HomeHealth articlesdiaper rashWhat Is Diaper Rash Dermatitis?

Baby Diaper Rash - From What Causes Them to How to Get Rid of Them!

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Diaper rash is the inflammation of the skin in the area under the diapers or the baby’s buttocks. It is commonly seen in infants between 4 to 15 months.

Medically reviewed by

Dr. Veerabhadrudu Kuncham

Published At November 10, 2022
Reviewed AtApril 18, 2023

What Is Dermatitis?

Dermatitis, in layman’s terms, is the general irritation of the skin followed by itchiness and rashes that are not contagious. They are of three types,

  • Atopic dermatitis.

  • Contact dermatitis.

  • Seborrheic dermatitis.

What Is Diaper Rash Dermatitis?

Diaper rash dermatitis is an inflammatory reaction in the perianal areas and buttocks, which appear as a patch of bright red, irritated skin. They are most commonly seen in babies and also on anyone who wears a diaper regularly. It usually begins between the legs and spreads to the stomach and genitals. It is not a serious condition and is treated by home remedies such as keeping the area dry, frequently changing diapers, avoiding irritant substances, and ample hygiene.

What Causes Diaper Rash In Babies?

  • Diaper rash dermatitis is frequently noticed when the baby starts to take solid foods. This is because the content of the stool changes, frequency of stools increases, causing rashes in their perianal parts.

  • Another most common cause is the fungus Candida albicans. Candidal infections are the primary source of diaper dermatitis.

  • Bacterial infection follows the fungal growth and causes infectious diaper rash dermatitis. The organisms responsible are the Staphylococcus aureus in newborns and the Streptococcus pyogenes.

There are also several other factors such as,

  • Excess moisture due to prolonged skin contact with urine and feces.

  • Too tight diapers or clothes that cause friction between the legs.

  • Allergic reactions due to the use of powders, lotions, and soaps.

  • Breastfed babies whose mothers take antibiotics.

  • Antibiotics given to the babies kill both the good and harmful bacteria in the body, causing superimposed fungal growth resulting in diaper rashes.

Who Is More Prone to Diaper Rash Dermatitis?

Any individual using diapers for a prolonged time regularly is prone to get diaper rash irrespective of gender preference. But newborns and infants between 9 to 12 months of age have increased chances due to their immature and sensitive skin type. About 50 % of infants are affected by diaper rash, and 25 % of them make their hospital visits to a pediatrician or a general physician.

How Does This Occur?

The most important predisposing factors are :

  • Moisture.

  • The pH of the skin.

How Does Moisture Contribute to Diaper Rash Dermatitis?

The excess amount of moisture present in the diapers causes friction between the thighs, and the skin is subjected to irritation and damage, which increases the chances of microbial invasions resulting in diaper rash dermatitis. The excess moisture from wearing diapers increases the friction. Skin is more vulnerable to damage and irritation. Invasion of the skin by microorganisms causes diaper rash dermatitis.

What Is the Role of Skin pH?

The breakdown of urinary urea increases the pH around the diaper area, which in turn increases the fecal enzyme activity, further damaging the skin and causing local irritation in the perianal areas causing diaper rashes.

These sequelae of events result in the colonization of microorganisms. The species responsible are,

  • Candida albicans.

  • Staphylococcus aureus.

  • Streptococcus pyogenes.

What Are the Clinical Features?

It may be variable in each individual. It begins with the history of increased frequency of stools and change in its nature (loose stools) accompanied by fever. The baby always cries when the diaper rash area is being washed or touched during diaper changes.

  • Skin appears red and tender in the thighs, diaper area, genitals, and buttocks.

  • The rashes tend to get bigger but do not extend beyond the diaper.

  • In boys, red scaly areas are seen on the scrotum and penis.

  • In girls, rashes are seen on the labia and the vagina.

How to Diagnose Diaper Rash Dermatitis?

Diagnosis is made clinically based on physical examination and the history obtained from the parents. There is no need for laboratory investigations; however, confirmation of diagnosis for candidal infections is made by potassium hydroxide (KOH), and gram staining is done for bacterial infections.

How Does Diaper Rash Dermatitis Differ From Other Skin Conditions?

Seborrheic Dermatitis:

  • They are seen in the first month of life and are characterized by skin erythema (redness) and scaling (shedding).

  • It begins from the scalp and extends to the face and also to the diaper area.

Atopic Dermatitis:

  • They are seen between three and 12 months of age, characterized by pruritus (itching), dryness, and erythema.

  • It involves the skin of the flexures, but the diaper area is unaffected.

Allergic Contact Dermatitis:

  • It is seen after the introduction of new skin products, talcums, lotions, etc

  • It affects any part of the body where the product is applied.

What Is the Treatment for Diaper Rash Dermatitis?

Generally, diaper rashes can be treated successfully by home remedies themselves. The two main objectives in managing the rashes are:

  1. Healing.

  2. Prevention from recurrence.

Steps to achieve the above objectives,

  • Good hygiene plays an integral part. Always wash your hands before changing diapers. This prevents the spread of bacteria to the baby.

  • Change your baby’s diaper often.

  • Use super-absorbent diapers for hydration.

  • Wash the baby’s bottom with lukewarm water during each diaper change.

  • Now dry the area with a clean, soft cotton towel.

  • Recent studies have shown the use of wet wipes has no harm, but they should be free from alcohol fragrances as they may irritate the skin.

  • Do not use tight diapers.

  • Use diapers only in unavoidable circumstances; otherwise, let the baby free or just lay them on a towel during playtime.

