Diaper Rash

Diaper Rash

Diaper Rash is redness in the diaper area. It is usually the result of skin irritation by urine and stool kept in close proximity by the diaper. Occasionally, the diaper itself contributes to the irritation because of the effect of wet paper against warm, soft skin.

Why does the skin break down?
When healthy skin is exposed to unhealthy products, it will break down, causing a rash. Once the skin has broken down a little bit, it is even more irritated by these unhealthy things.

Babies have a quadruple whammy:

They have thinner, more delicate skin,
The outer layers are not as securely “attached” as they are on an older person
Diapers keep unhealthy products closer to the skin for a longer time allowing for greater friction against the skin
Babies spend the first two years of their life erupting teeth (“teething”). When “teething” extensively, a non toilet trained child may produce up to a liter of saliva a day. Saliva is designed to digest your food. It also digest the skin around your butt!

Unhealthy products that contribute to diaper rash include:

Chemical irritants: Urine over-hydrates (over moisturizes) the skin, making it easier for chemical irritants (found in the urine and stool) to penetrate and damage the skin.
Enzymes: These proteins found in the stool attack the skin, especially when it is mixed with urine.
Yeast: A moist environment also makes it easier for fungi like yeast to grow on the skin.

Types of Diaper Rash

Irritant or contact dermatitis. This is the most common type of diaper rash, and is the result of contact with irritating things (such as urine or stool). The appearance of this standard diaper rash varies from mild redness to raw bleeding skin. Many times it is described as “sunburned.”
Yeast dermatitis. This rash pattern is caused by yeast (a fungus) found in the stool called Candida Albicans. The yeast can either start the skin break down, or it can grow once there has been a previous breakdown in the skin. Having diarrhea or teething a lot, predisposes to a years infection. Yeast spreads by budding so you will see a lot of small red bumps that seem to spread beyond the original red area as so-called satellites. Often these little bumps will go into the fat folds of the legs. If there are only a few red bumps in the whole area, it is not likely yeast

Principles of Treatment
In order to be repaired, the skin must be protected from irritants (diaper, urine and stool) long enough for damaged skin to recover, or for missing layers to be replaced. The goal of diaper rash treatment is to keep the skin clean and protected.

Cleansing: It is critical to keep the area clean.
- Rinse the chemicals out of the diaper wipes
- Wash the diaper area with water to avoid the drying character of soap
- If using soap, use a cleanser like Cetaphil^TM but not for every change
- For very bad rashes use a sitz bath for 10 minutes 2-3 times/day (add about 2 Tbsp baking soda to warm water, or use plain water
- Wipe off the outer soiled layer of the barrier/diaper cream and reapply, without removing the inner layer if it is unsoiled.
Keep the area dry:
- Allow “naked time” as much as possible.
- If the rash is raw and you’re giving sitz baths, definitely give 15-30 minutes after each bath with nothing on the skin. Small babies can be put in a crib or playpen on a towel or two. Older children are more of a challenge. Try playtime in a room with a linoleum or tile floor.
- Consider using a medicated powder called Caldasene^TM. Be careful to avoid having the child ingest the particles of the powder. Corn starch and talcum powder are not particularly helpful.
Protective Creams: Since the diaper eventually has to go back on, you want to protect the skin as well as possible from contact with more irritants. These are referred to as “Barrier Creams” because they form a barrier between the damaged skin and the harmful diaper environment.
- Zinc Oxide is an excellent protective ingredient found in most diaper creams. It is combined with a variety of other ingredients such as lanolin, petrolatum, dimethicone, oatmeal, and many others. The truth is that they are all very similar and different families swear by different creams. Choose one that you like! There is no magical correct answer to “Which one should I use?”
- Consider a specialty cream, especially for more severe rashes. These can also be used for daily maintenance if your child’s skin breaks down very easily and the standard diaper creams are not enough. Blonds and redheads or the children of blonds and redheads have particularly sensitive skin and benefit from daily use with these types of creams.
- 1. Butt paste: Make a paste by mixing Aquaphor (a thick ointment base-found in the hand cream aisle) with liquid Maalox (or another antacid) and apply generously. You may want to add Bacitracin (antibiotic ointment) to the mix if the skin is raw and bleeding. The antacid neutralizes the acid found in saliva and this product is particularly helpful in irritant rashes after diarrhea or in association with teething.
  2. Pinxav (pronounced “pink salve”): This Cleveland based company has been making this product since 1927. It has largely gone under the radar until recently. Pinxav users are some of the most loyal around. For more information, see http://www.pinxav.com/.
  3. Boudreaux’s Butt Paste: Formulated by a pharmacist, this paste has routinely shown up on national polls of favorite diaper creams. For more information, see http://www.buttpaste.com.
  4. Mei Mei Baby Diaper Cream: What makes this different is the calendula oil which soothes and serves as an antiseptic. For more information, see http://www.meimeibabyusa.com
  5. Calmoseptine: Many of the providers in our office like this product which contains calamine, menthol and zinc oxide. For babies with wool sensitivities, it does contain lanolin. For more information, see http://www.calmoseptineointment.com/
  6. Vaseline Constant Care Moisture Barrier Salve: This is one of the best commercial products we have found. It is available on many websites.
Yeast Treatment: Use an antifungal cream called Clotrimazole (generic equivalent to Lotrimin^TM). Generously apply this 3-4 times daily for a week. It is usually a good idea to also apply a protective barrier cream (see above) over the top of the antifungal cream, for added security.