Diaper rash in children

Diaper rash or diaper dermatitis is often seen in newborns and is usually related to the contact irritant dermatitis which is caused by a large number of factors. It can be complicated by the development of secondary bacterial or fungal infection.

Primary contributors to the occurrence of diaper rash are warm and moist environment under the diapers and mechanical skin damage due to frequent cleaning which undermines the barrier function of the skin. The development of the disease can follow from numerous predisposing factors such as seborrhea, atopic dermatitis, systemic diseases and various allergens from detergents, softeners and synthetic materials with irritants (ammonia from urine and lipases and proteases from the stool) and infections (fungal and bacterial) can increase the occurrence of the disease. The disease is clinically manifested by the appearance of the smudged redness, pimples, plaques and erosions on the gluteal and perianal region.

Presence of small pustules on the perianal and genital region points to the presence of fungal infection caused by Candida albicans. In most cases the diagnosis is based on the clinical picture.
If changes don’t retreat under standard therapy, other diseases that can lead to inflammatory changes in gluteal region should be considered, such as psoriasis, granuloma gluteale infantum, primary candidiasis and histiocytosis X.

Prognosis

In most cases diaper rash lasts for 3 to 4 days and has a tendency to spontaneously retreat. More severe forms of the disease are a consequence of chronic skin irritation or secondary infection with Candida or bacteria.

Treating the diaper rash

In order to prevent and reduce the rash in the diaper region it is necessary to comply with following recommendations:

  • Maintain gluteal and genital region of the child clean and as dry as possible by gently cleaning it (with cotton wool dipped in tepid water or under a stream of running water) and by frequent changing of diapers immediately after urination or defecation.
  • Avoid the use of moist skin cleaning hankies, softeners and aggressive detergents when washing clothes.
  • It is recommended to occasionally expose the skin to the air without wearing diapers.
  • Protective creams and child oils can prevent the influence of moisture and irritants on the skin and speed up the healing.

In stronger inflammation, a therapy with mild corticosteroid creams is indicated in shortest possible period. Presence of fungal infection demands the use of antimycotic creams. Bacterial infections should be treated with antibiotic creams. In very pronounced inflammations a general therapy with antibiotics is required.

MA.Sci.Med.Dr. Danica Milobratovic, dermatologist
Dermatological clinic DERMATIM, Belgrade, Serbia