Diaper rash

What is a diaper rash?

Diaper rash is a common skin rash in babies who wear diapers. Most babies will get diaper rash at some time while they are in diapers, but there are some simple things you can do to help prevent problems.

Causes

Diaper rash is caused by irritation of the skin in the diaper area, usually around the buttocks and groin, as a result of prolonged exposure to urine and stools contained by diapers.

There are a number of other factors that can contribute to the irritation of the baby's skin:

• Rubbing of the skin by the diaper;
• Chemicals in urine such as ammonia;
• Traces of detergent in the material of cloth diapers;
• Infection, and;
• Some skin conditions, such as eczema and contact dermatitis.

Signs and symptoms

The symptoms of diaper rash include:

• Red, inflamed skin in the area of skin covered by the diaper;
• Blisters, and;
• Ulcers, which can occur when blisters burst.

The rash may spread to areas beyond those covered by the diaper.

Babies may be unsettled due to the discomfort of the rash, particularly when skin is wiped or comes into contact with urine. Older babies may scratch at skin in the affected area.

Methods for diagnosis

A simple examination by a doctor is usually enough to diagnose diaper rash. If the doctor suspects that another infection or health condition is causing the rash, they may recommend other tests from a skin swab.

Types of treatment

Most cases of diaper rash can be cared for at home. There are simple things you can do to help your baby to get better:

Using diapers

To minimize irritation of the skin:

• Choose a disposable diaper with good absorbency, as this helps to minimize contact of the urine with skin;
• Change the diaper often, preferably as soon as you notice they are wet. For infants this may be around 5-7 times a day, and;
• Avoid fastening the diaper too tightly.

If you choose to use cloth diapers:

• Drying diapers in a tumble dryer can help make them softer to reduce skin irritation;
• Using soft diaper liners may help to protect skin;
• Avoiding plastic pants can reduce the amount of moisture held against the skin, and;
• When hand-washing diapers, rinsing them thoroughly can help to remove all traces of detergent.

Cleaning baby's skin

Keeping skin clean of stools and urine can help to reduce irritation, but it is important to remember that over-cleaning of the skin can also cause irritation. To help minimize this, you can:

• Avoid or minimize use of soaps and cleansers, including baby wipes, that can have irritating ingredients, such as alcohol;
• Use a soft cloth or cotton wool rinsed in warm water to clean skin, and;
• Gently wash and pat dry, rather than rubbing the skin.

Applying barrier creams

Another way to help protect the skin is to apply barrier creams, such as zinc cream or soft white paraffin. Only apply barrier cream to areas where there are no breaks in the skin.

Avoid talcum powder as it can irritate the skin. As this is a fine powder, there is also a risk of it being inhaled by your baby.

If the diaper rash is severe, it does not improve within one week or spreads beyond the diaper area, your baby may need review by a doctor.

Medications

Medicated creams may be used in more severe cases of diaper rash. Creams containing a weak anti-inflammatory medication, such as hydrocortisone 1%, can help to reduce inflammation in the skin. All medicated creams containing cortisone must be used with medical advice, as prolonged or inappropriate use can lead to ulcers in the skin.

Potential complications

Diaper rash may develop into a skin infection. The usual signs are worsening redness, blisters, and possibly pus. Also, new areas of affected skin may develop beyond the main rash. This is particularly common with fungal infections, commonly known as thrush. If the diaper rash becomes infected, antifungal and/or antibacterial medication may be needed. Your doctor can advise if these are necessary.

Prognosis

Most cases of diaper rash get better within a week. However, repeat episodes of diaper rash can occur. It is important to consider ways to prevent them.

Prevention

To reduce the risk of your baby developing diaper rash:

• Use disposable diapers as they are more absorbent than cloth diapers, therefore the skin is kept comparably drier;
• If you prefer cloth diapers, it is best to dry them in a tumble dryer as it can help make them softer. If hand-washing diapers, rinse them thoroughly to help remove all traces of detergent.
• Use soft diaper liners to help protect the skin;
• Avoid plastic pants as they reduce the airflow and absorption of moisture from the skin;
• Frequent diaper changes are important - 5-7 times per day - to reduce the time that the skin is in contact with irritating urine and stools. Also, allow periods of time where your baby does not wear diapers;
• Wipe baby's bottom with each diaper change with cotton wool or a clean cloth dampened with lukewarm water. Avoid or minimize use of soaps and cleansers, including baby wipes, that can have irritating ingredients, such as alcohol. Avoid talcum powder as it can also irritate the skin, and;
• Apply a barrier cream with each diaper change to protect the skin. Seek help from your pharmacist or doctor if you are unsure what to use.

References

1. Board A. D. A. M. Editorial. Diaper Rash. PubMed Health August 22 2013. link here
2. Clinical Practice Guidelines?: Nappy Rash. Accessed July 11 2014. link here
3. Kids Health Info?: Nappy Rash. Accessed July 11 2014. link here
4. Murtagh John MD. John Murtaghs General Practice. 5th Revised edition edition. North Ryde N.S.W.: McGraw-Hill Medical Publishing 2011.
5. Nappy Rash. Better Health Channel. Accessed July 10 2014. link here

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