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Diaper rash: treatment and prevention

by Josephine Andrews
Published: Last Updated on 347 views

Diaper rash is a skin rash in the diaper region. It typically affects infants and young children. But older, incontinent people can also suffer from diaper rash. In many cases, the skin is also affected by fungi. There are simple ways to prevent diaper rash. You can read here how it works and how the right treatment for diaper rash can help against sore bottoms in babies and toddlers.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

L22

Diaper rash: description

A sore buttocks in a baby, toddler or incontinent patient is referred to as diaper rash. This term generally stands for skin inflammation in the intimate and buttocks area .

Sometimes the affected skin area is also affected by fungi or bacteria . In the damp and warm diaper region, these germs can multiply particularly well. Yeast fungi of the genus Candida colonize the skin with about 75 percent more frequently than bacteria. A fungal infection localized in the diaper area is what doctors refer to as candidose genito-glutealis .

In some cases, diaper rash can spread to adjacent areas of skin (eg, thighs, back, lower abdomen). Doctors speak of stray herds .

A red, sore buttocks in babies is relatively common. About two out of three children will get diaper rash ( type I ) at least once in their life, usually in the first few months of infancy. Older people who can no longer control their urine or stool (urinary or fecal incontinence ) often wear diapers to protect themselves. Therefore, diaper dermatitis ( type II ) can also occur in them.

Diaper rash: symptoms

Typical symptoms of diaper rash are:

  • widespread reddening of the skin (erythema), which usually begins around the anus and extends to the inner thighs and abdomen
  • Formation of small skin nodes and scales
  • open, oozing, sores (often described as “soreness”)
  • Pain and itching in the buttocks
  • Burning when urinating
  • Diapers smell like ammonia

Because the sore buttocks are very uncomfortable for babies, they cry more often and sleep less well.

Infestation with fungi or other germs

Yeast fungi can spread to babies’ sore buttocks : The fungus Candida albicans , which typically lives in the intestines , can easily settle on the damaged skin and thus lead to diaper thrush . In this case, the skin changes are no longer sharply demarcated, but individual nodules as well as pustules and pimples spread to the surrounding area (eg on the thighs). The skin often flakes around the edge of the rash.

Rarely, diaper rash leads to an infection with bacteria (such as staphylococci). Typical signs of this are isolated pustules, blisters or nodules, which are bordered with a clear red ring – in diaper thrush, the pustules are smaller, more numerous and less clearly bordered in red. If the patient develops a fever , the bacteria have spread throughout the body.

Skin changes on the upper body, face and head can sometimes also occur as a result of an infection. For example, the connection between bacterial diaper dermatitis and bark lichen ( impetigo contagiosa ) was observed in studies.

Diaper rash: causes and risk factors

The development of diaper rash can have various causes. Basically, the genital skin is irritated primarily by repeated and prolonged contact with stool and urine. The resulting moisture and heat (occlusion) accumulate under the waterproof and airtight diaper – a so-called moist chamber is formed. As a result, the top layer of skin swells and loses its protective function.

Irritant factor ammonia

This effect is enhanced by ammonia. This chemical compound of water and nitrogen is formed during the splitting (by the enzyme urease) of the urea in the urine. Ammonia irritates the skin of the diaper area. It also slightly raises the pH of the skin. In this way, the skin loses its protective acid mantle. This usually prevents the growth of some germs.

Infection with fungi or bacteria

Pathogens (in particular the yeast fungus Candida albicans ) can now multiply particularly easily and penetrate the skin in warm and humid diaper environments and due to a disturbed protective function of the skin . There they trigger inflammatory reactions and the skin appears very red. This happens particularly easily with a weakened immune system. This is why newborns are particularly affected in the first three months of life – their immune system is not yet mature.

