Newborn Skincare

A dermatologist’s guide to diaper rash: tips on how to prevent and treat it.

One study showed that more than half of babies will have diaper rash at some point, peaking at around nine months to one year. However, not all diaper rashes are created equally.

Diaper dermatitis, commonly known as diaper rash, is a general term for irritation of the skin in the diaper area. It is one of the of the most common skin problems in newborns and is a big source of stress for both you and your baby. One study showed that more than half of babies will have diaper rash at some point, peaking at around nine months to one year. However, not all diaper rashes are created equally. Another study showed that about 60 percent of babies have a mild rash, 30 percent have a moderate rash, and 10 percent have a severe rash, requiring a visit to the pediatrician and medical treatment.

Diaper rash can be a big headache for parents and is a frequent reason for a trip to the pediatrician or dermatologist.

What causes of diaper rash?

This turns out to not be a straightforward question, and there are probably a bunch of contributing factors. One factor is the fact that a newborn’s skin is not as effective of a barrier to the environment as adult skin because it is immature. This is especially true in the diaper region where the skin is very thin. Friction combined with prolonged exposure to poop and pee can irritate the skin and cause it to get inflamed. Once the skin is inflamed it is at high risk of getting infected with fungi or bacteria. Several other factors can worsen or prolong diaper rash, including how often your baby pees or poops, general hygiene, how often you change their diaper, the types of products you use in the area, diet, medications, and diarrheal illnesses.

Easy things you can do right now to prevent diaper rash

The main goals of treating diaper rash are to speed up healing the damaged skin and prevent it from recurring. In many cases, all that needs to be done is just general skin care. Things like more frequent diaper changes, air exposure, and gentle cleaning will go a long way. Your choice of diaper and certain barrier creams can also make a difference.

1)  Bathing and cleaning: appropriate hygiene helps to promote a good skin barrier and prevents it from breaking down and getting infected. Bathing is usually preferable to washing with a cloth. Liquid cleansers WITHOUT soap that are specifically formulated for infants are best. There is also good evidence using an emollient like petroleum jelly or Aquaphor can improve your baby’s skin barrier function and prevent diaper rash. It is very important that the cleanser or emollient you use has a neutral pH (not overly acidic or alkaline) and only contains ingredients approved for babies. Babies have very sensitive skin and products that may work great for mommy can be very irritating to their skin and worsen their diaper rash.

2) Wipes: A few studies have compared baby wipes versus cotton wipes with water. As an example, one large trial of 280 full-term newborns found that there was no difference between commercial baby wipes and cotton wipes with water on skin development, skin water loss, or skin pH. In my opinion, there is NO good evidence to suggest that baby wipes harm your baby’s skin or disturb its development. There are SO MANY types of wipes at the store making all kind of claims; so how do you decide? An ideal wipe will contain a pH buffer to maintain the natural environment of diaper area skin. Wipes should be free of irritating detergents (watch out for one called sodium lauryl sulfate, especially), alcohols, soap, and fragrances. Also be aware that wet wipes can contain preservatives like methylisothiazolinone (MI), methylchloroisothiazolinone (MCI), bronopol (2‐bromo‐2‐nitropropane‐1,3‐diol), and iodopropynyl butylcarbamate which are known to cause allergic reactions. Look specifically for those!

3) Barrier creams: Barrier creams protect the diaper region by covering the skin’s surface and preventing exposure to the wetness and irritants that cause inflammation. You should consider a minimum of twice weekly application of a barrier cream to your baby’s skin. There are wide range of products available that contain things like zinc oxide and petrolatum.

4) Diapers: the technology in diapers has improved a lot over the past 50 years, which has reduced the severity of diaper rash. Diapers are now WAY more absorbent, which decreases leaking and irritation that leads to diaper rash. It is estimated that modern disposable diapers with newer gel technology have reduced diaper rash by 50%. Some modern diaper technologies include a topsheet to spread urine over a greater area reducing pooling, and more breathable material that improves airflow and reduces friction.

Barrier creams like zinc oxide are a cheap and easy way to prevent diaper rash.

Medical Management of Diaper Rash

Sometimes the more conservative measures described above don’t do the trick. Severe or long lasting diaper rash needs a thorough evaluation to look for other causes of irritation to the area, including allergic reactions, fungal, and bacterial infections.

A diaper rash that seems to be getting worse with a barrier cream or wipe may actually be an allergic reaction. Fragrances and preservatives are common culprits and may not be listed on the packaging. Additionally, products containing boric acid, camphor, phenol, benzocaine, and salicylates should also be avoided because of the potential for absorption into your baby’s bloodstream.

Depending on the age of your baby and how severe their diaper rash is, a low to medium strength steroid cream or ointment can be considered to help reduce the inflammation and discomfort. These medications should not be used for a more than a week or two because they can thin the skin or cause difficult to treat stretch marks. More importantly, the skin of the diaper area is very delicate and there is the possibility of absorption of the steroid into the bloodstream, which can cause all sorts of problems like diabetes and growth delay. However, when used correctly and for a short time, low to medium strength topical steroids are safe and effective, and side effects are pretty rare.

In case of Candida (a type of fungus) infection, an antifungal powder like nystatin or antifungal cream like clotrimazole or ketoconazole can be used in the diaper area after every diaper change. Sometimes, combining an antifungal cream with a mild topical steroid like hydrocortisone may help reduce inflammation in very severe cases of diaper rash. If there is a bacterial infection, a doctor may prescribe an antibacterial ointment like mupirocin for a week. Occasionally, oral antibiotics may be necessary.

So, that is diaper rash in a nutshell. Do you have any home remedies or treatments that have been helpful? Please share in the comments section. Also, please share this article with other parents who may find it helpful!

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