What is Diaper Dermatitis (Diaper Rash)?
Diaper rash is an inflammation of the skin in the diaper area. It’s the most common skin issue in young babies. Usually, it’s caused by skin irritation, but it can also be due to skin conditions like atopic dermatitis and seborrheic dermatitis. Another reason for diaper rash can be an infection with a yeast called Candida albicans. Typically, diaper rash is not serious and goes away on its own needing only a little care. Management includes taking care of the skin, maintaining cleanliness, and avoiding irritants.
What Causes Diaper Dermatitis (Diaper Rash)?
Diaper rash is a skin irritation that commonly occurs in the area covered by a diaper. It’s usually caused by a mix of factors like too much dampness, prolonged contact with pee or poop, and exposure to irritants such as laundry detergents.
One of the main reasons for diaper rash is infection, particularly from a type of fungus called Candida albicans. This fungus can initially cause the rash or worsen an already irritated skin. Other sorts of fungi, like dermatophytosis, Malassezia which can make seborrheic dermatitis worse, and pseudomycotic conditions like erythrasma are also associated with diaper rash.
Bacterial infections are the second most common infectious cause of diaper rash. It may include infections from Staphylococcus aureus, which can happen in newborns via the umbilical cord, and Streptococcus pyogenes, another bacterium related to this condition.
Risk Factors and Frequency for Diaper Dermatitis (Diaper Rash)
Diaper rash, or diaper dermatitis, can affect anyone who uses diapers, regardless of gender. However, it’s especially common in newborns and infants because their skin isn’t fully developed yet. The issue is most common when a child is between 9 to 12 months old. In fact, about half of all infants experience diaper rash, making it responsible for a quarter of all the skin-related complaints that doctors hear from parents during a baby’s first year.
Several factors can increase or decrease a baby’s chances of developing diaper rash:
- Age: Newborns and infants have less developed skin, making them more susceptible to diaper rash.
- Diet: As a baby’s diet changes, so do the bacteria in their gut and the pH of their stool, both of which can affect diaper rash. Breastfeeding, on the other hand, may help protect against it.
- Diaper changing habits: Babies are more likely to develop diaper rash if their diapers aren’t changed often enough. This is because they can get inflamed skin from being in contact with irritants like urine and feces for too long. The problem is often less severe in young babies and newborns whose diapers are changed frequently than in older infants.
Signs and Symptoms of Diaper Dermatitis (Diaper Rash)
Diaper rash typically begins with an increased number of bowel movements or changes in their appearance, becoming looser. After a couple of days, a red rash appears in the diaper area. Doctors will usually ask parents about their baby’s hygiene habits, how often they change the diaper, the kind of diapers they use, and if they are applying any products that might be making the irritation worse.
Not all cases of diaper rash look the same. The skin might show redness, tiny raised bumps, roughness, and even sores. These skin changes can be found on the thighs, around the genitals, in the lower belly region, and on the buttocks. Interestingly, the skin folds are usually not affected.
- Redness
- Tiny raised bumps
- Roughness
- Sores
If the diaper rash is caused by a yeast infection, known as Candida dermatitis, the skin appears red and scaly with swelling. There will be distinctive tiny spots or bumps around the main rash, called satellite pustules or papules. In this type of diaper rash, the skin folds can also be involved. In severe cases, sores and ulcers can be formed.
Infection caused by the bacteria S. aureus can range from small spots and bumps to large, delicate blisters. The S. pyogenes bacteria causes a bright red rash and wetness that also involves the skin folds.
Testing for Diaper Dermatitis (Diaper Rash)
Diaper rash, known medically as diaper dermatitis, is usually diagnosed by the doctor based on the child’s symptoms and a physical check-up. Generally, there’s no requirement for any lab tests to confirm this. However, in cases where a Candida albicans infection (a type of yeast infection) is suspected, a test using potassium hydroxide, or KOH, can be helpful, but it’s not always needed. If the doctor suspects a bacterial infection, a test known as Gram staining can be carried out.
