DIAPER RASH DEFINITION
Diaper rash is a common form of inflamed skin (dermatitis) that appears as a patchwork of bright red skin on your baby’s bottom.
Diaper rash is often related to wet or infrequently changed diapers, skin sensitivity, and chafing. It usually affects babies, though anyone who wears a diaper regularly can develop the condition.
Diaper rash can alarm parents and annoy babies. But it usually clears up with simple at-home treatments, such as air drying, more frequent diaper changes and ointment.
DIAPER RASH CAUSES
- Leaving a wet or dirty diaper on too long
- Rubbing or chafing against the diaper itself
- Yeast infection
- Bacterial infection
- Allergic reaction to diaper
A harmless rash that’s often seen on a baby’s scalp, called cradle cap, can also show up on his bottom. Doctors call it seborrheic dermatitis.
It causes red, scaly, waxy patches that eventually go away without treatment. You might notice it on other parts of your baby’s body, too.
Babies get a diaper rash more often when they:
- Get older — especially between 9 and 12 months old
- Sleep in poopy diapers
- Have diarrhea
- Start eating solid foods
- Are taking antibiotics, or if you take antibiotics and are nursing
DIAPER RASH PATHOPHYSIOLOGY
The precise etiology of most diaper rashes is not clearly defined. They likely result from a combination of The precise etiology of most diaper rashes is not clearly defined. They likely result from a combination of factors that includes wetness, friction, urine and feces, and the presence of microorganisms. Anatomically, this skin region features numerous folds and creases, which present a problem with regard to both efficient cleansing and control of the microenvironment.
The main irritants in this situation are fecal proteases and lipases, whose activity is increased greatly by elevated pH. An acidic skin surface is also essential for the maintenance of the normal microflora, which provides innate antimicrobial protection against invasion by pathogenic bacteria and yeasts. Fecal lipase and protease activity is also greatly increased by acceleration of gastrointestinal transit; this is the reason for the high incidence of irritant diaper dermatitis observed in babies who have had diarrhea in the previous 48 hours.
The wearing of diapers causes a significant increase in skin wetness and pH. Prolonged wetness leads to maceration (softening) of the stratum corneum, the outer, protective layer of the skin, which is associated with extensive disruption of intercellular lipid lamellae. A series of diaper studies conducted mainly in the late 1980s found a significant decrease in skin hydration following the introduction of diapers with a superabsorbent core.Recent studies confirm that this trend is ongoing. Weakening of its physical integrity makes the stratum corneum more susceptible to damage by friction from the surface of the diaper and local irritants.
DIAPER RASH SYMPTOMS
Diaper rash is characterized by the following:
- Skin signs. Diaper rash is marked by red, tender-looking skin in the diaper region — buttocks, thighs and genitals.
- Changes in your baby’s disposition. You may notice your baby seems more uncomfortable than usual, especially during diaper changes. A baby with a diaper rash often fusses or cries when the diaper area is washed or touched.
DIAPER RASH DIAGNOSIS
Diaper rash is common. Most people who care for children know it when they see it. Sometimes, it’s still a good idea to call a doctor, who will offer an expert opinion based on prescriptions and other baby items.
Diaper rashes caused by yeast infections sometimes occur when an infant takes antibiotics. Those kinds of rashes will not get better without physician-prescribed ointment.
When you speak to your doctor, be prepared to discuss brands of diapers, lotions, detergents, and other household items your baby comes into contact with.
DIAPER RASH TREATMENT
The best treatment for diaper rash is to keep your baby’s skin as clean and dry as possible. If your baby’s diaper rash persists despite home treatment, your doctor may prescribe:
- A mild hydrocortisone (steroid) cream
- An antifungal cream, if your baby has a fungal infection
- Topical or oral antibiotics, if your baby has a bacterial infection
Use creams or ointments with steroids only if your baby’s pediatrician or dermatologist recommends them — strong steroids or frequent use can lead to additional problems.
Diaper rashes usually require several days to improve, and the rash may come back repeatedly. If the rash persists despite prescription treatment, your doctor may recommend that your baby see a specialist in skin conditions (dermatologist).