Diaper Dermatitis (Diaper Rash)

What causes diaper dermatitis

The skin under a diaper is warm, damp and in contact with urine and stool. Moisture softens the skin, friction rubs it, and enzymes in stool combine with ammonia from urine to irritate it further. Diarrhea is a common trigger, as are teething, starting solid foods and antibiotics (which encourage yeast).

Types of diaper dermatitis

Irritant diaper dermatitis

The most common form. It affects the convex surfaces that touch the diaper most and spares the creases. It often flares with diarrhea.

Candida diaper dermatitis

Yeast (Candida albicans) commonly infects irritated skin after 2 to 3 days, especially after antibiotics. The rash is bright red, involves the folds, and has scattered small red bumps beyond the main area. Babies may also have white patches of thrush in the mouth. See candidiasis.

Other types

• Bacterial infection: impetigo causes blisters and crusts. Perianal strep causes a bright red, tender ring around the anus.
• Allergic or contact dermatitis: from fragrances, preservatives in wipes, dyes or rubber.
• Seborrheic dermatitis: greasy, salmon-colored rash in the folds, often with cradle cap.
• Psoriasis: rare in infants, with persistent sharply demarcated red patches.

Diagnosis

Diagnosis is usually made by looking at the rash. A doctor may take a swab if bacterial infection is suspected, or a skin scraping for yeast if the diagnosis is unclear. Persistent or unusual rashes may prompt further tests.

Treatment

For all diaper rashes

• Change diapers often, ideally as soon as they are wet or soiled, including once overnight if the rash is bad.
• Clean gently with warm water and a soft cloth, or fragrance-free, alcohol-free wipes. Pat dry; do not rub.
• Diaper-free time: let the skin air dry for a few minutes at each change, or longer periods on a towel.
• Apply a thick barrier cream at every change: zinc oxide paste or petroleum jelly. Apply generously "like icing a cake". You do not need to wipe off all the old cream at each change.
• Use well-fitting, highly absorbent disposable diapers, and loosen them slightly. For cloth diapers, rinse well and avoid plastic covers during a rash.
• Avoid talc powder (can be inhaled), scented products, and baby wipes containing alcohol or fragrance.

For yeast rash

Apply an over-the-counter antifungal cream such as clotrimazole or miconazole, or prescribed nystatin, 2 to 3 times a day, under the barrier cream, for at least 7 to 10 days and a few days after the rash clears.

Other treatments

• Mild hydrocortisone 1% cream for a short time (a few days) may be suggested by a doctor for inflamed irritant rash. Do not use stronger steroids in the diaper area unless prescribed.
• Antibiotic cream or oral antibiotics for bacterial infection.
• Treatment of the specific condition for seborrheic dermatitis, psoriasis or zinc deficiency.

Most irritant rashes improve within 2 to 3 days. Yeast rashes may take a week.

Prevention

• Change diapers promptly and frequently
• Keep the skin clean and dry
• Use a barrier cream regularly, especially during diarrhea or teething
• Choose fragrance-free products
• Wash hands before and after changes to prevent spreading infection

Frequently asked questions

What is diaper dermatitis?

Diaper dermatitis is inflammation of the skin in the diaper area, usually caused by prolonged contact with urine and stool. It is very common in babies and toddlers and typically causes red, sore skin on the buttocks, genitals and thighs.

How do I know if a diaper rash is yeast?

A yeast diaper rash is bright red with raised edges, extends into the skin folds, and has small red spots scattered around the edges. It often lasts more than 3 days despite barrier cream and may follow antibiotics or come with oral thrush.

What is the best treatment for diaper rash?

Frequent changes, gentle cleaning with water, diaper-free time, and a thick layer of zinc oxide or petroleum barrier cream at every change. For yeast rashes, an antifungal cream such as clotrimazole is added under the barrier cream.

When should I see a doctor for diaper rash?

See a doctor if the rash has blisters, pus, crusts or bleeding, if your baby has a fever, if it spreads beyond the diaper area, or if it does not improve within 3 days of home treatment. Babies under 3 months with fever need urgent care.

Can teething cause diaper rash?

Teething does not directly cause rash, but around teething some babies have looser stools and more drool, and stool changes can irritate the skin. Diet changes when starting solids are another common trigger.