Risk factor diapers and care products

In addition, there are numerous other risk factors that can trigger or worsen diaper rash. Tight diapers can chafe the skin, irritating and damaging it. In a few cases, those affected cannot tolerate certain diaper materials. Such allergic reactions are called contact eczema. Children and adults can also have an allergic reaction to fragrances or preservatives in some skin care products or detergents and thus develop diaper rash.

Poor sanitation

Poor hygiene is a major contributor to baby’s sore bottom. Babies and adults who wear protective pants, are rarely swaddled or are not washed or dried thoroughly have an increased risk of diaper rash.

Risk factor underlying diseases

If a baby has sore bottom skin, you should always think about intestinal or diarrhea diseases. Frequent and liquid bowel movements increase skin irritation. In addition, an intestinal fungal disease (intestinal candidiasis) increases the risk of diaper rash with fungal infection. The skin does not have to be damaged beforehand. The moist chamber in the diaper alone is sufficient for the fungi to multiply and colonize the genital and anal skin.

An additional infection of the skin with disease-causing pathogens is also favored by various underlying diseases. These include skin diseases such as neurodermatitis (atopic eczema), psoriasis (psoriasis) , seborrheic eczema or dry skin in general. But a weakened immune system also increases the risk of diaper rash.

Studies have also found that a lack of biotin (vitamin B7, especially in eggs, milk, soy products, nuts) promotes the development of diaper rash. The same applies to the vital trace element zinc . An absorption disorder such as in congenital acrodermatitis enteropathica, but also unbalanced diets typically cause a zinc deficiency and thus increase the risk of diaper rash.

Diaper rash: diagnosis and examination

The diagnosis of diaper rash is made by the pediatrician or a specialist in skin diseases, the dermatologist. It is usually sufficient if the doctor examines the affected skin areas thoroughly. Classic signs (redness, pustules, weeping, dandruff ) and the occurrence in the typical skin area (genitals, buttocks, back, lower abdomen, thighs) are usually sufficient to diagnose diaper rash.

The exact skin examination is also important to differentiate diaper rash from other diseases. Atopic eczema (neurodermatitis, cradle cap), for example, appears in a few cases in the diaper region. The weeping, crusty skin changes usually appear on the head and trunk. Psoriasis in children also affects several skin areas and can be recognized by reddish, scaly skin hardening (plaques).

Further investigations

During the physical examination, the doctor also looks for other signs of illness outside the diaper area. The yeast fungus Candida albicans , for example, often affects the mouth and intestines. In order to determine the exact pathogen, the doctor takes a swab of the affected skin area. This is necessary above all in the case of severe courses (additional bacterial infection) or if the prescribed diaper dermatitis therapy has failed.

If an allergy is suspected, the doctor will carry out appropriate tests. This includes, above all, the epicutaneous test . Possible triggering substances of the diaper rash are stuck with certain test patches on a healthy area of ​​skin. In the case of an allergy, the typical rash develops within 48 hours. The doctor may also take blood from the patient (eg to determine the inflammation values ​​​​or the zinc content). In the case of severe diarrhea, stool samples usually help to clarify the cause.

Diaper rash: treatment

If underlying diseases have been ruled out as the cause, the following measures are used to heal babies’ sore buttocks. They are also great for preventing diaper rash!

Let your baby’s sore bottom breathe!

Constant contact with a wet diaper promotes the development of diaper rash. Therefore, let your child kick, crawl or run around without a diaper as often as possible. Existing diaper rashes also heal quickly in fresh air. The same applies to diaper rash in older people. For example, it is common in intensive care units to leave patients without protective pants at all times.

Change diapers regularly!

It is recommended not only to check the nappies several times a day, but also to change them every three to four hours (change immediately when urinating and defecation). So that the diaper does not rub too much, it should be put on loosely. Then less heat can accumulate underneath.

Use diapers that are breathable and highly absorbent (possibly with a gel pad). If you have diaper rash, disposable diapers are preferable to cloth diapers because they are better at wicking away moisture.

