Diaper rash (also known as nappy rash) is an irritation of the area of skin covered by the diaper. This can be worrisome to a mother as diaper rash causes discomfort to the baby. It involves several inflammatory conditions that affect the diaper area in babies, which usually becomes red and tender. Diaper rash is the most common dermatitis (skin irritation) in babies.1 Breastfed babies have a lower tendency to develop diaper rash when compared to other babies. At least every child will experience an episode at some point during toilet training. Most cases of diaper rash come from habits involving diaper changes. When your baby wears wet diapers for long periods without them being changed, the urine and faeces begin to irritate the skin. Bacteria and yeast infections are commonly implicated in diaper rash. It takes about 2-3 days for diaper rash to clear up when treated at home by frequent diaper changes and use of skin ointments. Overall, you have to plan ahead as your child will most likely have a diaper rash at some point no matter how careful you may be. Arm yourself with the necessary knowledge as we explore the causes, treatment, and prevention of diaper rash.
Causes of diaper rash
Diaper rash can be caused by the following:1,2
Prolonged wearing of wet or soiled diapers:
Leaving wet diapers on your baby for long periods can predispose them to having diaper rash. If your baby has diarrhoea or passes water stools, this can irritate their skin and cause rashes around the diaper area.
Using new products:
When you use new brands of diapers, lotions, wipes, detergents, or products that your baby isn't used to, they can irritate the skin and cause rashes or even worsen an existing problem.
Tight-fitting or undersized diapers:
Diaper rash can occur from the friction caused by tightly-applied or undersized diapers.
When the diaper area is moist, it becomes prone to bacterial and yeast infections. These may appear as red spots scattered on the diaper area.
Babies with sensitive skin:
In babies with sensitive skin, like in a condition called atopic dermatitis, they could develop spontaneous reactions in different parts of their bodies, including the diaper area.
The use of antibiotics either directly by the baby or from the mother through breast milk can kill the normal protective bacteria that keep fungal infection in check. When these fungal infections overgrow their limit, they can cause diaper rash.
Change of diet:
Once a baby’s diet changes from breast milk to solid meals, there could be an increased frequency of passing stool and subsequent diaper rash. Even some new substances from the mother’s breast milk following something she ingested can cause diaper rash.
The nature of the diaper area's folds and creases makes it prone to being moist. The moistness can support the growth of microorganisms, especially fungal organisms, which cause diaper rash.
Improper cleaning and drying of the diaper area occasionally can lead to diaper rash. Also, when you don't apply ointments after cleaning, dryness can occur and cause rashes.
Signs and symptoms of diaper rash
The following signs and symptoms show that your child has diaper rash:
- Skin Inflammation in the diaper area involving the buttocks, thighs and genitals
- Pain around the genital area
- Itching in the diaper area
- Rashes or other eruptions around the genitals
- Sores in the diaper area
- Discomfort, irritability, and crying, especially during diaper changes
In complicated cases, your baby could have skin changes in the diaper area and signs of infection like fever. In this case, normal home remedies may not be sufficient.
Management and treatment for diaper rash
A dermatologist (skin specialist) is responsible for the management of diaper rash. A thorough examination is done by the doctor, and an accurate diagnosis is made based on what symptoms your child has.1,5 Your doctor can conduct some tests if there is a suspicion of infection. Complications, if any, also need to be addressed.
Treatment involves the following:3,4
- Use of breathable disposable diapers that are not tight-fitting. Breathable diapers are preferred to cloth nappies.
- Use of zinc-containing creams (zinc oxide cream)
- Protective ointments like petroleum jelly
- For severe diaper rash, petroleum and zinc oxide may not suffice; hence pastes are recommended like Boudreaux's butt paste.
- For fungal infections (most common being candidiasis),1 antifungal cream like miconazole, clotrimazole, or nystatin is usually prescribed.
- Antibiotics are useful in diaper rash from bacterial infections
- Steroid creams are also used in some cases
- Vitamins A,D, and E are skin conditioners that your doctor may prescribe6
How is diaper rash diagnosed?
To make a diagnosis of diaper rash, your doctor needs to properly examine your baby. History should be taken to further narrow the possible cause.
How can I prevent diaper rash?
