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What to do About Diaper Rash?

Diaper rash, or diaper dermatitis, is common and often occurs in the first year of life.  In fact, both of my children had diaper rashes during their first month of life – fortunately, their diaper rashes resolved quickly! Most cases of rash in the diaper area is due to irritants to the skin and can often be treated easily.  

What causes diaper rash?

There are four main factors that contribute to diaper rash:

  • Wet diapers
  • Friction of the diaper on the skin
  • Urine and feces 
  • Microorganisms such as Candida albicans or Staphylococcus aureus

What does diaper rash look like?

Diaper rash is red skin on the area in direct contact with the diaper.  Areas like the buttocks, genitals, lower stomach, and upper thighs are most common.  The reddened skin can look raw but is usually not painful.  Severe enough, diaper rash can cause the skin to break down and be painful for the infant.

Diaper rash usually does not occur in the skin folds unless there is a coexisting fungal infection. 

How do you treat diaper rash?

Treating diaper rash at home is as simple as ABCDE!

A – Air

One of the easiest things to do at home is to maximize exposure of the affected skin to air.  Removing the diaper removes the cause of the rash – there is no longer a warm, wet diaper rubbing against the affected skin.  

If diaper free time is not practical for your family, then frequent diaper changes at least every 3 hours or more often is suggested.  

B – Barrier

Topical barriers are of the most important strategies for managing diaper rash at home.  Pastes are the preferred product over ointments and creams.  

Find a barrier paste that contains at least 20% zinc oxide and apply it thickly (like icing on a cake!).  It can even be covered with petroleum jelly to avoid the paste sticking to the diaper.  

Avoid products with fragrance or other ingredients as this can aggravate the skin. 

C – Cleansing

The diaper area should be cleaned daily with lukewarm water using irritant-free soap or cleanser.  Aggressive wiping of the diaper area should be avoided.  Residual barrier paste does not need to be removed at each diaper change.  

Baby wipes should be fragrance free and with minimum preservatives.  Another alternative is to use a damp cloth with water for cleaning the affected area.

D – Diapers

Disposable diapers may be better at wicking moisture away from the skin. But there is no clear consensus in the literature that they are “better” than cloth diapers. 

Change diapers frequently, every 3 hours or more often.  

Cloth diapers should be washed with mild detergents and bleach should be thoroughly rinsed out to avoid skin irritation. 

E – Education

Parents and caregivers should be educated about prevention and treatment of diaper rash.  

Products to avoid include those with baking soda, cornstarch or talc powders, boric acid, phenol, camphor and salicylates.  

Steroid creams should not be applied to areas affected by irritant diaper rash unless directed to do so by a physician for moderate to severe rash.

When to see the doctor

Following the above steps, diaper rash should improve in 2 to 3 days.  If there is no improvement after 7 days of following ABCDE or if you are concerned, then the baby’s rash should be assessed for other causes, such as Candida or Staphylococcus infection.

This post was co-authored by Erin Manchuk, BScPharm, BCGP and Stephanie Liu, MD, MSc, CCFP, BHSc.

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