Diaper Rash: Causes and Treatment

This is one of those topics that is important for every parent with a baby at home. Diaper rash is one of the most common problems infants face, and it’s no wonder given that baby poop is soft and sticky and comes into direct contact with the skin. But there are several other factors that contribute to diaper rash. Understanding the different causes, along with the proper treatments for each, will help parents combat this common condition.

Something Is Touching the Skin

Stool contains traces of digestive enzymes, which is great for breaking down food, but they also break down skin. That’s why a red, blotchy diaper rash is common when your child has diarrhea. Frequent loose stool coats the skin and breaks it down. We have a neat trick to treat this type of rash.

Those digestive enzymes require an acidic environment to work, which the baby poop provides. A one to one mixture of an emollient and an antacid works very well. The emollient coats, soothes and moisturizes the skin, while the antacid renders the digestive enzymes ineffective. Unfortunately, this combination of products can be difficult to mix, but your friendly neighborhood pharmacist has the tools to get the job done right.

Other things touch the skin: disposable diapers, soap, laundry soap (if using cloth diapers) and various ointments, some of which contain fresh-smelling scents. Chemicals in these products can directly irritate the skin or stimulate the immune system to respond, which results in a similar-looking rash. Lumped together, we call these rashes a contact dermatitis. Twice daily hydrocortisone cream (a steroid) can calm the rash, along with a thick layer of zinc-oxide-containing diaper rash ointment. This should be applied thickly with every diaper change, so you can’t see the skin. The idea here to create a barrier. That way the offending chemicals touch the ointment instead of the skin.

Bacteria Is Growing

You’ve probably heard we all have bacteria growing on our skin. That’s a normal thing. However, babies have a smaller amount of these microbes. That leaves room for other things to grow, like yeast (or fungus). A common yeast is called Candida albicans. This is the same organism that causes thrush in the mouth and cradle cap on the scalp. In the diaper region, this typically appears as redness in the skin folds, surrounded by little red dots called satellite lesions.

Treatment for this condition calls for an anti-fungal cream. It’s important to correctly identify a Candidal rash because if hydrocortisone is used without an anti-fungal, it will often make this rash much worse. When in doubt about which type of rash is present, be sure to ask your baby’s doctor!

Bacteria Is Invading

Remember those normal bacteria that live on everyone’s skin? They’re fine as long as they stay on the surface. But when the skin is disrupted by a contact dermatitis or a yeasty diaper rash, the bacteria may travel into the skin, causing bacterial infections, such as impetigo, cellulitis and abscess. These require topical and/or oral antibiotics to treat. These rashes tend to be intensely red, tender, and sometimes accompanied by swelling, hardness, drainage or scabbing. If you suspect a bacterial infection of the skin, let your child’s doctor know right away.

Prevention Is Worth a Pound of Cure

The best way to combat diaper rash is to prevent it from happening in the first place. This can be accomplished by:

1. Avoiding chemicals previously known to cause a rash.
2. Creating a barrier by using an emollient or diaper rash ointment with each diaper change.
3. Changing diapers as soon as possible after each bowel movement.

However, even with the best of care, diaper rash is likely to happen sooner or later, and until you are confident which rash (or combination of rashes) you are dealing with, be sure to touch base with your child’s doctor for guidance on next steps.