DIAPER RASH

DIAPER RASH

Nothing can be more disheartening than changing your baby’s/child’s diaper and finding a solid red raw area of skin or multiple areas of red pimples all over the diaper area. The rash may be confined or may extend from one area of the diaper to another. It is probably the most common type of rash seen in the under two years age group. Diaper rash is any rash that is found within the confines of the diaper.

Among the most common reasons are:

  1. Contact irritation due to the diaper itself...both from the paper in the diaper and the plastic/elastic bands that keep it snug around the thigh. In cloth diapers from washing with strong soaps or detergents. Probably the most common of the five. The areas start out red, rough and irritated and goes on to become palr red and shiny. Sometimes you can match up a specific area on the skin to the causative area on the diaper.
  2. Irritation due to the prolonged presence of urine and feces in the diaper. This starts out as a red pimply eruption and proceeds with break down of the skin with the area becoming raw. The involved areas would be the genitals and the anal opening.
  3. Irritation in the thigh creases due to sweating and maceration (rubbing of two sides of the skin together)...a problem referred to as intertrigo. This rash is red, and mirror image. It is found in the creases of the thigh, along the suprapubic region or between any skinfold. The area may be moist and a pasty discharge may be present.
  4. Irritation around the anal opening and the buttocks secondary to acidic foods or frequent diarrhea stools, or both. This is a red, raw looking rash with a burned out look.
  5. Irritation is mostly confluent (although sometimes pimply), raised, red areas due to a fungus (candidiasis), most commonly secondary to antibiotic therapy. Borders may be well demarcated. Usually some satellite pimples outside the border.

    The general treatment for diaper rash is to keep the area clean and dry. Frequent diaper changes and washing the area to keep it clean should be sufficient to prevent the rash from recurring. Barriers such as Vaseline or Aquaphor help to keep the areas free from the effects of urine and feces and also provide a frictionless surface so that the effects of the rubbing of the diaper are minimal. For rashes that have a burned skin appearance that may be due to acidic stools or contact with urine or feces my approach is to wash the area with Ivory soap and rinse with water. Afterwards blow dry the area with a blow dryer on a mild heat setting. Keep the diaper area open to fresh air for as long as possible and then apply a diaper paste that acts both as a barrier and a drying agent (usually contains aluminum acetate) to promote quick healing. If a fungus is present in the rash then a combination of OTC preparations such as lotrimen cream and 1% hydrocortisone cream could be used effectively. Apply twice a day along with your usual diaper cream. Other prescription therapies are available. If thrush (oral fungus caused Candida Albicans, that causes white patches in the mouth: on the lips, cheeks, and tongue) is present as well then additional treatment should consist of oral therapy (either Nystatin or Diflucan) as prescribed by your pediatrician.

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