Treatment Options for Diaper Dermatitis (Diaper Rash)
The main goals of treating diaper rash are to heal the damaged skin and to prevent the rash from returning.
To achieve these goals, a few key strategies are used:
* Maintaining good hygiene is crucial. This can help preserve the skin’s natural defenses and avoid further irritation. Regular diaper changes and using high-quality, superabsorbent diapers can help decrease contact with pee and poop, which can irritate the skin.
* Bathing and cleaning the diaper area with water and a soap-free cleanser are also recommended.
The use of wet wipes on a baby’s skin has been debated. Some people fear that certain ingredients in wipes might irritate the skin further. However, recent studies indicate that baby wipes don’t harm the skin. Modern wipes usually include pH balancers which help neutralize the pee’s alkalinity, thus avoiding pH-related skin damage. It’s important to tell parents to choose wipes without soap, essential oils, fragrances, or harsh cleaners, as they might irritate the skin.
Topical ointments are suggested for both prevention and treatment of diaper rash. They improve the skin’s natural barrier and provide an extra barrier between the skin and the diaper, pee, and poop. This not only lessens contact and irritation but also prevents too much moisture from building up on the skin. To treat existing diaper rashes, these ointments should be applied during each diaper change. Common ones include zinc oxide, petrolatum, cod liver oil, and lanolin. If the diaper rash doesn’t get better after two or three days of using these measures, or if the rash is moderate to severe, a low-strength steroid cream, like hydrocortisone, can be used twice daily for a week.
For candida diaper rashes, which are caused by a type of yeast, an antifungal cream should be added to the treatment plan. Initially, nystatin is recommended; if there’s no improvement after one to three days, switch to azoles like clotrimazole, miconazole, or ketoconazole can be used twice a day for 7 to 10 days. If there is a bacterial infection, topical antibiotics may be needed. In severe cases, like perianal streptococcal dermatitis, which is a specific type of bacteria, oral antibiotics might be necessary.
What else can Diaper Dermatitis (Diaper Rash) be?
Diaper rash, also known as diaper dermatitis, can be caused by various skin conditions. The most common culprits include:
- Seborrheic dermatitis: This usually shows up within the first month of a baby’s life. It starts with skin redness and scaling on the scalp before spreading to the face. It can also affect the diaper area, increasing the risk of diaper rash.
- Atopic dermatitis: This usually occurs between 3 and 12 months of age. It’s characterized by extreme itchiness, dryness, and skin redness. While most often it affects areas where the skin folds, it usually doesn’t affect the diaper area.
The rash can also be caused by an allergic reaction to fragrances or preservatives in new skincare products. This type of rash can occur wherever the product has been applied.
Other conditions to consider when diagnosing a diaper rash include jock itch (tinea cruris), a skin parasite (scabies), a nutrient-absorption disorder (acrodermatitis enteropathica), biotin deficiency, a rare type of cancer (Langerhans cell histiocytosis or Letterer-Siwe disease), congenital syphilis, Kawasaki disease, and HIV infection.
What to expect with Diaper Dermatitis (Diaper Rash)
Diaper rash typically has a great outlook when it’s correctly identified and treated promptly. Generally, it’s a mild condition that gets better on its own over time.
Possible Complications When Diagnosed with Diaper Dermatitis (Diaper Rash)
Problems that can occur due to diaper rash include additional infections with fungus or bacteria. Extra care is required when these infections happen in patients with weakened immune systems, as they are at higher risk for more severe conditions.
Preventing Diaper Dermatitis (Diaper Rash)
As part of regular, routine health check-ups, parents should be given lessons on how to properly take care of their baby’s skin, especially in relation to diaper care. This includes how often to change diapers, which types of diapers and wipes are best to use, and how to properly apply skin-protective creams during diaper changes.