Wash all textiles used after use at least 60 degrees Celsius (white wash).

Clean and dry the diaper area properly!

Only use warm, clear water for cleaning. You should avoid soaps or special care products, as they irritate the skin unnecessarily and may trigger allergies. Dried dirt or ointment residues can be easily removed with a cloth moistened with oil (eg olive or almond oil) or so-called syndets (synthetic detergents).

Finally, dab the diaper area thoroughly dry – with a soft cloth, so as not to further irritate the inflamed skin of diaper rash. When drying, pay particular attention to skin folds, where the moist, warm environment can easily form.

Question recently changed care measures!

Diaper rash often occurs when changing diaper brands or using new care products. Therefore, always ask yourself whether you have recently changed anything. If you have already tried certain diaper rash ointments without success, stop using them and consult a doctor. So, be aware of possible new eating habits. Diets, spicy foods or certain intestinal diseases can trigger or worsen diaper rash.

See your doctor!

If you notice a rash on your child or relative, you should consult your pediatrician or dermatologist. This can rule out possible underlying diseases and gives useful tips for diaper rash treatment. Do not hesitate to ask him directly about special treatment options. If there is an additional infection of the skin, the doctor will also prescribe medication.

Midwives often have tips on how to treat diaper rash. Some midwives have had the experience that, for example, healing wool can heal sore buttocks in small children and babies. This wool, which comes from the sheep, is inserted into the diaper. The natural wool wax (lanolin) it contains is said to inhibit inflammation and serve to aerate and absorb moisture from the skin. However, it can also trigger allergic reactions.

Only use ointments or pastes specified by the doctor!

Soft, water-based pastes containing zinc are particularly suitable for diaper rash. Drying and disinfecting soft pastes can be applied to heavily weeping rashes beforehand. In the case of severe skin damage, cortisone ointments may also be helpful. However, these should only be used by the doctor and only for a short time.

If the doctor finds that the diaper rash is colonized by yeast fungi or bacteria, he prescribes medication that is specifically effective against these germs. Fungal infections are treated with antimycotics (e.g. miconazole, nystatin ). It is sufficient to apply the prescribed pastes thinly to the affected skin region several times a day. However, if the fungus has also spread elsewhere, for example in the mouth or intestines, the antifungal treatment must be extended (mouthwashes, tablets). In the case of a bacterial infection, antibiotics are the drugs of choice.

In summary: ABCDE recommendations

A group of experts from California summarized the recommendations for diaper rash treatment with the letters ABCDE in a specialist article:

  • A = air (air) – diaper-free times
  • B = barrier (barrier) – the natural skin barrier should be protected or maintained by suitable pastes.
  • C = clean (clean) – careful and careful cleaning is an important part of diaper dermatitis therapy.
  • D = diapers (nappies) – the right choice of diapers helps decisively against diaper dermatitis.
  • E = education (education) – a doctor or expert (eg midwife) should be consulted who can explain diaper rash and give useful treatment tips.

Diaper dermatitis: course of the disease and prognosis

Diaper dermatitis usually heals within a short time without consequences. It is important to comply with preventive measures, avoid causative risk factors and treat possible infections carefully.

A possible consequence of improper diaper dermatitis therapy is the so-called granuloma gluteale infantum . It can result from excessive treatment with diaper dermatitis ointments containing cortisone and is manifested by firm, bluish-red and painful nodules along a line of skin in the genital area. These often recede with diaper rash, but can also leave visible scars .

Sometimes, after the diaper rash has healed, there are recurrences (once or several times). It is particularly advisable then to visit a pediatrician or dermatologist and have the child examined for possible underlying diseases (weak immune system, allergies, etc.). Under certain circumstances, the diaper rash also spreads to other parts of the body. In some cases, this can indicate an infection of the entire body. Here, too, a doctor should be consulted as soon as possible. Thus, with timely treatment, serious complications of infected diaper rash can be avoided.

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