Diaper rash – the painful red irritated dreaded rash all babies experience at least once. Some babies seem to get them repeatedly and some only occasionally. But nothing is more heart wrenching than a sore bottom and screaming diaper changes knowing your baby is in pain.

What Is Diaper Rash?

Diaper rash occurs when the skin’s outermost layer is compromised, causing it to become more permeable and easily damaged by urine and stool acids and enzymes. Wetness from urine and stool is the most common cause of the breakdown of the skins barriers. When this happens, it can also create a window of opportunity for bacteria and yeast to take advantage, creating infections that need specific medical treatments. Many medical entities fall under the term diaper rash, and causes include burning from bile acids in stool, friction, irritants, allergies, infections, seborrheic dermatitis, chronic diarrhea, malabsorption, or other more significant diseases.

Common Types of Diaper Rash

Friction – This is a common cause of redness in areas of the skin where the diaper meets the body such as at the hips or thighs. It is quickly remedied by loosening the diaper, leaving the diaper off for a few minutes and applying a barrier ointment such as Aquaphor to the area

Irritants – Irritants such as urine, stool, creams, wipes, or soaps can cause red, flat, sore areas where the irritants touch the skin. In general, this type of diaper rash spares any inner folds and creases, and rather occurs on the buttocks, vulva and scrotum. It can be quite painful for the baby. It may occur when the baby has diarrhea from illness or antibiotics, or may happen after being left in a wet or soiled diaper for too long. Harsh wipes, soaps, or even chemicals in the diapers may be the culprit as well.

Allergies – Some babies may develop an allergy to their diapers, wipes, or soaps. This may cause a contact dermatitis, or atopic dermatitis (eczema). They can also get eczema in this area simply because the skin is compromised by chronic wetness. Allergic skin appears to be bright red and rough. It may seem dry and sometimes will even get blistered. If your baby has other areas of her body with eczema, this may also be a clue that she has eczema in the diaper region as well.

Yeast – Yeast is perhaps one of the most common opportunistic infections that comes with a diaper rash. This type of rash will often occur after a few days of redness or after regular barrier diaper creams aren’t working. The redness is beefy and dark and often the infection will create redness in the creases and folds of the area. Small circular lesions will also commonly start on the edges of the redness.

Bacterial – When the skin barrier is broken down, another opportunistic organism is bacteria. Skin bacteria such as Staph and Strep will invade the area and cause infection. For an older child out of diapers, Group A Strep can colonize in the rectum and cause an intermittent bright red area around the anus that may be itchy or uncomfortable. These infections require topical and sometimes oral antibiotics.

Treatments for Diaper Rash

Basic diaper area protectants – These products tend to be ointment based and have healing ingredients such as oils, calendula, and beeswax. They are best for day to day protection against diaper rash, or for mild pink skin. Once the skin barrier is truly broken down, they tend not to be as effective for healing the skin, and I recommend moving to a zinc based barrier cream. Recommended products in this category include Aquaphor, Mother Love Balm, CeraVe Healing Ointment, and Burt’s Bees Multipurpose Ointment.

Zinc based cream –The mainstay of treatment for diaper rash is a barrier cream. Barrier creams sit on top of the skin and protect it from urine and stool, allowing for the underlying skin to heal. The main ingredient in these creams is Zinc oxide, in varying percentages. Apply them liberally with every diaper change. See my Diaper Rash Treatment Recommendations page for some great products.

Stronger Barrier Ointments – Occasionally I will have a baby with an extreme diaper rash that isn’t responding to our traditional treatments, or has a medical condition that is causing a relentless diaper rash. Jacquet’s’s Diaper Dermatitis is one such entity. In these cases, I will often suggest ILEX ointment or Criticaid ointment. These are both products used to protect burns or ulcers and work beautifully for severe diaper rashes. Consult your doctor before using.

Yeast Creams – Once yeast has settled in to the skin, it needs to be treated with an anti-fungal cream. Clotrimazole 1% cream or ointment is a good choice. Apply with diaper changes and apply a zinc based cream on top of it as well.

Hydrocortisone Cream – Hydrocortisone 0.5% or 1% over the counter ointment or cream is useful for eczema based or allergic diaper rashes. Consult your pediatrician before using this on your baby.

Anti-bacterial ointments – Prescription topical cream is used for specific bacterial infections.

Other Helpful Treatments

In addition to using protective creams, there are other things one can do to help a baby suffering from diaper rash:

1. Give the baby some diaper-free time. Let him crawl around naked or lay on a blanket diaper-less for as much time as you can during the day. The air dries the diaper area out and the exposure to sunlight helps prevent yeast from taking over.

2. Change the diaper frequently. The less time the urine and stool sits on the skin the better. This is especially important when on antibiotics, which can cause diarrhea.

3. Use Water Wipes to wipe. Even the sensitive wipes can be painful and irritating to a baby with diaper rash. So use water wipes or a warm wet rag. Occasionally even dipping the baby in water after stooling is necessary. Make sure to pat or air dry before applying diaper cream.

4. If your baby has diarrhea, consider probiotics to help reduce it, especially if antibiotic-induced.

If your baby has frequent, recurring diaper rashes, consult your pediatrician to discuss possible causes, including something they are eating, skin conditions, or other systemic illnesses.

There are many treatments and ideas for diaper rash – comment below about things that have worked for you!



Dr. Jenna

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