Dr. MJ Bazos MD, Patient Handout
DERMATITIS, DIAPER

About Your Diagnosis
Diaper dermatitis, commonly referred to as diaper rash, affects most infants at least once. It can be caused by irritants, yeast, or bacteria trapped against the infants’ skin by diaper materials. In some cases, the diaper materials (synthetic absorbents, germ-killing rinses, etc.) cause irritation as well. It can be treated, and recurrences can be prevented by simple changes in diapering methods and proper medication.

Living With Your Diagnosis
Signs of diaper dermatitis include redness and irritation in the diaper area. Often this begins with faint, raised, pink spots, which seem to enlarge and to soon cover the diaper area if untreated. In extreme cases, the skin may look red and begin to peel. Skin folds may become raw as well. Baby is usually fretful and fussy, and may cry, especially after voiding or moving the bowels. Diaper dermatitis does not normally cause a fever.

Treatment
The best treatment for diaper dermatitis is prevention. By keeping baby’s diaper area as dry as possible, outbreaks can be minimized. Once the dermatitis occurs, it requires treatment with topical creams as well as frequent diaper changes. Many topical creams and ointments can be used for diaper dermatitis. If irritation from urine is the primary problem, a simple ointment containing zinc oxide will often be enough to provide relief. It should be applied at each diaper change after the diaper area is gently cleansed with lukewarm water and patted dry. If the diaper dermatitis persists despite careful use of zinc oxide and frequent diaper changes, changing the type of diaper used may provide relief. Some babies are sensitive to chemicals in cloth diaper rinses, and others are irritated by synthetic materials in disposables. Switching brands or double-rinsing cloth diapers may eliminate the problem. Commercial diaper wipes are another source of irritation.

If yeast (Candida) has caused the dermatitis, your doctor may prescribe nystatin or clotrimazole ointments. Often yeast dermatitis occurs after antibiotic treatment for ear infections, and it may be accompanied by thrush (oral yeast infection). If so, your doctor may also prescribe oral nystatin drops to treat the thrush as well.

The DOs
• Do leave the skin open to fresh air as much as possible.
• Diaper loosely and change baby frequently.
• Do use lukewarm water with a soft washcloth for cleaning the diaper area after urination. A small amount of baby bath can be used on the washcloth for cleansing after bowel movements.
• Do reapply zinc oxide or antiyeast ointment at each diaper change.

The DON’Ts
• Do not wait for a physician visit to begin treating diaper dermatitis. If the diaper area appears reddened, immediately begin frequent (hourly) diaper checks, and change if any dampness is noted.
• Do not use commercial diaper wipes on a baby with diaper dermatitis because they will worsen the irritation.
• Do not use over-the-counter antibacterial ointments unless specifically recommended by your doctor. These can cause irritation and rash themselves and are rarely needed.

When to Call Your Doctor
• If body temperature is greater than 101°F (rectal) or 100°F (axillary).
• If rash worsens despite home treatment, or rash is expanding beyond the diaper area
• If baby refuses breast or bottle.
• If vomiting or diarrhea occur.