  • In case of recurrent rashes, the application of zinc oxide creams or petroleum jelly prevents skin irritation.

Commonly Used Medicaments:

  • Nystatin: This can be used first during every diaper change, and if the condition does not improve, Azoles can be used

  • Azoles such as Miconazole, Clotrimazole and Ketoconazole are used for fungal infections.

In case of severe rashes, steroids such as one percent of Hydrocortisone can be used strictly under a physician’s guidance.

What Is the Prognosis?

Diaper rash dermatitis is a mild, self-limiting disease that responds well to treatment. Maintaining personal hygiene for the baby prevents its recurrence.

When to Seek Medical Help?

Generally, diaper rash dermatitis can be successfully treated by home remedies itself and does not require hospital visits. However, it can worsen in some individuals and requires a physician's examination if any of these conditions are present:

  • If the rash gets worse and does not resolve within two to three days of home remedies or with over-the-counter creams.

  • A bright red rash having crusted areas, sores, or boils must be examined by the doctor

  • When the rash spreads to the abdomen, back, arms and face.

  • If the baby has a fever, immediately seek medical appointments.

  • A rash during the first six weeks after birth

What Type of Diaper to Use?

Many parents' concern is regarding the type of diaper to use to prevent the diaper rash. There is no such evidence that cloth diapers are better than disposable ones. You can use any diaper, irrespective of the brand, that does not irritate the baby. In case of such irritation, change that diaper and try another brand.

Special care to be taken while using cloth diapers.

  • The soiled diaper should be soaked in cold water.

  • Hot water is recommended for washing purposes as it kills the germs if present.

  • Double rinsing of the diapers is always recommended to remove the excess soaps and detergents.

  • Always dry the diaper in sunlight well before using them on the baby.

Conclusion:

Diaper rash dermatitis is not a serious condition and can always be prevented if the baby's hygiene is maintained well. Proper guidelines to the parents by the medical professionals in handling diaper rashes. However, it may be challenging to manage diaper rash dermatitis. Initially, seeking timely help from the interprofessional team may be helpful for the parents.

Frequently Asked Questions

1.

What Is the Treatment for Diaper Rash Dermatitis?

- Nystatin: This can be used first during every diaper change, and if the condition does not improve, Azoles can be used.
- Azoles such as Miconazole, Clotrimazole, and Ketoconazole are used for fungal infection.
- In case of severe rashes, steroids such as one percent of Hydrocortisone can be used strictly under a physician's guidance.

2.

What Are the Clinical Features of Diaper Rash?

It may be variable in each individual. It begins with the history of increased frequency of stools and changes in its nature (loose stools) accompanied by fever. The baby always cries when the diaper rash area is being washed or touched during diaper changes due to pain. In boys, red scaly areas are seen on the scrotum and penis. In girls, rashes are seen on the labia and the vagina.

3.

What Is the Hygiene Measure to Cure Diaper Rash?

Good hygiene plays an integral part. Always wash one’s hands before changing diapers. This prevents the spread of bacteria to the baby. Use superabsorbent diapers for hydration. Wash the baby's bottom with lukewarm water during each diaper change.

4.

What Causes Diaper Rash In Babies?

Diaper rash dermatitis is frequently noticed when the baby starts to take solid foods. This is because the content of the stool changes, and the frequency of stools increases, causing rashes in their perianal parts. Another common cause is the fungus Candida albicans. Candidal infections are the primary source of diaper dermatitis.

5.

How to Diagnose Diaper Rash Dermatitis?

Diagnosis is made clinically based on physical examination and the history obtained from the parents. Therefore, there is no need for laboratory investigations; however, confirmation of diagnosis for candidal infections is made by potassium hydroxide (KOH), and gram staining is done for bacterial infections.

6.

Who Is More Prone to Diaper Rash Dermatitis?

Any individual who regularly uses diapers for a prolonged time is prone to get diaper rash, irrespective of gender preference. However, newborns and infants between nine and 12 months have increased risk due to their immature and sensitive skin type. About 50 percent of infants are affected by diaper rash, and 25 percent of them make their hospital visits to a pediatrician or a general physician. Diaper rash usually gets healed within three to four days, and in some severe cases, it may take weeks or months to vanish completely.

7.

How Does Moisture Contribute to Diaper Rash Dermatitis?

Excess moisture in the diapers causes friction between the thighs, and the skin is subjected to irritation and damage, which increases the chances of microbial invasions, resulting in diaper rash dermatitis. Therefore, babies should be left without diapers to nap and play for some time so that air can help heal and dry the rashes caused by diaper use.

8.

How Frequently Diapers Should Be Changed?

Many parents are concerned about the type of diaper to prevent diaper rash. Therefore, diapers should be changed after every two to three hours to prevent the rash. One must change the diaper before it gets wet, and in case a baby defecates, the diaper should be changed immediately. The area must be cleaned thoroughly, and diaper cream should be applied before using a new diaper.

9.

Can Wipes Cause Diaper Rash?

Recent studies have shown that wet wipes do no harm, but they should be free from alcohol fragrances as they may irritate the skin. Use diapers only in unavoidable circumstances; otherwise, let the baby free or lay them on a towel during playtime.

10.

Can Vaseline Be Used on Diaper Rash?

Vaseline can create a moisture barrier and help treat diaper rash to some extent. It should be applied every time after changing the diaper, along with keeping the skin clean and dry. Also, vaseline can be applied over the ointment or cream used for diaper rash to cover it and prevent sticking to the diaper.
Dr. Veerabhadrudu Kuncham
Dr. Veerabhadrudu Kuncham

Pediatrics

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dermatitisdiaper rash
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