When baby has Diaper rash

BY Dr Arusha Campbell-Chambers

Diaper rash, or diaper dermatitis, refers to inflammation of the skin caused by prolonged exposure to body fluids in the diaper area. It is a form of irritant contact dermatitis.

The factors that cause diaper rash include:

1. Prolonged wetness

2. Friction

3. Waste products (urine and faeces, in particular enzymes in the faeces).

4. Microorganisms (yeast and bacteria can secondarily invade skin that is macerated).

5. Diarrhoea

Diaper rash has been found in up to 35 per cent of babies in the first two years of life. It is less common in breastfed babies and also less common when superabsorbent diapers are used. It can also occur in adults who cannot control their urination. The most common symptoms of this condition are pain, which may cause babies to cry excessively during diaper changes or with urination and defecation, and itching.

Shiny reddish skin

The area can be shiny and reddish, with or without scaling, red bumps, water bumps or raw skin. Usually, it is the prominent part of buttocks, thighs and genitals that are affected, while the creases are usually spared. In cases where there is an overgrowth of yeast in the area, red bumps, pus bumps, redness with sharp borders, scattered satellite bumps outside the border and maceration are often present. The skin creases are usually involved in these cases.

Other conditions which may cause a rash in the diaper area include:

Seborrhoeic eczema - redness and scaling in the diaper area, skin folds, scalp (cradle cap), face and neck.

Atopic eczema - red bumps, water bumps, scaling, oozing or dry, thick scaly areas usually affecting face, neck, outer aspects of arms and legs in infants and may also occur in diaper area.

Psoriasis - dry, well-defined patches with thick, white scaling. Lesions are usually present elsewhere.

Advice to caregivers

Diaper rash can be diagnosed with a clinical evaluation. Special laboratory tests are not routinely required; however, they may be ordered if deemed necessary. Advice to parents and other caregivers regarding care of the diaper area include:

1 Frequent diaper changes to reduce the exposure of the skin to urine and faeces.

2 Gentle cleaning of the skin (avoiding harsh soaps and fragranced wipes, use non-perfumed products instead, avoid scrubbing the area).

3 Using superabsorbent diapers if possible. Newer options also include breatheable diapers, diapers that deliver petrolatum to the skin, and those that let out water vapour but absorb moisture.

4 Avoiding tight-fitting diapers.

5 Using barrier creams, for example, zinc oxide or petroleum jelly, with every diaper change.

6 Cornstarch and talc powders are not as protective of the skin as barrier creams and so are not ideal.

7 Medical attention should be sought if over-the-counter remedies are not working, if rash is recurrent, fever develops, excessive pain, bleeding and/or blisters are noted.

Medical treatments include mild steroid creams and ointments, for example, one per cent hydrocortisone, and antifungal creams and antibacterial creams as needed. In severe cases, oral antibiotics may be prescribed to treat infection with bacteria.

Dr Arusha Campbell-Chambers is a dermatologist and founder of Dermatology Solutions Skin Clinics & Medi-Spas; email: yourhealth@gleanerjm.com.