Diaper rash, also known as diaper dermatitis, is one of the most common skin diseases in early childhood. Around 25 percent of babies suffer from a diaper rash within their first four weeks of life, though most cases self-resolve in just a few days. The skin within the diaper-covered area often appears red, inflamed, and tender, creating a very uncomfortable situation for your little one. Luckily, most cases of diaper rash aren’t serious and can be managed with the help of preventative hygiene strategies combined with topical creams and lotions.
Why does diaper rash occur?
Moisture and Friction: When there’s increased moisture in the area from prolonged exposure to urine, the skin is more susceptible to frictional damage from the diaper itself. This causes inflammation and redness in the area, which can further develop into ulcers and tears in the skin if left untreated.
pH Balance: pH measures how acidic or alkaline our skin is. Healthy skin is slightly acidic, which helps protect it from damage and different types of bacteria. Urine is quite alkaline (high pH), which disrupts the skin barrier and makes it more susceptible to rashes and irritation.
Enzymes: Stool contains a variety of enzymes that break down our food and usually don’t pose any issues for our skin; however, when the pH of a baby’s skin is made more acidic or neutral (from contact with urine), it becomes the perfect place for fecal enzymes to become active. These enzymes can start eating away at the skin, causing discomfort.
Immature Skin: Newborns and infants also have a very different skin structure, composition, and function compared to the skin of adults. The skin barrier is a lot less mature and isn’t able to lock in moisture, which emphasises the importance of using barrier creams and lotions. In addition, the outer layer of the skin—called the stratum corneum—is quite thin in infants; this layer is responsible for skin barrier function and protects the skin from different irritants in the environment, such as chemicals and feces or urine. As you can imagine, a weak skin barrier combined with lots of bacteria can be a recipe for disaster. It usually takes about two years for the skin to become mature enough to handle irritants in the environment.
Is my baby at risk of diaper rash?
There are some risk factors that parents can control and others they simply cannot. For instance, it seems as though breastfed babies are less likely to have diaper rash compared to babies that are formula-fed. Breast milk seems to change the stool such that it has a lower pH and is less irritating to the skin. So, if you can, choosing to breastfeed may reduce your baby’s chance of experiencing diaper rashes. Premature babies are also more prone to diaper rashes because the skin is so fragile and immature. It takes several weeks after gestation for the skin to develop the proper acid mantle and barrier protection that it requires.
Newborns and infants who suffer from diarrhea are also at an increased risk of developing a diaper rash. When there’s a fast passage of stool through the digestive tract, there’s also a higher concentration of enzymes in the stool, meaning a higher chance of skin irritation. It’s also important to note that diaper rash can occur simultaneously with other skin disorders like psoriasis or eczema. To be safe, it’s always best to have diaper rashes assessed, especially if they fail to heal or worsen over time.
The ABCDE approach to diaper rash
A: Air—Give your baby’s skin some air. Removing their diaper for a while can help eliminate any friction or irritation in the area while also keeping it dry.
B: Barrier—Applying a barrier cream containing zinc oxide or petroleum jelly can help protect the skin from contact with urine or stool. It also allows the underlying skin to heal.
C: Cleansing—Keep the area clean. You can use water, a soft washcloth, or baby wipes that are formulated to be alcohol-and fragrance-free. Make sure you’re gentle when wiping and pay special attention to any folds that stool or urine may be hiding in. If the rash is severe, you can also use a squirt bottle of water to clean the area or run a warm bath.
D: Dry—A dry diaper means a happy baby. Opt for super absorbable and breathable diapers. Some guidelines state that newborns should be changed every two hours, and older infants every three to four hours.
E: Education—Education on hygiene should never be overlooked. Make sure you wash your hands before and after each diaper change, wipe the area front to back, and avoid scrubbing the skin.
Natural & Conventional Topicals for Diaper Rash
Corticosteroids can usually clear diaper dermatitis quite quickly; however, excessive and persistent use can lead to some unfavourable side effects, including changes in skin colour and thinning of the skin itself. For this reason, some parents may be interested in natural remedies for diaper rash. Here are some of my favourites:
Zinc oxide
A five percent zinc oxide ointment applied after each diaper change is anti-inflammatory, antibacterial, and moisturising. Not only does it reduce the risk of secondary infection, but it creates a physical barrier between the skin and stool or urine.
Vitamin B5
Panthenol is an analog of vitamin B5 and contains moisturising properties that prevent the loss of water in the skin.
Calendula (Pot Marigold)
This is an antiseptic and anti-inflammatory herb used to cure skin disorders and relieve pain and discomfort.
Chamomile
This has been used for centuries as a mild astringent and anti-inflammatory herb to treat diaper rash and an array of other skin infections and wounds.
Petroleum jelly
Using petroleum jelly on diaper rash has been shown to significantly reduce redness and rash severity by providing a protective barrier to the skin. Alternatively, if you’ve been using a corticosteroid cream for diaper rash, consider applying petroleum jelly on top, as this will prevent the diaper from sticking to the cream.
Breast milk
This contains antibodies that can kill off bacteria and viruses when applied topically to the skin. It also contains a variety of vitamins, including Vitamin E, which is effective for wound healing.
Other herbal remedies
Other antimicrobial and anti-inflammatory herbs can be compounded into diaper rash creams, including aloe vera, olive oil, and witch hazel. Not only are these natural oils soothing to the skin, but they can also improve skin barrier integrity.
What to do if diaper rash doesn't go away?
A diaper rash should begin to resolve after a few days. If it doesn’t, this could mean that your baby has acquired a secondary infection and help from a medical professional should be sought after. For example, fungal infections from Candida albicans and bacterial infections from S. aureus or S. pyogenes require prescribed antimicrobial treatment and should not be managed at home.
Red Flags:
- Broken, raw, and/or bleeding skin
- Blisters, sores, or boils that drain pus
- Fever
- Dehydration
- Small red spots surrounding large red patches
Diaper rash is a common condition in babies and infants. With a little know-how, you can make your little ones more comfortable if they do get it, or potentially prevent diaper rash from occurring altogether. Remember: If a diaper rash doesn’t clear up in a few days, seek assistance from your healthcare practitioner as it may be a more serious problem.
