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Diseases and Conditions
Diaper rash
From MayoClinic.com
Special to CNN.com

Introduction

You start to change your baby's diaper, and there it is — a patchwork of bright red skin on your baby's bottom. Don't panic. What you're seeing is most likely diaper rash, a common form of inflamed skin (dermatitis).

Most infants develop a diaper rash at some time or another; some even arrive home from the hospital with a slight rash. Diaper rash may be more common after solid foods are added to your baby's diet or when your baby is taking antibiotics. Other factors that can lead to diaper rash include continuously wet or infrequently changed diapers, diarrhea and the use of plastic pants to cover a diaper. Diaper rashes can occur intermittently, anytime while your child wears diapers, but they're more common in babies during their first 15 months, especially between 8 and 10 months of age.

Diaper rash can alarm parents and annoy babies, but fortunately most cases disappear after a few days with simple home treatments.

Signs and symptoms

Diaper rash is characterized by red, puffy and perhaps slightly warmer skin in the diaper region — buttocks, thighs and genitals. 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.

Causes

Diaper rash can be traced to a number of causes, including:

  • Irritation from stool and urine. Prolonged exposure to urine or feces can irritate a baby's sensitive skin. Your baby may be more prone to diaper rash if he or she is experiencing frequent bowel movements, because feces are more irritating than urine.
  • Introduction of new foods. As babies start to eat solid foods, generally when they're between 4 and 12 months old, the content of their stool changes, increasing the likelihood of diaper rash. Changes in your baby's diet can also increase the frequency of stools, which can lead to diaper rash. If you're breast-feeding, your baby may develop diaper rash in response to something you've eaten, such as tomato-based foods.
  • Irritation from a new product. Disposable wipes, a new brand of disposable diaper, or a detergent, bleach or fabric softener used to launder cloth diapers can all irritate your baby's delicate bottom. Other substances that can add to the problem include ingredients found in some baby lotions, powders and oils.
  • Bacterial or yeast (fungi) infection. What begins as a simple skin infection may spread to the surrounding region. The area covered by a diaper — buttocks, thighs and genitals — is especially vulnerable to this tendency because it's warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes generally start within the creases of the skin, and there may be red dots scattered around the creases.
  • Sensitive skin. Babies with skin conditions, such as atopic dermatitis or eczema, may be more likely to develop diaper rashes. However, the irritated skin of atopic dermatitis and eczema commonly affects more than just the diaper area.
  • Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.
  • Use of antibiotics. Antibiotics kill bacteria — both bad and good. Without the right balance of good bacteria, however, yeast infections can occur. This can happen when babies take antibiotics or when mothers, who are breast-feeding their infants, are taking antibiotics.

When to seek medical advice

Diaper rash is usually easily treated and improves within several days after starting home treatment. If your baby's skin doesn't improve after a few days of home treatment with over-the-counter ointment and more frequent diaper changes, talk to your doctor. Sometimes, diaper rash leads to secondary infections that may require prescription medications. Have your child examined if the rash is severe, worsens despite home treatment or occurs along with any of the following:

  • Fever
  • Blisters or boils
  • A rash that extends beyond the diaper area
  • Pus or weeping discharge
  • Rashes that don't respond to home treatment

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 during home treatment, your doctor may prescribe an antifungal cream or possibly a mild hydrocortisone cream. Diaper rashes usually require several days to improve and can continue for weeks. If the rash persists despite prescription treatment, your doctor may recommend that your baby see a dermatologist.

Use creams with steroids only if your baby's pediatrician or dermatologist recommends them — strong steroids or frequent use can lead to additional problems.

Prevention

A few simple strategies can help decrease the likelihood of diaper rash developing on your baby's skin:

  • Change diapers often. Remove dirty diapers promptly. If your child is in child care, ask staff members to do the same.
  • Rinse your baby's bottom with water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths and cotton balls also can aid in cleaning the skin. Don't use wipes that contain alcohol or fragrance.
  • Pat your baby dry with a clean towel. Don't scrub your baby's bottom. Scrubbing can further irritate the skin.
  • Don't overtighten diapers or use diapers with elastic edges. Both prevent airflow into the diaper region, setting up a moist environment favorable to diaper rashes. Tightfitting diapers can also cause chafing at the waist or thighs.
  • Give your baby's bottom a little breathing room. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your baby on a large towel and engage in some playtime while he or she is bare-bottomed.
  • Wash cloth diapers carefully. Pre-soak heavily soiled cloth diapers and use hot water to wash them. Use a mild detergent and skip the fabric softeners and dryer sheets because they can contain fragrances that may irritate your baby's skin. Double rinse your baby's diapers if your child already has a diaper rash or is prone to developing diaper rash. If you use a diaper service to clean your baby's diapers, make sure it takes these steps as well.
  • Try diaper liners and breathable diaper covers. Diaper liners in cloth diapers may help keep your baby's skin drier. Choose breathable diaper covers instead of plastic or rubber pants over cloth diapers because they let air circulate.
  • Consider using ointment regularly. If your baby gets rashes often, apply a barrier ointment during each diaper change to prevent skin irritation. Petroleum jelly and zinc oxide are the time-proven ingredients included in many prepared diaper ointments. Using these products on clear skin helps keep it in good condition.
  • After changing diapers, wash your hands well. Hand washing can prevent the spread of bacteria or yeast to other parts of your baby's body, to you or to other children.

Many parents worry about what kind of diapers to use. When it comes to preventing diaper rash, there's no compelling evidence that cloth diapers are better than disposable diapers or vice versa, though disposables may keep baby's skin slightly drier. Since there's no one best diaper — use whatever works best for you and your baby. If one brand of disposable diaper irritates your baby's skin, try another.

Whether you use cloth diapers, disposables or both kinds, always change your baby as soon as possible after he or she soils the diaper to keep the bottom as clean and dry as possible.

Self-care

Various diaper rash medications are available without a prescription. Talk to your doctor or pharmacist for specific recommendations. Some popular over-the-counter products are A and D, Balmex and Desitin ointments. Zinc oxide is the active ingredient in many diaper rash creams. These products are usually applied in a thin layer to the irritated region several times throughout the day to soothe and protect your baby's skin.

Ointments or creams are often less irritating than lotions or liquid solutions, but ointments completely cover the skin and don't allow it to receive air. Creams dry on the skin and allow air through. Your doctor can tell you whether a cream or ointment would be better for your child's particular rash. As a general rule, stick with products designed specifically for babies.

To aid the healing of diaper rash, do what you can to increase airflow to the diaper region. These simple suggestions may help:

  • Let your child go without a diaper for short periods of time.
  • Avoid using plastic or tightfitting diaper covers.
  • Use larger sized diapers until the rash goes away.

While your baby has a diaper rash, avoid washing the affected area with soaps and disposable, scented wipes. Alcohol and perfumes in these products can irritate your baby's skin and aggravate or prolong the rash.

In the past, it was common to use talcum powder to protect a baby's skin and absorb excess moisture. However, doctors no longer recommend this. Inhaled talcum powder can irritate a baby's lungs.

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  • November 02, 2006

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