Diaper rash can be prevented in the following ways:
- Use breathable disposable diapers
- Ensure you change diapers often.
- Maintain hygiene, especially around your baby's buttocks and genital area. Also, keep it dry with a towel.
- Use plain water to wash your baby's poo off
- Wash your hands before and after handling your baby's diaper
- Avoid wipes that contain alcohol because they could burn your baby's skin. Use mild ones or a soft cloth to clean your baby.
- Do not use plastic pants for your baby. They trap moisture and predispose them to candida diaper rash.
- Avoid the use of talcum. They allow the build-up of moisture
- Use mild, hypoallergenic detergents to wash your baby's clothing.
- Use ointments like zinc oxide and vitamin A+D ointment after each diaper change.
- Be gentle when cleaning the buttocks area. Do not rub, but gently pat. You can also use squirt bottles for this.
- Diapers should be fastened securely but not tightened
- Allow your baby some time (5-10 minutes) without diapers so that the skin can be exposed to natural air
Who is at risk of diaper rash?
Children in wet or soiled diapers for long periods are at risk of having diaper rash. Children with sensitive skin who easily react to body products are more likely to develop diaper rash. Not maintaining proper hygiene, especially after a diaper change, is also a risk factor.
How common is diaper rash?
Diaper rash is very common and every child will experience it at least once during toilet training. It is more common in children between 9-12 months of age and also in children who are not breastfed.
When should I see a doctor?
You should consult your doctor if your child doesn't get better after home remedies have been used. A prescription may be required.
Your doctor should know when you notice the following:
- Rash with fever
- Severe rash
- Rash with blisters
- Rash with a burning sensation
- Bleeding rash
- Rash with pus draining from it
- Painful rash
- If your child is inconsolable and irritable,
Diaper rash (or nappy rash) is a very common skin condition among babies. It is due to the skin’s reaction to irritants like urine, faeces, lotions, diapers, nappies and even detergents. Other causes are infections like candidiasis or bacterial infections, use of talc or alcohol-containing wipes, and infrequent changing of wet or soiled diapers. When babies develop diarrhoea and are frequently passing loose stool, their nappies should be changed regularly to avoid their skin reacting to faecal substances. Look out for symptoms like redness, pimples, streaks, and other forms of rashes around the diaper areas, as these are the symptoms of a diaper rash. If necessary hygiene measures are put in place, including the use of ointments and yet no result is seen, you should immediately consult with your doctor for professional guidance and management.
- Benitez Ojeda AB, Mendez MD. Diaper dermatitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Aug 29]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK559067/
- Dunk AM, Broom M, Fourie A, Beeckman D. Clinical signs and symptoms of diaper dermatitis in newborns, infants, and young children: A scoping review. Journal of Tissue Viability [Internet].2022 Aug 1 [cited 2023 Aug 29];31(3):404–15. Available from: https://www.sciencedirect.com/science/article/pii/S0965206X22000286
- Sharifi-Heris Z, Amiri Farahani L, Hasanpoor-Azghadi SB. A review study of diaper rash dermatitis treatments. Journal of Client-Centered Nursing Care [Internet]. 2018 Feb 10 [cited 2023 Aug 29];4(1):1–12. Available from: http://jccnc.iums.ac.ir/article-1-159-en.html
- Ward DB, Fleischer Alan B, Jr, Feldman SR, Krowchuk DP. Characterization of diaper dermatitis in the United States. Archives of Pediatrics & Adolescent Medicine [Internet]. 2000 Sep 1 [cited 2023 Aug 29];154(9):943–6. Available from: https://doi.org/10.1001/archpedi.154.9.943
- Hattier G, Talasila S, Cohen B. Looking at the spectrum of diaper dermatitis. 2022 Apr 14 [cited 2023 Aug 29];39. Available from: https://www.contemporarypediatrics.com/view/looking-at-the-spectrum-of-diaper-dermatitis
- Davies MW, Dore AJ, Perissinotto KL. Topical Vitamin A, or its derivatives, for treating and preventing napkin dermatitis in infants. Cochrane Database Syst Rev [Internet]. 2005 Oct 19 [cited 2023 Aug 29];2005(4):CD004300. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718230/