Most parents are very familiar with the difficult task of keeping a baby's bottom clean and dry.  Frequent contact with urine and feces makes the diaper-area skin prone to irritation and infection.  Most diaper rashes are caused by chemical irritation from stools and and urine.  Less common causes of diaper area rashes include yeast or bacterial infection of the skin, allergy, or vitamin deficiency.  Some infants may be sensitive to diaper materials, soaps or chemicals in baby wipes.  Baby anatomy in the diaper area leads to an amazing number of creases and crevices which are difficult to keep clean.  Most diaper rashes can be treated with cleaning, drying, moisture barrier ointments, or powders.

What is different about baby skin?

Baby skin must make the dramatic transition from a water environment (in the mother's uterus) to an air environment after birth.  Babies are born with a full body moisture barrier substance called the vernix caseosa.  This white cream-like substance disappears (or is cleaned off) after birth.  Baby skin then must moisturize itself with normal skin oil glands called sebaceous glands.  Babies have functional sweat glands that help regulate the baby's body temperature.  Like adult skin, baby skin serves as an important barrier to germs, moisture and heat.

Should I use cloth or disposible diapers?

Cloth diapers are often used as an environment-friendly means to limit cost and volume of trash associated with diaper changing.  Some have argued that the energy and expense of cleaning re-usable diapers outweighs the benefit...but that is beyond the scope of this article.  Modern disposible diapers are designed to absorb moisture and contain waste.  Moisture is locked away from the baby's skin, which helps reduce chemical irritation.  Cloth diapers must be changed quickly to prevent prolonged contact with your baby's skin.  Cloth diapers are associated with a higher risk of spread of fecal germs.

What causes diaper rash and what do they look like?

Chemical irritation - This type of irritation is often centered around the anus and typically causes a single area of red or pink skin.  More severe irritation will make the skin raw.  Bacteria may infect the raw skin and cause a combined type of diaper rash.

Mechanical abrasion - Wet skin is more likely to be damaged by rubbing diapers and aggressive cleaning.

Bacteria - The diaper area is constantly bombarded with bacteria from feces.  Normal skin bacteria may also infect raw skin areas.

How is a simple diaper rash treated?

Most diaper area irritation can be treated with these strategies...

• Keep the area dry and clean with frequent diaper changes
• Allow the diaper area to air dry between diaper changes
• Apply a moisture barrier cream to the diaper area with every diaper change (i.e., petroleum jelly or zinc oxide containing ointments or creams)
• Use baby wipes instead of water and a wash cloth (baby wipes have a slightly acidic solution that helps maintain the normal skin acid level.  This acid helps prevent overgrowth of bacteria.)

What if my baby has a yeast rash?

Candida albicans skin infections can be treated with anti-yeast ointments or creams.  Nystatin is the most commonly used medication.  Some skin yeast infections will heal without medications.

How do I know there is a bacterial infection?

Skin bacterial infections are often painful, red, swollen, warm to the touch and may have a yellow discharge.  See article on skin bacterial infections.  This type of infection may need antibiotic ointments or oral medicines in severe cases.  If your baby has a fever you should contact your doctor.

When is a diaper rash due to eczema?

Eczema is a rash that typically avoids moist skin areas.  The diaper area stays moist due to frequent contact with urine and feces and there is a high concentration of sebaceous (oil-producing) glands in this area.  Infants with moderate or severe eczema may have eczema in the diaper area, however there is usually significant eczema in other body areas as well.  Eczema and chemical irritation typically spare the deep diaper area creases.

Can vitamin deficiency cause a diaper rash?

Yes. Specifically, a deficiency in zinc can cause a rash called acrodermatitis enteropathica.  This is rare in a child with access to breastmilk in a well-nourished mother, or baby milk formula.

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