Diaper Rash: Information & Diaper Rash Specialists

Diaper rash is very common among infants and toddlers. Two-thirds of all diapered children experience diaper rash at least once, though usually more frequently.

Exclusively breastfed infants, however, are less likely to be affected. People who must wear protective underwear due to fecal or urinary incontinence may also develop diaper rash.

Diaper rash can range from mild to severe.

Diaper rash occurs in the diaper area. Skin irritation occurs primarily in the anal region, but also in the genital area. Areas covered by the diaper are most severely affected, including

• the buttocks,
• the groin area,
• the thighs, and
• the external genitalia.

In rare cases, diaper rash can also extend to the back and lower abdomen. Diaper rash is rarely found in deep skin folds, where the diaper does not come into direct contact with the skin.

Diaper rash causes

• redness with indistinct borders as well as
• possible weeping blisters (known as vesicles) or blisters 
• swelling (edema),
• scaling (desquamation),
• secondary skin or mucous membrane lesions (erosions), or
• crusting (exudate).

Not all of these symptoms necessarily occur in diaper rash. However, they can all indicate this condition.

The painful areas on the affected skin are very uncomfortable for infants and children. As a result, they are often irritable. Many children cry more frequently and react to being touched (e.g., during diaper changes) on the affected areas of skin.

There are many different causes of diaper rash.

Generally, heat and moisture buildup—which are common in modern diapers—are to blame. In particular, the frequent urination typical in infants creates what is known as a “moist environment.” This irritates the skin.

The urea in urine breaks down into ammonia due to alkaline decomposition. This raises the pH level, which is comparable to constantly washing your hands with soap. As a result, the skin becomes more susceptible to bacteria.

Other causes include, among others,

• the child’s poor health,
• a genetic predisposition to atopic or seborrheic eczema, and
• psoriasis.

In some cases, sensitivities can trigger diaper rash. Possible culprits include

• skin care creams containing fragrances and preservatives,
• wipes, or
• laundry detergents or fabric softeners.

Rarely, but it is possible, intolerance to a specific brand of diapers can cause diaper rash. Changing to a different brand of diapers may resolve the diaper rash.

Diaper rash can lead to several complications.

One possibility is a secondary infection with yeast fungi of the Candida group (e.g., Candida albicans). This fungal infection is known as diaper thrush. The fungus can also spread to the intestines. Such a fungal infection usually causes whitish-yellowish blisters or nodules.

A scaly rash (seborrheic dermatitis) can also occur as a result of diaper rash. Rarely, but under certain circumstances, the symptoms of diaper rash may also appear on

• arms,
• legs,
• the face, or
• the head

.

In extreme cases, the infection can spread over large areas of the skin. If the fungal infection is treated with cortisone, it can also lead to skin atrophy. The skin then becomes thinner and more susceptible to further irritation.

As part of the diagnosis, the doctor discusses the symptoms with the parents of the affected child. This is followed by an examination of the symptoms.

If a bacterial or yeast infection is also suspected, the doctor will typically take a swab. The tissue sample is then examined microbiologically.

In addition, the doctor must rule out other conditions with similar symptoms. These include, for example,

• psoriasis,
• eczema, or
• a herpes virus infection.

Diaper rash is caused by various factors in the diaper area © Kristin Gründler | AdobeStock

After a diagnosis of diaper rash, you should not use

• wipes,
• ointments,
• lotions, or
• soaps

on your child. Soft, clean cotton cloths and warm water are suitable for cleaning.

If ointments are absolutely necessary, you should use pastes that absorb moisture. One option, for example, is a gentle zinc oxide paste. Apply a thin layer of this to the affected areas of skin. These pastes may also contain paraffin oil or cod liver oil, which makes them easier to apply and gentler on irritated skin.

It may help to switch to a different brand of diapers or to switch to cloth diapers.

If the child also has diaper thrush, you should see a doctor. The doctor will prescribe a special paste (antifungal) to treat the fungal infection. In severe cases, treatment with a mild hydrocortisone may also be considered.

If intestinal candidiasis is suspected, a stool test for fungi will be performed. The intestines are then treated accordingly.

Bacterial infections are usually treated with an antibiotic.

Use all textiles that may come into contact with fungi or bacteria only once. Afterward, you should wash them on the high-temperature cycle. This kills the pathogens and prevents reinfection.

You should consistently follow through with the treatment of fungal or bacterial infections. Continue the treatment for a few days even after the symptoms have disappeared. Otherwise, diaper rash can quickly recur, along with possible complications.

As a rule, diaper rash detected early heals within a few days. However, if it is more advanced, a diaper rash may, under certain circumstances, persist for several weeks.

If diaper rash is not treated or is treated inadequately, it can spread to other parts of the body.

If diaper rash occurs frequently or if preventive measures do not help, the child’s overall health should be evaluated. The child may have

• allergies,
• a weak immune system, or
• another serious medical condition

.

Many parents swear by naturopathic treatments for diaper rash. The treatment of choice here is chamomile. Other suitable options include

• lycopodium,
• speedwell,
• oak,
• calendula,
• thyme, and
• sage.

These medicinal herbs have healing properties and are usually also antifungal and drying. You should only use a cream such as Multilind (which contains the antifungal agent nystatin) in severe cases.

The most important step in preventing diaper rash is to change diapers regularly. It’s best to change diapers immediately after a bowel movement, but no later than three to four hours afterward.

The diaper should fit loosely to prevent heat buildup.

Use detergent and laundry additives sparingly. Especially in the first few months of life, the skin should not become swollen.

Avoid using skincare products containing fragrances and preservatives, especially if the child is prone to skin irritation.

Gentle almond or olive oil is suitable for removing dirt or residue from ointments.

Clean the diaper area carefully. Then thoroughly dry the entire area, including the inner thighs and all skin folds.

As a breastfeeding mother, you should avoid acidic and spicy foods. Even later on, as long as children are wearing diapers, they should not be given such foods.

The best way to prevent diaper rash is to go without a diaper. Let your baby or toddler kick their legs or run around without a diaper as often as possible—and for as long as possible.