Diaper rash: Dermatologist Guide

Baby skin care

Diaper rash: Dermatologist Guide

“Doctor, Why does my child get diaper rash so often? Does my baby has diaper rash or yeast infection? How can I prevent diaper dermatitis?”

Diaper rash is so common, that most children in first year get diaper rash. This is so because they urinate and defecate frequently. In this article, I have answered the various question from parents who face the vows of diaper rash or nappy rash.

Symptoms of diaper rash

Diaper rash begins with redness in the genitals and in the area of the thigh that comes in contact with the diaper. If precautions are not taken, the redness will increase and skin will appear moist and macerated. In the worst case, bumps and blisters develop.

Rarely, the rash may spread beyond the diaper area. The involvement of fold indicates superadded fungal or bacterial infection. Infants might try to touch or scratch the diaper area or cry when you touch it. The older ones might resist putting diapers.

Cause of diaper rash

Following factors contribute to the development of diaper rash:

  • Frequent soiling: Frequent urine and stools irritate the tender skin of your baby.
  • Incorrect use of diaper: The incorrect use of diaper like fastening too tight (suffocate this area further) and delay in the nappy or diaper change can leave your kid’s bottom eventually bathed in urine.
  • Diet: The problem might increase when solid foods are introduced because this further increases the irritant effect of urine and defecated matter.
  • Diarrhoea: For obvious reasons episodes of diarrhoea can trigger diaper dermatitis.
  • Antibiotics: A course of antibiotics that kills the good bacteria in the gut of your baby can also trigger diaper dermatitis.

Diaper rash versus yeast infection

The diaper rash affects the convex surface of the diaper area and spares the folds, but the yeast infection involves the fold primarily.

Prevention of diaper dermatitis

The general principle is to keep this area dry, free from irritants and moisturised. Here are steps to follow when your child wets the diaper with urine or stool:

  • Step 1 Awareness: Mother should be aware of:
    • The time of the last nappy change,
    • the time baby usually defecates
    • if the crying baby refuses to take a feed, please look at the nappy area.
  • Step 2 Changing the Diaper/Nappy: Please remove the diaper/nappy gently without rubbing the skin of your baby. Clean the urine or stool with a soft cloth soaked in warm water especially the folds.  After this pat dry the area with a soft towel.
  • Step 3 Moisturize: Let the diaper area, especially the folds further air dry for few minutes, followed by application of a bland moisturiser, white petrolatum jelly or coconut oil.  Apply the emollient generously over the diaper area including the fold. This helps in conserving the natural moisturising factors of the skin and works as a barrier that delays the irritant effect of stool and urine.

Treatment of diaper rash

Diaper rash in the form of mild redness only, can be taken care by the above-mentioned steps along with the frequent change of diapers or giving diaper breaks to your kid.

If the diaper rash is severe, then stop the diaper use altogether. Use a plastic sheet to save your mattresses and lay the child on a soft cloth with diaper area undressed. You can put soft cotton loose-fitting cotton pants; that should be changed as soon as they get wet following the steps highlighted above. Fix an appointment with the doctor, if the rash does not settle in a day or two.

Best diaper rash cream

You might need a zinc oxide-based diaper rash cream. There are lots of brands of diaper creams available in the market but, unfortunately, few of them might actually worsen the rash. A general guideline is the diaper cream should be free from

  • fragrance
  • preservative
  • Menthol-containing brands though they may give a cooling sensation, menthol can further irritate skin.
  • Herbs and essential oils

It would be better to ask your paediatrician well in advance which diaper rash cream you should use if required and how frequently it can be used.

When should I visit the doctor?

Diaper rash if tackled at an early stage should heal within 2-3 days. However if the rash is severe, and does not respond to over the counter available diaper rash creams in 2-3 days and if it is spreading beyond diaper area or involving folds; you should consult your doctor. It is important not to ignore such cases as the diaper area may be involved in various skin disorders like atopic dermatitis, seborrhoeic dermatitis, Zinc or Biotin deficiency, etc.

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