Diaper rash

Overview

Diaper rash is a form of dermatitis that looks like patches of inflamed skin on the buttocks, thighs and genitals. It can be caused by wet or soiled diapers that aren't changed often enough. Or it may be due to skin sensitivity and chafing. The condition is common in babies, though anyone who wears a diaper regularly can develop it.

Diaper rash usually clears up with simple at-home care, such as air drying, more-frequent diaper changes, and using a barrier cream or ointment.

Symptoms

Symptoms of diaper rash include:

• Inflamed skin in the diaper area — buttocks, thighs and genitals.
• Itchy, tender skin in the diaper area.
• Sores in the diaper area.
• Discomfort, fussiness or crying, especially during diaper changes.

When to see a doctor

If the diaper rash hasn't improved after a few days of home treatment, talk with your doctor or other health care professional. You may need prescription medicine to treat diaper rash. Or the rash may have another cause, such as seborrheic dermatitis, atopic dermatitis, psoriasis or nutritional deficiency.

Take your child to a doctor or other health care professional for:

• A rash with a fever.
• A rash that's severe or unusual.
• A rash that persists or gets worse despite home care.
• A rash that bleeds, itches or oozes.
• A rash that causes burning or pain when your baby passes urine or stool.

Causes

Diaper rash may be caused by:

• Leaving on wet or soiled diapers too long. Skin can develop a rash if wet or soiled diapers are left on too long. Babies may be more prone to diaper rash if they're having many stools or diarrhea.
• Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.
• Using a new product. Your baby's skin may react to a new brand of baby wipes, diapers or a detergent, bleach or fabric softener used to wash cloth diapers. Ingredients in lotions, powders and oils might add to the problem.
• Developing a bacterial or yeast infection. What begins as a simple infection may spread to the surrounding skin. The area covered by a diaper is at risk because it's warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes can be found within the creases of the skin.
• Introducing new foods. As babies start to eat solid foods, the content of their stool changes. This increases the likelihood of diaper rash. Changes in your baby's diet can also increase the frequency of stools, which can lead to diaper rash. Breastfed babies might develop diaper rash in response to something the mother has eaten.
• Having sensitive skin. Babies with atopic dermatitis, seborrheic dermatitis or other skin conditions may be more likely to develop diaper rash. The irritated skin of atopic dermatitis also tends to be in areas not covered by a diaper.
• Using antibiotics. Antibiotics can contribute to a rash by killing bacteria that keep yeast growth in check. Antibiotic use also increases the risk of diarrhea. Breastfed babies whose mothers take antibiotics also are at increased risk of diaper rash.

Risk factors

Risk factors for diaper rash include wearing diapers that aren't changed often enough and having sensitive skin.

Complications

• Changes in skin color. In babies with brown or Black skin, diaper rash might cause the affected area to lighten. This is called post-inflammatory hypopigmentation. Mild skin lightening often clears up in a few weeks. Skin affected more severely could take months or years to return to its usual color.
• Infection. Diaper rash can develop into a severe infection that doesn't respond to treatment.

Prevention

The best way to prevent diaper rash is to keep the diaper area clean and dry. A few simple skin care tips can help:

• Change diapers often. Remove wet or dirty diapers as soon as you can. If your child is in child care, ask staff members to do the same. Disposable diapers that contain an absorbent gel may help because they draw wetness away from the skin.
• Rinse your baby's bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls or baby wipes can aid in cleaning the skin. Be gentle. Some baby wipes can be irritating, so use wipes that don't contain alcohol or fragrance. Or use plain water or water with a mild soap or cleanser.
• Gently pat the skin dry with a clean towel or let it air dry. Don't scrub your baby's bottom. Don't use talcum powder.
• Apply cream, paste or ointment. If your baby gets rashes often, apply a barrier cream, paste or ointment with each diaper change. Petroleum jelly and zinc oxide are the time-proven ingredients in many diaper rash products. If the product you applied at the previous diaper change is clean, leave it in place and add another layer on top of it.
• After changing diapers, wash your hands well. Hand-washing can prevent the spread of bacteria or yeast to other parts of your baby's body, to you and to other children.
• Allow airflow under the diaper. Secure the diaper, but not too tightly. Airflow within the diaper helps the skin. Diapers that are too tight can rub against the skin. Take a break from plastic or tightfitting diaper covers.
• Give your baby's bottom more time without a diaper.When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your bare-bottomed baby on a large towel and engage in some playtime.

Diagnosis

Diaper rash often can be diagnosed simply by looking at the affected skin. Testing may be needed to rule out other conditions, such as allergic contact dermatitis.

Treatment

The best treatment for diaper rash is to keep your baby's skin as clean and dry as possible. If the rash doesn't go away with home treatment, your doctor or other health care professional might suggest:

• A mild (0.5% to 1%) hydrocortisone (steroid) cream twice a day for 3 to 5 days.
• An antifungal cream, if your baby has a fungal infection.
• Antibiotic medicine taken by mouth, if your baby has a bacterial infection.

A diaper rash might take several days to improve, depending on how severe it is. A rash may come back again and again. If a rash persists even with prescription products, your doctor or other health care professional may recommend that your baby see a specialist in skin conditions (dermatologist).

