What is Diaper Rash?
Diaper rash is a red, sometimes scaly and tender, rash or inflammation. It appears most commonly on your baby’s bottom.
This condition usually affects babies, but can happen to anyone who needs to wear a diaper. While it can be alarming to parents and irritating or sore for babies, with treatment it can heal quite quickly.
It is a condition which, in most cases, can be relieved and treated with just a few changes in routine.
There are a number of things which cause the development of diaper rash. There are also factors contributing to instances of diaper rash occurring or worsening. We will detail both scenarios of the symptom.
The causes of diaper rash include:
Irritation from Stools and Urine
A baby’s skin is very delicate and sensitive; therefore, prolonged exposure to either stools or urine can irritate their skin. Of the two, excrement tends to cause more irritation; therefore, if your infant has diarrhea or frequent bowel movements, they are more susceptible to diaper rash. (1)
We have all probably experienced chafing or rubbing from wearing clothes that are too tight.
Chafing (frictional dermatitis) is the most common type of mild diaper rash. It will be seen in areas where the diaper rubs against the skin: mainly in the inner thighs, abdomen or buttocks. It can also occur on the surface of the genital area, particularly in male infants.
A mild redness might be seen; however, making sure diapers are not too tight and changing them frequently will help. This type of diaper rash will usually resolve itself if you follow these measures. (2)
A number of factors can irritate a baby’s delicate skin and lead to diaper rash.
If you are using cloth diapers, a change of detergent, bleach or softener used when laundering might not agree with baby’s skin. Likewise, some brands of disposable diapers could cause irritation.
Wet wipes or lotions that you use to clean your infant may aggravate the skin. Some talcum powders and creams might also contain ingredients which have a negative reaction on the skin.
We have already mentioned urine and feces: these are irritants as well. This is particularly the case when they remain in the moist, warm environment created by wearing a diaper. (3)
The introduction of solid food to a baby’s diet will change the nature and content of their stools. It may also mean they defecate more often. These changes can contribute to outbreaks of diaper rash.
Mothers who are breastfeeding also need to consider their own diet. What you eat can pass to the baby through your breast milk and might cause diaper rash. (4)
Antibiotics wipe out bacteria and deal with infections. However, they don’t discriminate; they kill good as well as bad. A yeast infection may develop as a result, leading to diaper rash. Antibiotics also increase the likelihood of diarrhea.
This can also apply if a breastfeeding mother is taking antibiotics; they can pass to the baby through the milk. (5)
We have already mentioned that a baby’s skin is delicate and sensitive. This is because the lower layers of skin are thin and still developing.
The thinner skin means it is more likely to be overhydrated by urine retained within a diaper. It becomes more permeable and fragile, letting irritants pass into the skin. (6)
Diaper rash can occur at any age; about 5% of children will develop severe diaper rash during their infancy. The highest incidence of moderate diaper rash seems to occur in infants aged between nine and twelve months. This could be because older infants diapers are changed less often and their diet is changing as they are weaned. (7)
Babies and infants who are breastfed seem to have lower incidences of moderate or severe diaper rash.
The acidity of urine and feces in breastfed babies is reported to be lower, and intestinal bacteria different to those fed with baby formula. These factors could contribute to less diaper rash. (8)
Candida albicans is the most common type of fungal infection caused by yeast. This fungus lives in the digestive system. (9)
Generally, this yeast does not cause any infection; however, it can exacerbate diaper rash. (10)
An increased number of bowel movements can also affect the severity of diaper rash. This is likely to be down to extended contact of the skin with feces. (11)
Frequency of Diaper Changes
The environment created by wearing diapers leaves the skin susceptible to diaper rash. This is the case whether using cloth or disposable diapers.
It is important diapers are changed frequently, particularly when wet or soiled. Feces contain enzymes which can increase the acidity level in the skin and leave it more susceptible to diaper rash.
Disposable diapers containing an absorbent gel may be more beneficial in preventing the onset of diaper rash. (12)
Mild diaper rash will be seen as redness in the areas affected. This often clears up quite quickly without treatment, particularly when diapers are changed frequently.
Moderate diaper rash will also be red and the skin could be a little scaly. There might also be a raised rash or small pimples on the skin.
If the condition worsens, the skin will become redder, more inflamed and hot to the touch. There will be an extensive rash and blisters or pus filled pimples could appear on the skin. There may also be open, oozing areas where the skin has broken down. (13)
If a yeast infection is involved, then the rash will be red and slightly raised. There could be small red dots extending across the skin, beyond the borders of the rash. You may find this begins in the deep creases at the thighs or buttocks and spreads up the front and back of the diaper area. (14)
While there are over the counter remedies for diaper rash, if these are not working or if you are concerned, you should seek medical advice.
Your doctor will make a thorough examination and review medical history, including how long the diaper rash has been present. They will want to know if the rash has caused pain or appears to itch.
The diaper type you use and frequency of diaper changes are noted. Tell the doctor whether you have made any changes to baby’s diet. Also inform them of switches to any products that come into contact with the baby’s skin.
Inform your doctor if either your baby or yourself (if breastfeeding) have been prescribed antibiotics recently. Frequent stools can increase the incidence of diaper rash, so let the doctor know if bowel movements have changed.
The doctor will examine your infant to diagnose diaper rash. There are other conditions to be considered as well, such as eczema, psoriasis, bacterial and viral infections. Rarer skin conditions include intertrigo (an inflammatory condition in the skin folds) or a rash caused by zinc deficiency. (15)
What is diaper rash? Diaper rash is a red, sometimes scaly, rash or inflammation which appears most commonly on your baby’s bottom.
What causes diaper rash? This condition is usually caused by an irritant to the skin, like urine, feces, change of food, or medication. Changes to products, like detergents, cleansing wipes and creams, can also cause diaper rash.
How do doctors test for diaper rash? A doctor will thoroughly examine the area and review the child’s medical history, noting any changes in diet and other possible irritants.
When should you go to the doctors with diaper rash? If the diaper rash is persistent or causes concern, then you should see a doctor.
Can you prevent diaper rash? There are steps you can take to help prevent diaper rash. Allow the infant to go without a diaper for a while, to let air get to the skin. Use barrier creams to protect a baby’s delicate skin from urine and feces. Cleanse the skin well with unperfumed wipes or water and a washcloth. Most importantly, change diapers frequently.
What can relieve diaper rash? There are over the counter medications and creams your pharmacist can advise you about, which help relieve this condition.
How do doctors treat diaper rash? A doctor may prescribe anti fungal, anti bacterial or corticosteroid treatments to treat diaper rash, depending on the diagnosis. (16)
Are there any natural remedies for diaper rash? Anecdotally, products like evening primrose and a mixture of honey, beeswax and olive oil have been used for diaper rash, but their efficacy has not been proven. Shampoo-clay (bentonite) and breast milk have also shown to help relieve this condition. (17, 18)
Diaper rash is a red, sometimes scaly and tender rash which can be inflamed and appears on your baby’s bottom. While this condition usually affects babies, it can happen to anyone who needs to wear a diaper.
Diaper rash can be uncomfortable and might make your baby fussy and unhappy. Fortunately, there are many ways to prevent and treat this condition successfully.
The main points to remember are: change a diaper frequently, urine and feces irritate the skin the most. Cleanse with gentle, non irritant wipes, or water and a washcloth. Use barrier creams to protect the skin and, whenever you are able to, remove the diaper and let air get to the skin.