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Dr Emily Altman answers “How to treat a diaper rash?”

Diaper rash is a rash that develops in the diaper-covered area. Most commonly it’s caused by irritation from urine or stool. Diaper rash rarely involves the groin folds because those areas are not in contact with irritants.

Skin infections can either cause a diaper rash or be superimposed on it. Bacterial (Staph and Strep) and yeast/fungal (Candida) are common causes of diaper rash. These may look like pustules or erosions on an area of redness.
If a diaper rash is resistant to treatment and looks like a bright red, painful rash around the anus, a skin culture may need to be done as perianal Strep infections present that way.

Allergic reactions are a less common cause of diaper rash. Fragrances, components of the diaper, and particularly wipes are common causes of allergic contact dermatitis.

Introduction of new foods can sometimes lead to a diaper rash because it may change the consistency or frequency of the stool. If you are breast feeding, something you eat, particularly tomato-based foods, can also affect the baby’s stool.

If the baby is given antibiotics, he/she would be more likely to develop a diaper rash with a yeast infection, as antibiotics affect the balance of the intestinal flora (yeast vs. bacteria)

There are also very rare causes of diaper rash, such as metabolic and nutritional deficiencies and immunodeficiency states. Usually these present not only with a diaper rash, but rashes around the mouth and failure to thrive.

So, because diaper rash is primarily an irritant dermatitis due to contact with urine and stool, it is necessary to minimize contact with those irritants by changing diapers more frequently.

Even though diaper rash is very common between the ages of 4 and 15 months, there are steps to take before the rash develops:

  • Keep the diaper area clean and dry.
  • Don’t use baby wipes to clean after a bowel movement. They can irritate. Use lukewarm water to rinse, then pat dry. Unfortunately that is not always easy to do when out with the baby.
  • If you must use a wipe when you are not home, use a fragrance and dye-free wipe, but try to minimize their use.
  • Do not use baby powder. The baby can actually inhale the particles when you are using it. Starch-based powders make yeast infections in the diaper area worse.
  • Use a barrier ointment with zinc oxide, such as Desitin, Balmex, or my favorite, Triple Paste (NFI) at every diaper change to prevent irritation from urine or stool.
  • If it’s possible to have periods of time when the baby is without a diaper, that goes a long way towards keeping the area dry.

What to do if the baby does develop a diaper rash:

  • Keep doing all the preventative measures as above.
  • Using an antifungal cream, like the over the counter, clotrimazole, particularly mixed in with the zinc oxide cream half and half is helpful.
  • If there is a lot of inflammation, adding hydrocortisone to the mixture for 2-3 days ONLY will help ease the discomfort, however anything longer than 2-3 days may lead to a worsening of the rash.

Diaper rash is usually easily treated and improves within a few
days after starting home treatment. If your baby’s skin doesn’t improve after a
few days of home treatment with over-the-counter ointment and more frequent
diaper changes, talk to your doctor. Sometimes, diaper rash leads to secondary
infections that may require prescription medications.

Call your doctor if:

  • The rash gets worse or does not go away in 2-3 days despite home treatment.
  • The rash spreads to the abdomen, back, arms, or face
  • You notice pimples, blisters, ulcers, large bumps, or pus-filled sores
  • Your baby also has a fever
  • Your baby is taking an antibiotic and develops a bright red rash with spots at its edges. This might be a yeast infection
  • Your baby develops a rash during the first 6 weeks of life
  • If the rash is severe

References:

  1. PubMed Health http://www.ncbi.nlm.nih.gov/pubm…
  2. Mayo Clinic http://www.mayoclinic.com/health…
  3. Medicinenet http://www.medicinenet.com/diape…

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