Irritant contact dermatitis
Irritant contact dermatitis is by far the most common cause of diaper rashes in infants. Irritation can be caused by exposure of the skin to urine and feces, as well as by friction from the diaper itself. This type of diaper rash usually affects the genitals and inner thighs, but spares the actual creases, since the creases (where skin touches skin) are not exposed to the irritating chemicals. The main treatment of irritant diaper dermatitis is barrier creams (Aquaphor, Vaseline, and zinc-oxide-containing diaper creams). My favorite is Triple Paste (http://www.triplepaste.com/). The barrier cream should be applied with every diaper change to protect the skin from urine, feces, etc. More severe cases may require application of a mild strength topical steroid for a few days.
Actual allergy is less common than irritant contact dermatitis, but kids can become allergic to actual components to the diaper, such as dyes (diaper manufacturers use blue dyes to make diapers appear bright white) and the rubber contained in th elastic. Like irritant diaper dermatitis, this rash tends to spare the creases of the groin where skin is not touching the diaper. The rash may also affect the inner thighs and lower abdomen where the elastic of the diaper touches the skin. The first step in management is removing the allergen. There are a couple of brands that make dye-free diapers: Tushies (http://www.tushies.com/) and Seventh Generation (www.seventhgeneration.com/Diapers) and Earth’s Best (http://www.earthsbest.com/). Barrier creams are also helpful, although more severe cases may require application of a mild strength topical steroid for a few days.
Candida albicans is the most common infection to cause a diaper rash. Candida is a yeast, and yeast loves warm, moist, environments. Because of that, diaper rashes caused by yeast tend to involve the skin in the creases of the groin, unlike rashes caused by irritation or allergy. The rash is likely to be a brighter, “beefy” red, and there may be “satellite lesions” (red bumps a slight distance from the main rash). A yeast diaper rash is less likely to clear up with traditional diaper creams. It needs to be treated with a topical antifungal or anti-yeast cream, such as nystatin or clotrimazole. Some are available at the drugstore without a prescription.
Psoriasis, zinc deficiency, perianal strep infection, etc.
There are several medical conditions, some common & others rare, which can present with a rash in the diaper area. If your child’s diaper rash does not follow the pattern of one of the common causes listed above, or if the rash does not clear up with over-the-counter treatments, it is important that the rash be evaluated by your child’s pediatrician or a pediatric dermatologist.
In summary, to prevent diaper rashes, you should change your child’s wet or soiled diaper as soon as possible, clean his or her bottom thoroughly after a bowel movement and allow it to dry before putting on a new diaper. Diaper creams such as Triple Paste are a good first-line treatment for most diaper rashes. Occasionally diaper rashes may require a change in diapers or prescription treatment, so if a rash doesn’t clear in a few days be sure to bring it to the attention of your child’s physician.