What is Diaper Rash or Nappy Rash?
Diaper rash is a generic term applied to skin irritation that develops in the diaper-covered area that is caused by various disorders and irritants. It causes the baby's skin to become sore, red, scaly, and tender. In bad cases, the rash can cause pimples, blisters and sores on the baby's buttocks, thighs or genital area. If the rash gets infected, it may become bright red and the skin may get swollen. Small red patches or spots may also spread beyond the main part of the rash, even out of the diaper-covered area.
Common synonyms are including diaper dermatitis (skin inflammation), napkin dermatitis and ammonia dermatitis. Amongst all published causes of diaper rash, contact irritation seems to be the most significant factor. Diaper rash could develop as early as in the first week of a new born baby. As surveyed, the highest risk is recorded between the range of 9 and 12 months old. There are almost 40% of children in this age range will be attacked by diaper rash.
In general, there are few causes that contributed to diaper rash:
1) Irritant or Contact Dermatitis could show various severities vary from mild redness (similar to sunburn) to skin erosion. To differentiate contact dermatitis from other causes, it seldom involves the skin fold areas which are not in immediate contact with urine. It can be caused by rubbing of diapers against the skin and tight fitting of diapers onto the baby's body.
2) Bacterial infection is resulted from a disruption of skin integrity and overwhelmed skin defence mechanisms within the diaper-covered region. Visually, bacterial infections could be a small blisters (1-2mm) and pustules that covering the baby's buttock, lower abdomen, anus, umbilical cord, thighs as well as other parts of the body. When the baby's urine mixes with bacteria from feces, it breaks down and forms ammonia which can be very harsh.
3) Yeast or Fungal infection is characterized by bright red zone with slightly raised small dots extending beyond the main rashes. It is usually tender, painful and appears in the folds of the baby's genitals, legs and creases. Conversely to contact dermatitis, they are commonly found in the skin folds creases, around the baby's anal and can spread to the front and back of body.
4) Allergic reactions due to allergens like fragrances and materials of the diaper (dyes, super absorbent gels) and laundry chemicals eg detergent, bleach and softener. These regions often have well-defined zones of redness with superficial vesicles and erosions on the legs and in the groin area.
5) Metabolic and Nutritional Deficiency could happen during the introduction of new food or solid food to the baby. New foods can change the composition of the baby's feces and increase the bowel movement at the same time. This could lead to a diaper rash, and the rashes get worsen with happening of diarrhea. If baby is breast-fed, their delicate skin could even be reacting to those foods mothers are eating.
6) Immunodeficiency and Malignancies is likely to be one of the causes of diaper rash nowadays. Sometimes, diaper rash can develop on a baby who is taking antibiotics, or the baby is breast-fed by the mother who is on antibiotics. Antibiotics reduce the number of healthy bacteria that combating with yeast, as well as the harmful bacteria that meant to be destroyed.
Despite other intrinsic factors, there are few handy tips which can be used to prevent diaper rash:
1) Change your baby's diaper diligently as soon as it is wet and soiled. Newborn babies urinate and pass loose stools very often and there is always trace amount of moisture left on the baby's skin. You should always keep the baby's skin as dry, clean and cool as possible, in order to get rid of feces and urine in irritating the baby's skin.
2) Put your baby on an open cloth diaper during nap time. As baby often urinates right after falling asleep, the diaper should be checked shortly after the baby falls asleep and replace instantly if it is wet. You may even let your baby to sleep with a bare butt (with plastic sheet placed on top of bed sheet) for a speedy recovery.
3) Soak the baby's bottom with running water occasionally in between of diaper changes; or by squirting with a water bottle. If possible, only use warm water with (or without) mild soap.
4) Allow the baby's skin to dry completely before covering up with a clean diaper. Avoid using plastic pant or diaper with plastic edge. Diapers with anti-leak plastic prevents air circulation, thus conduces a warm and moist environment where fungi can thrive.
5) Pat the wet bottom gently with a soft cloth or towel, rather than scrubbing that can lead to irritation on sensitive skin.
6) Put on the diaper loosely to prevent chafing, or use a bigger-sized diaper will be leaving more rooms for better air circulation. Make sure the diaper or nappy fits firmly, instead of tightly.
7) Avoid using scented wipes and soaps, which may contain alcohol, perfume or fragrance that make skin irritation worse. If you are using disposable diapers, you must buy ones that are fragrance-free.
8) Use cream which contains zinc oxide ointment or petroleum jelly to protect your baby's skin from moisture. Never use creams that contain boric acid, camphor, phenol, methyl salicylate or benzoin tincture.
9) Do not use talcum powder or cornstarch in healing diaper rash. Talcum powder can be inhaled into the baby's lung, whereas cornstarch could worsen a yeast-infected diaper rash.
10) Boil washable diapers for approximately 10-15 minutes after thorough cleaning to kill germs and remove chemicals like soap that could potentially irritate the baby's skin.
11) Food allergies may cause diaper rash. When you introduce new solid foods, try to do so one at a time so that a particular allergy can be identified easily.
With some diligence and perseverance in following those best practises, diaper rash should be healed within 3 to 4 days without seeking an out-patient consultation.
Please consult your family pediatrician if the rash turns to be complicated with yellow patches or open sores. The pediatrician may either prescribe a topical or oral antibiotic for your baby, or antifungal drug for yeast infection. You should also consult the medical experts if your baby develops a fever, diarrhea or any kind of discomfort after several days of home treatment.