Pediatrics: Diaper Rash

Overview

Diaper rash is an infection commonly seen in infants aged 4 to 15 months; some children may get diaper rash more often when they begin eating solid foods.

Signs and Symptoms

• Red rash that keeps growing
• Red, scaly patches near genitals
• Pimples, blisters, bumps, and pus-filled sores on skin in diaper area
• Rash that appears in the area that the diaper covers
• Infants scratching the area once the diaper is removed

Causes/Common Triggers

The most common cause of diaper rash is candida, a fungus that grows in warm, moist places. Diaper rash is more likely to occur if:

• The diaper area is not kept clean and dry
• The baby (or breast-feeding mother) is taking antibiotics
• The baby has more frequent stools

Other triggers include:

• A diaper that is too tight or rubs the skin
• Certain wipes or soaps that cause adverse reactions
• The presence of diarrhea or urine in the diaper

Tests and Diagnosis

In most cases, a physician will be able to diagnose a diaper rash just by looking at the affected area. If it is not clear, a KOH (potassium hydroxide) test can be performed to make a definitive diagnosis. The test is noninvasive and requires only a small scraping of the rash in order to obtain a sample.

Prevention

Diaper rash can be easily prevented by proper hygiene. Individuals should always wash their hands before and after changing diapers, and try to change a diaper immediately after it becomes wet or soiled. It is also important to pat—not rub—the area dry after bathing the child, and allow room for air circulation when putting on the diaper. Clothing that is too tight should be avoided.

Management

Diapers should be changed frequently, which can prevent the warm, moist environment that causes infections. Parents should avoid any substances to which the baby might be allergic. It is also advisable to introduce solid foods into the diet 1 at a time, keeping track of any reactions, including diarrhea.

Treatment and Care

Parents should thoroughly wash and dry the area when changing a diaper and use unscented soaps and wipes, as added chemicals may irritate or dry out the skin. Applying an ointment before putting on another diaper can help protect the skin against urine or stool in the diaper. Cornstarch or talc powders should not be used on the rash; if recommended by a pediatrician, topical antifungals or steroid creams may be used to ease the rash.

A pediatrician should be contacted if:

• The rash worsens, or does not go away in 2 to 3 days
• The rash spreads
• Large blisters are present
• The child develops a fever along with the rash

Homeopathic and Alternative Remedies

A number of other remedies can be used to treat diaper rash, such as giving the child a sitz bath or using topical treatments that have been prepared by a compounding pharmacist. It is important to consult with a pediatrician and a pharmacist before using any of these methods, as they could worsen the rash.

Self-Care

OTC products available to treat and mitigate diaper rash include:

• Zinc oxide paste
• Topical steroids
• Topical antifungals
• Petroleum jelly—based ointments

Parents should consult with a pharmacist to recommend an OTC treatment and to provide guidance on its use.

Resources for Patients

• HealthyChildren.org (American Academy of Pediatrics)
• KidsHealth (Nemours Foundation)
• MedlinePlus (National Institutes of Health)

Resources for Pharmacists

• American Academy of Pediatrics
• Journal of Pediatrics Online