Self care

Generally, a diaper rash can be treated successfully at home with these practices:

• Keep the diaper area clean and dry. The best way to keep your baby's diaper area clean and dry is by changing wet or soiled diapers as soon as you can. Until the rash is better, this may mean getting up during the night to change the diaper. Try using disposable diapers that contain an absorbent gel. They draw wetness away from the skin.
• Rinse your baby's bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls or baby wipes can aid in cleaning the skin. Be gentle. Some baby wipes can be irritating, so use wipes that don't contain alcohol or fragrance. Or use plain warm water or water with a mild soap or cleanser.
• Gently pat the skin dry with a clean towel or let it air dry. Don't scrub your baby's bottom. Don't use talcum powder.

• Apply cream, paste or ointment. After you've gently cleaned and dried the skin, apply a barrier cream, paste or ointment. If the product you applied at the previous diaper change is clean, leave it in place and add another layer on top of it. If you do want to remove it, try using mineral oil on a cotton ball.

  Products with a high percentage of zinc oxide or petroleum jelly work well to protect the skin from moisture. Various diaper rash medicines are available without a prescription. Some popular products include A + D, Balmex, Desitin and Triple Paste. Ask your doctor or pharmacist to suggest a product.

  After applying the diaper rash product, you could also apply petroleum jelly on top. This helps keep the diaper from sticking to the paste, ointment or cream. If you've been using a product with every diaper change and it isn't working, you may want to try an antifungal cream or ointment. An example is Lotrimin. Antifungal products should be applied twice a day. If the rash isn't better in 5 to 7 days, take your child to the doctor.

  As a general rule, stick with products designed for babies. Avoid items containing baking soda, boric acid, camphor, phenol, benzocaine, diphenhydramine or salicylates. These ingredients can be toxic for babies.

• Increase airflow. To aid the healing of diaper rash, do what you can to increase air exposure to the diaper region. These tips may help:
  • Let your baby go without a diaper and paste, ointment or cream for short periods of time, such as during naps.
  • Take a break from diaper covers that are plastic or tightfitting.
  • Use diapers that are a bit larger than your baby needs until the rash goes away.
• Bathe your baby daily. Until the rash clears up, give your baby a bath each day. Use warm water with mild, fragrance-free soap or a gentle nonsoap cleanser.
• Stop using products that seem to trigger your baby's rash. Try a different brand of baby wipes, disposable diapers, laundry soap or whatever other product you think might be causing the problem.

Alternative medicine

The following alternative treatments have worked for some people:

• Human breast milk. Results are mixed on whether human breast milk applied to diaper rash is better than other treatments. One study showed that applying breast milk to diaper rash is an effective and safe treatment. Infants with diaper rash were treated with either 1% hydrocortisone ointment or breast milk. Treatment with breast milk was as effective as the ointment alone. The study included 141 infants.

  Another study compared human breast milk with a cream made from zinc oxide and cod liver oil. Newborns with diaper rash were treated with the cream or the breast milk. Treatment with the cream was more effective.

• Other substances. Other natural remedies have been tried, including aloe vera, calendula, bee pollen, beeswax and cod liver oil. Further study is needed to prove their effectiveness for treating diaper rash. Some of these substances may promote bacterial growth.

Preparing for your appointment

Generally, diaper rash can be treated successfully at home. Make an appointment with your baby's doctor or other health care professional if the rash gets worse despite several days of home treatment, is severe or occurs along with a fever.

Here's some information to help you get ready for your appointment.

What you can do

• List your baby's symptoms and when they started.
• List key information about your baby's medical conditions and food intake. For example, has your baby been treated for any illness or given any medicines recently? Has the baby's diet changed? If your baby is breastfed also note any medicines that might reach the baby through breast milk. Also note changes in the mother's diet, such as an increase in acidic foods.
• List all products that come into contact with your baby's skin. Your baby's doctor will want to know what brand of wipes, diapers, laundry detergent, soaps, lotions, powders and oils you use for your baby. If you think that one or more products may be causing your baby's diaper rash, you may wish to bring them to the appointment so your doctor can read the labels.
• List questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Below are some basic questions to ask your health care provider about diaper rash.

• What is the most likely cause of my baby's rash?
• What are other possible causes?
• What can I do to help my baby's skin heal?
• What diaper ointments, pastes, creams or lotions do you suggest?
• When should I use an ointment or paste instead of a cream or lotion?
• Do you suggest any other treatments?
• What products or ingredients should I avoid?
• Should I avoid exposing my baby to certain foods?
• I'm breastfeeding. Should I avoid certain foods that could affect my baby?
• How soon do you expect my baby's symptoms to improve?
• What can I do to prevent this condition from recurring?
• Is the rash a sign of some other internal problem?

What to expect from your doctor

Your doctor is likely to ask you questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• When did you first notice your baby's symptoms?
• What type of diaper does your baby wear?
• How often do you or your baby's child care provider change your baby's diaper?
• What types of soap and wipes do you use to clean your baby?
• Do you apply any skin care products to your baby?
• Is the baby breastfed? If so, is the mother taking antibiotics? Are there any changes to the mother's diet?
• Have you introduced your baby to solid foods?
• What treatments have you tried so far for your baby's rash? Has anything helped?
• Has your baby recently had any other medical conditions, including any illness that caused diarrhea?
• Has your baby taken any new medicines lately?