Diaper Rash

    

     There are three basic types of diaper rash. Parents can tell which kind they are dealing with by the way the rash looks.

     The most common diaper rash is caused by contact with stool and urine. This is a flat, raw, red rash that is on the areas of skin around the anus, on the buttocks or in the front on the scrotum or the labia. It is a chemical burn and looks like a sunburn. There can be small, open sores that bleed when they are wiped and the baby cries when wiped because the area is very tender.

     This rash occurs when there has been contact with stool and urine from infrequent changing, or contact with acidic stool that comes when the infant has diarrhea or even with normal loose stools (see the article on “Infant Pooping”). It can also come from overuse of store-bought diaper wipes. Finally, this rash can just be a consequence of wearing diapers. Some infants have sensitive skin and anytime they have urine or stool on their skin it causes irritation.

     The cure for a contact diaper rash is protection. Even frequent changing might not help because, once the rash has begun, even a few seconds of contact will make it worse. Use a thick diaper cream/paste that contains zinc oxide. There are many brands and everyone seems to have their favorite but the only important ingredient is zinc oxide which covers the skin with a thick, hard-to-rub-off layer of protection. What kind of cream you use is not as important as how you use it. Put it on much thicker than you would ever think necessary. It needs to be so thick that when you open the diaper, you should see poop lying on top of a layer of diaper cream. If you can see the skin, the stool can hit the skin and burn it. The sores should heal up rapidly but any further contact makes the rash come and go. When you change the diaper, only wipe enough to get the stool off. Don’t try to clean the area too aggressively because that will irritate the skin, too. Wipe the stool off the zinc oxide and put on more zinc oxide. Store-bought diaper wipes are handy in the diaper bag when you are on the road, but for normal cleaning at home, use a soft cloth and a little water.

     The next most common diaper rash is caused by a yeast infection. Because yeasts grow in dark, wet places, this rash is found more in the folds where the legs and the groin meet or are inside the labia and under the scrotum. This is a bright red, slightly raised, scaling patch of rash that slowly expands in the hidden area. It usually doesn’t have that “raw” appearance or cause open sores. The treatment for this rash is to use any of the anti-fungal/yeast creams which you can buy without a prescription. Again, use a lot of it with every diaper change. Sometimes you may see both a contact rash and a yeast rash together – the contact rash injures the skin and allows the yeast to infect the skin. In this case, rub in the antifungal cream first and then cover it with the zinc oxide. The yeast infection should gradually improve but less rapidly than the contact rash.

     The last type of diaper rash  is caused by a bacterial infection of the skin. This rash is the least common. It causes blisters and open sores, especially on the buttocks, without the surrounding raw contact rash. As with a yeast infection, the infant may start with a contact rash first that allows the bacteria a chance to infect the skin. But the primary thing with a bacterial diaper rash is spreading blisters. This rash should be treated with over-the-counter antibacterial ointment applied with each diaper change. However, if the blisters don’t clear rapidly or the skin appears to become more red or swollen, you need to consult the infant’s caregiver right away.