Diaper Rash

The four main causes of diaper rash: 

• CONTACT DERMATITIS
• Due to friction and trapped moisture
• Usually seen on the rounded skin surfaces sparing the skin folds where the diaper doesn’t touch
• Appears red and shiny
• Occasionally may be an allergic reaction to diapers and wipes
• Commonly occurs after 3 months

• CANDIDAL INFECTIONS
• Intense “beefy” red rash with sharp borders and red “satellite” bumps beyond the borders
• Will be present within the skin folds
• Often baby will also have “thrush” – a whitish yeast infection in the mouth

• ATOPIC DERMATITIS
• Usually not seen before 2 months of age
• The eruptions will ooze and crust
• May be dry, itchy patches on other parts of the body

• SEBORRHEIC DERMATITIS
• May be seen as early as 3-4 weeks of age
• Rash begins in folds and extends towards rounded skin surfaces without sharp borders
• Appears as yellowish, greasy, scales and may also be seen on scalp (“cradle cap”), face and behind ears

MORE SERIOUS INFECTIONS – CONTACT DOCTOR IMMEDIATELY
• BACTERIAL INFECTION
• Most commonly Staph
• Appears as large fluid filled blisters that easily rupture showing a red base

• SCALED SKIN SYNDROME
• Blood born illness
• May see skin rupture and peeling beginning under diaper area
•  Quickly spreads and exfoliation occurs on entire body

GENERAL GUIDLINES
• Because moisture and friction cause or worsen all forms of diaper rash – keep area dry and free from occlusion
• Change diapers more frequently and expose diapered area to air more often
• Wash area with plain water, sterile saline, or chemical free wipes (calendula soap after bowel movement if necessary)
• Wash cloth diapers in mild/hypoallergenic soap
• Avoid rubber pants
• Avoid petroleum jelly, baby (talcum) powder, cornstarch, baking soda, and medicines containing “fluorinated corticosteroids” which have local side effects including skin atrophy

TREATMENT
• Increase water intake if not breast feeding
• Avoid food allergens and sugar in baby’s and nursing mother’s diet
• Several times a day use a topical treatment that includes zinc oxide, or calendula
• See your baby’s doctor if rash does not respond to above guidelines within one week

Resources
1. Dyson N.D., Linda. Pediatric Topics. 2001.
2. Dershewitz M.D. Ambulatory Pediatric Care 3rd Edition.

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