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Diaper Rash & Irritation

FAQ: What is diaper rash or diaper irritation?

There are many different types of diaper rash or diaper irritation.

  • Friction rash: This is the most common form of diaper rash, and affects almost all babies at some time. It is most common on areas where friction is most pronounced, such as the inner thighs, or under the elastic of diapers that are too tight. It comes and goes quickly, and responds well to frequent diaper changes, airing out, and protective barriers.
  • Irritant rash: This type of diaper rash is most conspicuous on the exposed areas, such as the round part of the buttocks. It  usually doesn’t occur in skin folds and creases. It's generally the result of contact with stool enzymes or irritants such as harsh soaps, baby wipes, detergents, or topical medicines.
  • Allergic rash: This may occur in combination with an irritant rash or by itself. It is also more common on exposed areas. The skin may look like it’s been exposed to poison ivy.
  • Heat rash (caused by the blockage of the pores that lead to the sweat glands) is most common in very young children but can occur at any age. When the weather is hot or humid, the infant sweats, but because of the blockage of the sweat glands, this sweat is held within the skin and forms little red bumps, or occasionally small blisters in young infants.
  • Prickly heat causes rash or blotches during hot weather or in a hot environment (the same as heat rash).
  • Intertrigo: Moist heat causes this common type of diaper rash that occurs deep in the skin folds. The involved skin looks thin, as if it has lost several layers.
  • Seborrhea rash: A salmon-colored, greasy rash with yellowish scales characterizes this diaper rash that is also worse in the skin folds.
  • Psoriasis: This stubborn diaper rash doesn't necessarily look distinctive. Other signs of psoriasis usually accompany the diaper rash, though, such as pitting of the nails or dark red areas with sharp borders and fine silvery scales on the trunk, face, or scalp.

What causes diaper rash?

Skin wetness is the common denominator underlying the various causes of diaper rash. Urinary wetness increases skin friction, raises the skin pH, makes the skin less cohesive, and makes it more permeable. These effects combine to intensify the action of stool enzymes or other irritants that then inflame the skin. In all the above diaper rashes, the outermost layer of skin has been damaged. With this protective layer compromised, it is easy for microorganisms such as yeast or bacteria to invade the inflamed skin. This makes the rash worse and less responsive to usual treatments.

Yeast is by far the most common type of organism found in a diaper rash. The organism is quite prevalent and thrives in warm, moist skin. Yeast involvement should be suspected in any diaper rash that has not improved dramatically with 72 hours of appropriate therapy. Current or recent antibiotic use makes a yeast infection even more likely, since this reduces the amount of the skin's 'good' bacteria that fight infection. Classically a yeast rash is beefy red with sharp raised borders and white scales. Smaller lesions surround the main rash. Even without the classic pattern, however, yeast is often present.

What are the signs and symptoms?

  • The skin might be red.
  • The diaper rash is usually on the stomach, genitals, and inside the skin folds of the thighs and bottom.
  • The diaper rash may be warmer than other skin.
  • Your baby may seem uncomfortable, especially when you are changing her diaper or washing her diaper area.
  • More severe cases of diaper rash may have painful, open sores.

How common is diaper rash?

Diaper rash is very common.  All infants develop a diaper rash at some time or another; some even arrive home from the hospital with a slight rash. Still, diaper rash may be more common after solid foods are added to your baby's diet or when your baby is taking antibiotics. Other factors that can lead to diaper rash include continuously wet or infrequently changed diapers, diarrhea and the use of plastic pants to cover a diaper.

  • Many babies between the ages of 4 months and 15 months get diaper rash.
  • Diaper rash is most common between the ages of 8 to 10 months.
  • Diaper rash is more common in babies who have many stools, especially if the diaper is not changed overnight.
  • Diaper rash is more common in babies who have started to eat solid foods.
  • Diaper rash is more common in babies who are taking antibiotics.
  • Diaper rash is more common in babies who are nursing from mothers who are taking antibiotics.
  • Babies with a sensitive skin condition, such as eczema, are more likely to get diaper rash.

Is diaper rash contagious?

  • Diaper rash is usually not contagious.

How is diaper rash treated?

  • It may be helpful to remove the diaper and let your baby's skin be open to the air. Set your baby on a few cloth diapers or on a blanket over a plastic sheet. Use the time to play.
  • If you use disposable baby wipes and your baby has a rash, you may need to switch to another brand or stop use all together. Plain water is best.
  • Some products can irritate young skin. If you use harsh detergent, bleach, or fabric softener, you may need to change brands or stop using the product.
  • Use a thick ointment or balm on your baby's bottom. It helps protect the skin. Apply after each changing.
  • Avoid using adult products on your baby's skin.
  • You may want to try using a different brand of diapers if you think they are irritating your baby's skin and contributing to diaper rash.
  • Avoid using talcum powder. If inhaled, it could irritate your baby's lungs.
  • Avoid using cornstarch. It may help bacteria grow in your baby's diaper area.

Can diaper rash be prevented?

  • Keep the diaper area dry and clean. Change your baby's diaper often. Babies usually have 6-8 wet diapers every 24 hours.
  • Avoid using disposable baby wipes. They can irritate or dry out the skin. Wash your baby with each changing using plain water. Pat the skin to clean it. Do not rub.
  • Avoid using harsh soap. Gentle soap is best. Using soap once a day is enough.
  • Gently pat the diaper area dry after washing it. Do not rub it or use a hair dryer.
  • Avoid dressing your child in plastic pants. They do not let the diaper area get enough air.
  • Avoid using tight fitting diapers that could rub against the skin.
  • Use mild detergents to wash diapers.
  • Avoid using fabric softeners or antistatic sheets when washing diapers.

How long does diaper rash last?

  • Mild cases of diaper rash may clear up in 3 to 4 days without any treatment.
  • Some cases of diaper rash take several days to improve, even with treatment.
  • The diaper rash can last for weeks.

When do I seek medical help for diaper rash?

Diaper rash is easily treated in most cases and improves within several days after starting home treatment. If standard treatments such as frequent diaper changes and over-the-counter ointments don't bring improvement after a few days, consult your doctor. In some cases diaper rash can lead to secondary infections that may require prescription medications. Have your child examined if the diaper rash is severe, worsens despite home treatment or occurs along with any of the following:

  • Fever
  • Blisters or boils
  • Bleeding
  • Crusty areas
  • Bright red spots that together form a solid red area with a scalloped border
  • Pus or weeping discharge
     
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