Diaper Rash

2/8/2008

Nearly every child experiences diaper rash at some time. It’s a common problem because it has so many possible causes:

• Urine and stool are very irritating and can cause inflammation when left in contact with sensitive skin for too long.
• Chemicals in disposable diapers can cause redness and inflammation.
• Detergents used to wash cloth diapers can irritate, especially when diaper is wet.
• A virus or food allergy can cause loose bowel movements that are so irritating to a baby’s bottom that they can cause a burn-like loss of top skin layers.
• Plastic diaper covers may keep clothes dry, but they keep baby’s skin wet, encouraging the growth of bacteria and fungi.
• Hot weather can cause sweating that increases moisture the diaper area.

Diaper rash can sometimes be stubborn, but it’s almost always treatable. Different causes require different treatments:

• Contact rashes from irritants like urine require more frequent diaper changes. Keep the area dry, cool and clean. Clean baby with a warm water washcloth. When this isn’t practical, use baby wipes that are chemical- and alcohol-free. Look for baby lotions, powders and creams that contain natural rather than artificial ingredients to reduce the risk of chemical sensitivity.
• You’ll know if your baby is sensitive to a chemical in his disposable diapers or in your laundry detergent if the redness on his bottom is the size and shape of a diaper. Try different detergents or diapers until you find those that work best for your child.
• Diaper rashes associated with diarrhea stools that have caused  sloughing of the skin need a barrier butt paste (see box) applied generously to a diaper area that has been cleaned of all stool with warm water and patted dry. The paste protects the new skin growing in from being scorched by overly acidic or alkaline stools.

Dr. D’s Barrier Butt Paste
I usually use a combination of thick zinc oxide cream, a natural moisturizer such as cocoa butter or an olive-oil-based cream, and a small amount of an over-the-counter liquid antacid like Mylanta or Maalox. Store paste in the fridge or freezer until needed.

• Plastic pants and other barriers that lock in moisture provide a fertile ground for fungal or yeast infections. Candida is especially common in babies, who have not yet developed an immunity to this opportunistic infection. You can tell a Candida infection by the small red dots that creep out towards the thigh from the pubic area, often coalescing to form one contiguous reddish area. Fortunately Candida diaper rashes respond very nicely to anti-fungal drugs such as over-the-counter clotrimazole or prescription Nystatin. I would also suggest adding an oral probiotic to the child’s feedings for several weeks.
• A summer diaper rash with pus-filled bumps can be caused by bacteria growing unchecked in that sweaty diaper. I usually prescribe a topical antibiotic like Mupirocin to treat this infection so it doesn’t turn into full-blown impetigo, which can only be cured by an oral antibiotic.

Most diaper rash resolves in 7-10 days, but occasionally a stubborn case requires switching treatment approaches. Be patient but persistent with diaper rash, and eventually that little tushie will be clear up and be normal again.