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Diaper rash is a common condition in which skin in the diaper area becomes red and inflamed.

What are the causes?

Causes of this condition include:

• The diaper area may become irritated:
  • Through contact with urine or stool.
  • If the area is wet and the diapers are not changed for long periods of time.
  • If diapers are too tight.
  • Due to the use of certain soaps or baby wipes, if your baby's skin is sensitive.
• Yeast or bacterial infection, such as a Candida infection. An infection may develop if the diaper area is often moist.

What increases the risk?

Your baby is more likely to develop this condition if he or she:

• Has diarrhoea.
• Is 9–12 months old.
• Does not have her or his diapers changed frequently.
• Is taking antibiotic medicines.
• Is breastfeeding and the mother is taking antibiotics.
• Is given cow's milk instead of breast milk or formula.
• Has a Candida
• Wears cloth diapers that are not disposable or diapers that do not have extra absorbency.

What are the signs or symptoms?

Symptoms of this condition include skin around the diaper that:

• Is red.
• Is tender to the touch. Your child may cry or be fussier than normal when you change the diaper.
• Is scaly.

Typically, affected areas include the lower part of the abdomen below the belly button, the buttocks, the genital area, and the upper leg.

How is this diagnosed?

This condition is diagnosed based on a physical exam and medical history. In rare cases, your child's healthcare provider may:

• Use a swab to take a sample of fluid from the rash. This is done to perform lab tests to identify the cause of the infection.
• Take a sample of skin (skin biopsy). This is done to check for an underlying condition if the rash does not respond to treatment.

How is this treated?

This condition is treated by keeping the diaper area clean, cool, and dry. Treatment may include:

• Leaving your child’s diaper off for brief periods of time to air out the skin.
• Changing your baby's diaper more often.
• Cleaning the diaper area. This may be done with gentle soap and warm water or with just water.
• Applying a skin barrier ointment or paste to irritated areas with every diaper change. This can help prevent irritation from occurring or getting worse. Powders should not be used because they can easily become moist and make the irritation worse.
• Applying anti-fungal or antibiotic cream or medicine to the affected area. Your baby's health care provider may prescribe this if the diaper rash is caused by a bacterial or yeast infection.

Diaper rash usually goes away within two to three days of treatment.

Follow these instructions at home:

Diaper use:

• Change your child’s diaper soon after your child wets or soils it.
• Use absorbent diapers to keep the diaper area dry. Avoid using cloth diapers. If you use cloth diapers, wash them in hot water with bleach and rinse them two to three times before drying. Do notuse fabric softener when washing the cloth diapers.
• Leave your child’s diaper off as told by your healthcare provider.
• Keep the front of diapers off whenever possible to allow the skin to dry.
• Wash the diaper area with warm water after each diaper change. Allow the skin to air-dry, or use a soft cloth to dry the area thoroughly. Make sure no soap remains on the skin.

General instructions:

• If you use soap on your child’s diaper area, use one that is fragrance-free.
• Do not use scented baby wipes or wipes that contain alcohol.
• Apply an ointment or cream to the diaper area only as told by your baby's healthcare provider.
• If your child was prescribed an antibiotic cream or ointment, use it as told by your child's healthcare provider. Do not stop using the antibiotic even if your child's condition improves.
• Wash your hands after changing your child's diaper. Use soap and water, or use hand sanitizer if soap and water are not available.
• Regularly clean your diaper changing area with soap and water or a disinfectant.

Contact a healthcare provider if:

• The rash has not improved within two to three days of treatment.
• The rash gets worse or it spreads.
• There is pus or blood coming from the rash.
• Sores develop on the rash.
• White patches appear in your baby's mouth.
• Your child has a fever.
• Your baby who is six weeks old or younger has a diaper rash.

Get help right away if you:

• Your child who is younger than 3 months has a temperature of 38°C or higher.

Summary

• Diaper rash is a common condition in which skin in the diaper area becomes red and inflamed.
• The most common cause of this condition is irritation.
• Symptoms of this condition include red, tender, and scaly skin around the diaper. Your child may cry or fuss more than usual when you change the diaper.
• This condition is treated by keeping the diaper area clean, cool, and dry.

This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.

References:

Dey S., Purdon M., Kirsch T., Helbich H., Kerr K., Li L., et. al.: Exposure factor considerations for safety evaluation of modern disposable diapers. Regulatory Toxicol Pharmacol 2016; 81: pp. 183-193.

Šikić Pogačar M., Maver U., Marčun Varda N., Mičetić-Turk D.: Diagnosis and management of diaper dermatitis in infants with emphasis on skin microbiota in the diaper area. Int J Dermatol 2018; 57: pp. 265-275.

Smith M.V., Kruse A., Weir A., Goldblum J.: Diaper need and its impact on child health. Pediatrics 2013; 132: pp. 253-259.

Odio M., Thaman L.: Diapering, diaper technology, and diaper area skin health. Pediatr Dermatol 2014; 31: pp. 9-14.

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