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Diaper Rash

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Definition

  • Any rash on the skin covered by a diaper
  • Age: diaper-wearing age group (birth to 3 years)

Causes of Diaper Rash

  • Irritant Diaper Rash. Mild rashes can be caused by the drying effect of soaps.
  • Stool Diaper Rash. Stool left on the skin can be very irritating because it contains bacteria. Urine alone has no germs in it and usually doesn't irritate the skin. This rash is common on the scrotum or anywhere that stool can hide. Small ulcers around the anus are often from prolonged stool contact.
  • Ammonia Diaper Rash. Stool and urine left in diaper too long can combine to make ammonia. It can cause a mild chemical burn. The fumes when you change the diaper will smell like ammonia. This is more common with cloth diapers.
  • Diarrhea Diaper Rash. Rashes just found around the anus are common during bouts of diarrhea. Diarrhea stools also contain enzymes that digest food and irritate the skin.
  • Yeast Diaper Rash. Rashes from irritants can get a secondary infection with yeast. Yeast infections are bright red. They can be raw and weepy. The borders are sharp. Small red bumps or even pimples may occur just beyond the border. If treated correctly, a diaper rash should be cured in 3 days. If not, it has probably been invaded by yeast. Treat with an anti-yeast cream.
  • Bacterial Diaper Rash. Bacteria can also cause a secondary infection of irritated skin. This is less common than yeast rashes. Bacteria cause sores, yellow scabs, pimples or draining pus. They look like impetigo, a local skin bacterial infection. Can also become a painful red lump (boil).
  • Cellulitis (Serious). The bacterial infection spreads into the skin. Gives redness that spreads out from the sore. The red area is painful to the touch.
  • Staph Scalded Skin Syndrome (Serious). SSSS is caused by a Staph bacteria. The main finding is widespread large blisters. The skin is bright red. The baby acts very sick.

Symptoms of Diaper Rash

  • Mild rashes just have areas of pink, dry skin.
  • Severe rashes have areas of red skin. In some areas, the skin may become raw or even bleed.
  • Pink rashes are not painful, but raw ones can be very painful. This can lead crying and poor sleep.

Prevention of Recurrent Diaper Rash

  • Change diapers more often. Focus on preventing skin contact with stool.
  • Rinse your baby's skin with lots of warm water when cleaning off stool. Don't depend on diaper wipes alone to cleanse the skin.
  • Be sure to clean stool off all the skin folds. Cleaning the scrotum can be a challenge.
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When To Call

Call Doctor or Seek Care Now

  • Bright red skin that peels off in sheets
  • Fever and looks infected (spreading redness)
  • Age less than 1 month old with tiny water blisters or pimples in a group
  • Age less than 1 month old and looks infected (yellow scabs, spreading redness)
  • Age less than 1 month old and looks or acts abnormal in any way
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Any pimples, blisters, boils, yellow scabs, or open sores
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Rash is very raw or bleeds
  • Rash has spread outside the diaper area
  • Rash is not better after 3 days of using yeast cream
  • You have other questions or concerns

Self Care at Home

  • Mild diaper rash
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Care Advice

What You Should Know About Diaper Rashes:

  • Diaper rashes are very common in babies.
  • Often caused by not cleaning stool off the skin soon enough.
  • Stool is a strong irritant to the skin.
  • Here's some care advice that should help.

Change More Often:

  • Change diapers more often to prevent skin contact with stool.
  • You may want to get up once during the night to change the diaper.

Rinse with Warm Water:

  • Rinse the baby's skin with lots of warm water during each diaper change.
  • Wash with a mild soap (such as Dove) only after stools. Reason: using soap often can interfere with healing.
  • Do not use diaper wipes. Reason: they leave a film of bacteria on the skin.

Leave Bottom Open to Air:

  • Expose the bottom to air as much as possible.
  • Attach the diaper loosely at the waist to help with air exposure.
  • When napping, take the diaper off and lay your child on a towel. Reason: dryness reduces the risk of yeast infections.

Anti-Yeast Cream:

  • Most diaper rashes respond to 3 days of warm water cleansing and air exposure. If you've tried this or the rash is bright red, suspect a yeast infection.
  • Buy an anti-yeast cream (such as Lotrimin AF). No prescription is needed.
  • Use this cream 2 times per day.

Raw Skin - Treatment:

  • If the bottom is very raw, soak in warm water for 10 minutes. Add 2 tablespoons (30 mL) of baking soda to the tub of warm water.
  • Do this 2 times per day.
  • Then, put an anti-yeast ointment (such as Lotrimin AF) on the rash.

Pain Medicine:

  • To help with the pain, give an acetaminophen product (such as Tylenol).
  • Another choice is an ibuprofen product (such as Advil). Avoid ibuprofen under 6 months of age.
  • Use as needed.
  • Age less than 3 months. Don't use pain medicines unless your doctor says it's okay. Have your child seen if the rash is causing a lot of pain.

Sore or Scab on End of the Penis Treatment:

  • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
  • Do this 3 times per day.
  • Reason: the sore is a bacterial infection that can cause painful urination.

Diarrhea Rash - Use Protective Ointment:

  • If your child has diarrhea and a rash around the anus, use a protective ointment. Examples are Vaseline or Desitin.
  • This forms a barrier between the skin and the stool.
  • Otherwise, these generally are not needed.
  • Caution: wash off the skin before putting it on.

What to Expect:

  • With proper treatment, most diaper rashes are better in 3 days.
  • If the rash does not respond, a yeast infection has probably occurred.

Call Your Doctor If:

  • Rash isn't much better after 3 days of using yeast cream
  • It starts to look infected (with sores and scabs)
  • You think your child needs to be seen
  • Your child becomes worse

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Photos

Diaper Rash

This photo shows a red diaper rash in the area under the diaper.

Any diaper rash that lasts longer than a couple days can become infected with yeast. Note the red spots outside the main area of redness.

If a yeast infection is suspected, clotrimazole cream (such as Lotrimin; over-the-counter) should be applied 4 times per day.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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