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Common Diaper Rashes & Treatments

Common Diaper Rashes & Treatments Common Diaper Rashes & Treatments

By: Ingrid Polcari MD, FAAP

At least half of all babies get a diaper rash at some point. In fact, reddened, inflamed skin in the diaper area is one of the most common reasons parents seek medical care from their child's doctor. You're not alone!

Because there are many different types of diaper rashes―and they can look surprisingly similar―check out this list from the American Academy of Pediatrics (AAP) to help identify, soothe, and prevent several different types of diaper rashes.

1. Irritant diaper rash

The most common type of diaper rash is "irritant dermatitis." The diaper area spends much of the day in contact with two very irritating substances: urine and stool. If your child has diarrhea or is teething―meaning extra saliva is being swallowed and passes through the gut―the chance of developing a diaper rash is even greater.

Irritant diaper rash looks like pink or red patches on the skin covered by the diaper. The groin folds are more protected from urine and stool, so this skin usually looks normal.

Image caption: Examples of irritant diaper rash. The far right photo shows a more severe case with open sores.

What parents can do to prevent diaper rash:

In general, try to limit contact of urine and stool with the skin:

  • Change diapers frequently. Moisture from leaving a wet or soiled diaper on too long can cause skin to chafe. Urine in the diaper also can break down over time to produce irritating chemicals. In addition, the digestive enzymes that stool contains can start to wear away at skin.
  • Clean the skin gently during changes. For wipes, choose a product that is free of alcohol and fragrance. You can also cleanse the skin with water and a non-soap/gentle cleanser, which may be less painful than wiping if the skin is irritated or has open sores. Use a squirt or spray bottle of water for severe rashes, if possible, to rinse without rubbing. Pat gently and allow skin to air-dry.
  • Coat the skin with a thick layer of barrier paste. The brand is less important than the ingredients. Zinc oxide and petrolatum are both good choices, and fragrance-free products are best. Think of diaper paste as a shield that sits between the skin and the contents of the diaper. If the paste isn't soiled, no need to rub it off during changes; simply add more paste on top. In general, there is no such thing as too much diaper paste. Apply a thick layer, like icing on a cupcake.
  • Choose a highly absorbent diaper. The more absorbent the diaper, the better job it does of keeping the skin dry. Although there is no current evidence showing which type of diaper does the best job of preventing diaper rash, cloth diapers typically are less absorbent than most disposable brands. If you use cloth diapers, you may want to consider using disposable diapers until the rash heals.
  • Leave some breathing room. Make sure the diaper isn't too tight, especially overnight. A diaper that is loose will be less likely to rub against the skin.
  • Keep the area clean. If the diaper area is irritated, a daily bath will help remove debris, irritants and possible bacteria. Don't forget to apply a thick layer of barrier paste in the diaper area after bathing.

2. Yeast infection

Another fairly common cause of diaper rash is yeast infection, caused by overgrowth of a type of fungus found naturally in the digestive tract. Clues that the rash might be due to a yeast infection include shiny, bright red or pink patches with sharp edges. This rash may also have little pink bumps or pimples. In severe cases, there may be sores or cracking skin that oozes or bleeds. Unlike with irritant diaper rash, a yeast diaper rash is usually worse in the groin folds.

A yeast diaper rash may develop after your baby has taken antibiotics. If your baby has this type of diaper rash, be sure to wash your hands thoroughly before and after diaper changes. Your pediatrician may recommend or prescribe a topical antifungal cream for the rash. See Thrush and Other Candida Infections.

Image caption: Scaling skin spreading to the thighs and abdomen is typical with a yeast (candida) diaper rash.

3. Bacteria

Rarely, diaper rash can be caused by a bacterial infection. This is also called impetigo. Certain types of bacteria (like staph and strep) can cause diaper rash or make an existing one worse. Bright red skin around the anus can be a clue to a strep infection. Yellow crusting, weeping, or pimples can be a clue to a staphylococcus or "staph" infection. Any infection in the diaper area needs to be confirmed and treated by your child's doctor.

Image caption: Left, strep infection diaper rash; Right: staph diaper infection

Do not use over-the-counter antibiotic ointment for diaper rashes; sometimes ingredients in these products can worsen skin irritation.

4. Allergy

Occasionally, babies with sensitive skin may have an allergic reaction to a specific ingredient in diapers, wipes, and/or creams. Common allergens include dyes or elastics in the diaper, and fragrances or preservatives in diaper wipes or creams. Clues that might suggest an allergy include a rash that happens after every exposure to that product and a rash that shows up everywhere that product is applied. Switching brands or types of products for a 2-week period can sometimes help sort this out. 

Image caption: allergic reaction to diaper wipes.

5. Other rare types of diaper rashes

There are rare conditions that can start as or mimic diaper rash. Examples include seborrheic dermatitis, which may involve overproduction of oil in the skin, and pediatric psoriasis. Genetic conditions such as acrodermatitis enteropathica, an inherited form of zinc deficiency, may also cause rashes in the diaper area. 

When to call the doctor:

If your child's rash does not clear using the simple tips discussed, contact your child's doctor to see if a prescription medication is needed. Be sure to follow the instructions carefully; some prescription medications for diaper rash are only safe to use for short periods of time.

Other signs that it is time to call the doctor:

  • The rash is not going away, or it is getting worse after two to three days of treatment.
  • The rash includes pimples, peeling skin, blisters, pus-filled or oozing or crusty sores.
  • Your baby is taking an antibiotic medicine and develops a bright pink or red rash with red spots at the edges. 
  • The rash is especially painful, which could be a sign of cellulitis.
  • Your baby has a fever in addition to the rash.

Bottom Line:

Talk with your pediatrician if you have any questions about diaper rashes, and how to treat and prevent them.

Additional Information:

About Dr. Polcari: 

Ingrid Polcari MD, FAAP, is an Assistant Professor in the Departments of Dermatology and Pediatrics at the University of Minnesota and is the Program Director of the Dermatology Residency Program at the University of Minnesota. Within the American Academy of Pediatrics, she is a member of the Section on Dermatology. She is also a member of the Education Committee within the Society for Pediatric Dermatology.  





Last Updated
1/15/2020
Source
AAP Section on Dermatology (Copyright @ 2020 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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