Diaper Rash

Diaper rash is an extremely common condition, affecting anywhere between 25-50% of babies.  In the milder stages, you may see dryness, redness (often shiny), peeling and irritation.  In more severe stages, it may include extensive red bumps which may or may not be pus filled.

Diaper rash is likely caused by a variety of factors which include increased moisture, skin irritation by urine and feces, diarrhea, and constant friction between the bum and the diaper. The longer a baby sits in their dirty diaper, the more likely they are to get diaper rash.  Of course, you could also do everything “right”, and your baby might still get a diaper rash!

Infection by fungus or bacteria is also common because once the skin is broken, the bacteria and fungus in the stool can get in and cause infection. They also tend to grow in warm and moist environments.

Most cases of diaper rash can be easily treated at home. The most important thing is to protect the skin from further irritation so that it can heal.

Here are some suggestions for helping and preventing a diaper rash

  • Change diaper frequently
  • Do not use diaper wipes that can dry out the skin. Try to select wipes that are fragrance free, and definitely no alcohol on the skin
  • Ensure that the bum is nice and dry before you close it up again with a new diaper
  • Try not to rub the diaper area, either when you are changing the diaper or when you are towel drying them after a bath. Gently pat dry the genital area after a bath
  • Air out the bum.  As your baby gets older and their bowel movements become more predictable, consider placing them on the floor with a clean towel to air out the bum.  This is also a good time for floor play time!

So, how do I treat my baby’s diaper rash?

  •  You can treat AND prevent diaper rash by the use of a diaper rash cream.  This is usually a petrolatum based product (like Vaseline), or a product that contains Zinc Oxide. These products essentially form a barrier on the skin to protect it from further irritation, and can also decrease friction between diaper and skin.  A low concentration of Zinc Oxide (about 15%) is good for daily maintenance to prevent diaper rash. A higher concentration (up to 40%) is more suitable for treatment. These products need to be reapplied every few hours in a thick layer for best effect.
  • When choosing a diaper cream, choose one free of fragrances and lanolin, which may cause further skin irritation.

You should see that the redness and irritation is getting better every day, and should be mostly gone by 7-10 days time. In addition, you should not notice any more increase in bumps after the first 2 days.

If it does not get better, the diaper rash can also be infected with fungus.  A simple skin barrier cream will not treat infection by fungus or yeast.

In a fungal infection (yeast diaper rash), you may see a rash that is beefy red, perhaps with a scaly border and something called satellite lesions (which essentially look like smaller rashes that is separate from the large rash, as if the large rash had babies).

You can purchase over-the-counter fungal creams to treat a yeast diaper rash (clotrimazole, miconazole or nystatin).  Clotrimazole and miconazole is generally more effective for treatment. Apply the antifungal cream first, then followed by the barrier diaper cream.

You may have heard about the use of steroid creams on diaper rash.  The over-the-counter version of this cream contains hydrocortisone 0.5% (in Canada).  I do not recommend the use of a steroid cream unless recommended by your doctor.  A steroid cream can decrease the redness and irritation on the skin, but it will not treat any underlying infection.  As a result, if you use a steroid cream on a diaper rash, it can mask the symptoms making diagnosis more difficult.

If you have been prescribed a steroid cream to use, please ensure you only use a very thin layer and you can discontinue as soon as symptoms have improved.

It’s important to note that, if you’re unsure or if your baby does not get better in 7 -10  days with treatment, then it’s time to see your doctor.  Also, it’s better to just see the doctor right away if there’s any oozing blister, severe rash or rash that extends beyond the diaper area, or if your baby just seems unwell (fever, diarrhea etc). A diaper rash with bacterial infection should also be treated by a physician.


Pharmacy tip:

An antifungal cream (being an over-the-counter product) is typically not covered by private insurance. (You can, of course, always try!)

You may also be able to purchase antifungal creams cheaper if you ask the pharmacist directly. Often times, you can get more cream for less money compared to if you grabbed it off the shelf. There is a great variation in price, however, so it might be worthwhile to ask around.

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