Family Health Magazine - CHILDHOOD
The Bottom Line
Babies have such sensitive skin that diaper rash (diaper dermatitis) is a common and frustrating problem. Although diaper rash may seem like one condition, it can develop in several different ways. Fortunately, diaper dermatitis can be prevented and treated.
In a baby, skin is thinner, less hairy and has fewer gland secretions. Covered skin in the diaper area can be irritated by moisture, heat, friction and soiling. This may become a cycle, as shown in Figure 1. In most cases, the cycle ends when the diaper rash heals after two or three days.
Type 1 – Irritant/abrasion/ chafing dermatitis
This is the most common type of diaper rash. It comes and goes, often appearing along with mild discomforts such as diarrhea, colds, and teething. The rash is red, shiny, and may have a mild flaking of the skin. The genitals, buttocks, abdomen, and inner thighs are usually affected, while, unlike rash caused by yeast, deep groin skin folds are not. This rash normally clears up without help. To speed up the process, keep the area dry and clean, change the diaper frequently and apply petroleum jelly or a zinc-based or other barrier cream.
To Prevent Diaper Rash
- Change your baby’s diaper often.
- Avoid over-cleansing and scrubbing the diaper area.
- Use petroleum jelly or
- Wash and rinse cloth
- Wash your hands well after changing your baby.
Type 2 – Yeast/monilia/candida albicans dermatitis
If the first type of diaper rash is not treated properly and becomes severe, this rash can develop. It is hard to say whether yeast is normally found in a baby’s diaper area or if it just grows under the right conditions. It may be that yeast begins growing in any Type 1 diaper rash that does not heal in two days or that is treated with steroid creams. This rash is a sharply outlined area of glistening redness involving the thighs, genitals, abdomen, back, and, unlike the irritant rash, groin creases. It begins as small red bumps or blisters that rapidly join together. Around the borders, more red, pimply bumps appear to spread, like satellites. These lesions can become scaly. Since this can be a painful rash, the baby may cry when urinating or having a bowel movement. An anti-yeast preparation such as nystatin or imidazole cream can treat this severe diaper rash. Steroid creams are not required and may make it worse.
Type 3 - Infantile seborrheic dermatitis
- Up to 45 per cent of all babies experience diaper rash.
- It occurs most often in the seven-to 10-month age group and equally often between boys and girls.
- The chance of diaper rash increases dramatically if there has been diarrhea in the last 48 hours.
- Moderate and severe diaper rash is more likely with more frequent bowel movements and less likely if diapers are changed often.
- Infants in disposable diapers are drier, and tend to have fewer,
less severe rashes.
- Breast-fed infants have fewer, less severe rashes.
- Detergents, bleaches, improper use of steroid creams and over-scrubbing and cleansing the delicate diaper area can all cause rashes.
- Some infants are more likely to be affected by diaper rash. Whether this is due to the care they receive or to naturally sensitive skin is not yet clear.
This rash begins in the diaper area from the age of two to 12 weeks. It is a sharply bordered area of redness and may have the same type of red spreading satellite lesions as seen in the yeast-type diaper rash. Within a few weeks, babies may develop similar rashes on arms, legs, and scalp (often referred to as cradle cap). This rash can vary, in some cases being very greasy and in others, dry and scaly. Babies are not usually bothered by this rash, and it responds well to a mild steroid cream.
Less common diaper rashes
- Impetigo – This bacterial infection is often seen in the summer and occurs during the first six months of life. It takes the form of small areas of raw skin and crusty scabs. Usually, antibiotics are taken by mouth to treat it.
- Folliculitis – Another bacterial infection, folliculitis appears as red bumps around the hair follicles on the thighs, buttocks, and lower abdomen. If the condition is mild, no treatment is necessary. In more severe cases, antibiotics can be given by mouth.
- Atopic Dermatitis – This rash is linked with an inherited tendency towards allergies. It does not usually affect the diaper area.
- Psoriasis – This condition is uncommon in a young child. If it does develop, it can be difficult to treat with steroid creams.
- Intertrigo – These rashes don’t fit into the other groups. Redness appears in areas where the skin folds and moisture, heat, friction, and debris all irritate the skin. The stage is set for low-grade bacterial or yeast infection. Treatment consists of keeping the area dry.
While there are distinct varieties of diaper rash, it is often difficult to tell them apart. Some babies may have overlapping problems. The more common types are a periodic (low ph) rash occurring in response to diaper wetness, acidity and irritants in urine or stool, and friction that damages the skin. If the rash is mild, it can disappear on its own. Paying extra attention to cleaning, drying and diaper changes will help. If the rash persists and conditions remain unfavourable, a more severe rash can develop and yeast or bacteria can become involved. In this case, check with your family doctor.
Although diaper rash is a frustrating problem, with frequent diaper changes and good skin care, our babies may some day be able to turn the other cheek!
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6 [CH_FHc07]