Diaper Rash

Why do babies get diaper rash? There is a pediatric saying…”no diaper rash without a diaper.” Diapers, both cloth and synthetic, trap urine and acidic stool against the skin, causing irritation and skin break-down.  Chafing and rubbing from the diaper, particularly on the buttocks and where the elastic rubs, can also cause a dry, scaly, irritative rash.  In addition, stools naturally contain yeast, which can infect skin that is already rashy, particularly if your child is on or just finished an antibiotic (which kills off healthy bacteria in the gut, allowing yeast to flourish.)

What diapers to use? Scientific studies have not shown a significant difference between cloth or disposable diapers. If you are using disposable diapers, look for ones that are “breathable” which will help reduce the risk of candidal infection.

How to clean?  Do NOT use soaps, which have a high pH and are drying.  While pediatricians have classically recommended plain water and a soft cloth as least irritating, at least one study has come out in favor of infant wipes (just make sure they are alcohol and fragrance free.)  Make sure your baby’s skin is fully dry before replacing the diaper (a hair dryer on low heat setting works well!)

How to prevent?  Talc or cornstarch is NOT recommended- while they can help reduce friction, they will not provide an adequate occlusive barrier.  Regular use of a barrier cream or ointment is safe and effective.  Ointments adhere better and are longer lasting.  Lanolin and petrolatum are good skin protectants that can be used on a regular basis.  If your child tends to rash easily, we recommend paste zinc oxide preparations such as Triple Paste, Boudreaux’s Butt Paste, Balmex, Desitin and medicated A&D.   Several new spray products contain dimethicone (with or without  zinc oxide), which is a good skin protectant (look for Boudreaux’s rash protector.)  Be sure to change diapers frequently.

How to treat?  Air drying during naps helps.  Mild irritations can be treated with a low potency steroid such as 1% hydrocortisone (over the counter) used twice a day for 3-5 days.  If the rash starts looking bright red, splotchy or peeling consider adding an antifungal like miconazole, clotrimazole, Lamisil AT or Lotrimin AF (all over the counter, and generic versions work just fine.) We do NOT recommend using prescription combination yeast/steroid products such as Mycolog or Lotrisone- these higher potency steroids are very strong when applied in an occlusive environment (under a diaper) and can cause skin damage over the long term.  Instead, use a combination of an over the counter yeast cream and 1% hydrocortisone 3 times a day.  

If your child has a significant erosive rash, a product called ILEX may help– it is painted on the irritated area, and remains in place until it wears off (usually over the course of a few days). Use only water to wash the area, and use a layer of Vaseline over the ILEX with each change (not other diaper creams as they can cause the ILEX to break down.) ILEX can be found at surgical supply stores and on Amazon (*note that this may be hard to find now.) Coloplast hydrophilic wound dressing*– a thick wound salve found on amazon, serves the same purpose.

Young infants with yeast diaper rashes may also have yeast in their mouths (thrush.)  

If you see a whitish plaque on their gums or cheeks, or the rash isn’t improving with the over the counter products, please schedule a visit.

While it is uncommon for bacteria to cause a diaper rash, strep can sometimes cause a bright red, painful rash around the anus.  This needs to be seen in the office.  Also, any rash with significant blistering or vesicles/pustules also needs to be evaluated by a physician in person.