may prescribe a topical or oral antibiotic.

 

Preventing diaper rash in babies

The best way to avoid diaper rash 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 overnight).

Applying a petroleum or non-petroleum jelly or zinc oxide cream as a barrier can prevent stool and urine contact with the skin. Leaving the diaper off at times, allowing the skin to airdry can help prevent and treat 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, mainly when sleeping for long periods.

If your baby has a persistent or worsening diaper rash, please see your doctor to ensure no other medications are required.

Read my article on how to treat other baby rashes like eczema, and watch the video below:

Dr. Dina Kulik

Dr. Dina Kulik 

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