Diaper Rash in Babies

Diaper rash, also known as diaper dermatitis, describes a condition that shows up on the skin under where a diaper is worn. It also happens to be one of the most common skin problems seen in babies and children.

Diaper rash commonly occurs in babies and children, impacting between 7 and 35 percent of babies at some point. 

Both pee and poop can act as an irritant that causes your child to develop irritant dermatitis, which is the medical term for red and inflamed skin. Diaper rash can spread to other parts of the body. If this occurs you should consult your child’s doctor.

What are the types of diaper rash?

Diaper-related rash

Diaper-related rash can occur due to irritation, yeast infections, or allergic reactions. These rashes are more common if a child has diarrhoea or has recently been on antibiotics.

1. Irritant dermatitis

   Irritant dermatitis refers to red, inflamed skin caused by irritants such as urine or faeces with diaper rash. It is the most prevalent type of diaper rash, typically affecting the buttocks, lower abdomen, genitals, and upper thighs while sparing skin folds. Symptoms range from mild redness to painful, raised, peeling, or weeping areas of skin.

2. Yeast infection

   If irritant dermatitis is untreated for several days, a yeast (Candida) infection can develop. Yeast diaper dermatitis is characterised by dark red skin areas, sometimes with raised, yellow, fluid-filled pustules that can rupture and flake. Yeast infections often occur warm, moist places, like in the skin folds between the thigh and body, and around the genitals.

3. Allergic reaction

   Allergic reactions or sensitivities to the diaper itself are a less common cause of diaper rash. Signs include itchy, red, raised, scaly skin in the diaper area, particularly where the skin contacts dyes in the diaper. Some baby wipes containing preservatives may also trigger an allergic reaction.

Non-diaper-related rash

Certain skin conditions can affect the diaper area without being caused by the diaper:

1. Seborrheic dermatitis

   This condition causes patches of red, greasy, yellow scaly skin in infants, commonly found in the skin folds between the thighs and body. It can also appear on the scalp (cradle cap), face, neck, or other skin folds like the armpits, elbows, and knees.

2. Atopic dermatitis

   Also known as eczema, atopic dermatitis is not usually found in the diaper area due to the moisture trapped by the diaper. If it does affect this area, it may be evident through frequent scratching, scratch marks, or scabs.

3. Bacterial infection

   Impetigo is a bacterial infection that can develop in the diaper area and other body parts. It is usually caused by skin bacteria infecting through a break in the skin, characterised by tiny, raised yellow fluid-filled areas and honey-coloured crusted lesions that may be itchy or painful.

4. Psoriasis

   Psoriasis causes reddened and silver scaly patches of skin, though the silver scale may be absent in the diaper area.

5. Scabies

   Scabies is a highly itchy condition caused by mites burrowing under the skin, resulting in widespread red, raised, itchy areas on the abdomen, hands, feet, armpits, and genitals. Infants and young children often have affected palms and soles, and multiple family members may be affected simultaneously.

How to treat diaper rash? 

Your baby’s skin can be very sensitive and delicate. Here are some of the options to help treat diaper rash:

1. Diaper-free periods
   • Limit or discontinue diaper use to reduce skin contact with urine and faeces. 
   • Allow the baby to periodically go without a diaper and expose the skin to air.
   • Use a waterproof barrier under the baby to minimise soiling. 
   • Change diapers frequently—every two to three hours and immediately after bowel movements.
2. Skin barrier ointments or pastes
   • Common ingredients in diaper products include zinc oxide and petrolatum, which form a protective barrier against wetness. 
   • Apply them at every diaper change, covering with a thin layer of petroleum jelly to prevent sticking. These should adhere well to irritated or broken skin and need not be fully cleaned off at each diaper change. 
   • Products with preservatives, fragrances, or additives should be avoided as they can further irritate the skin.
3. Antifungal treatments
   • An antifungal treatment may be prescribed by your doctor. It usually comes in cream, ointment, or powder form. 
   • Apply two or three times per day beneath a barrier ointment or paste until the rash resolves.
4. Steroid ointment
   • For severe inflammation, a mild, over-the-counter steroid ointment such as 1% hydrocortisone may be recommended. 
   • Apply a thin layer to irritated skin twice daily for no more than one week. 
   • Avoid potent or adult-strength steroid ointments and steroid creams, as the latter can contain irritating ingredients.
5. Antibiotics
   • If signs of a skin infection develop, the doctor may prescribe an antibiotic ointment or oral antibiotic if necessary.
   • Over-the-counter antibiotic creams or ointments are not recommended due to potential allergies to ingredients like neomycin and bacitracin.

How to prevent diaper rash?

Preventing diaper rash starts with proper skin care, which includes:

• Keep your baby’s skin clean and dry under a diaper.
• Change your baby’s diapers frequently.
• Allow your child to go diaper-less whenever possible. 
• Gentle cleanse baby’s bottom with a soft cloth and warm water.
• Limit using soap or other strong products on the skin.
• Avoid using scented wipes or alcohol wipes.

When to see a doctor for diaper rash? 

Take your baby to see the doctor if: 

• Your baby’s diaper rash does not subside, it worsens or spreads to other areas of the body.
• Your baby has a high temperature.
• Your baby appears to be uncomfortable. 

Make an appointment at Pantai Hospitals

A dedicated and expert team of paediatricians at Pantai Hospitals is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding diaper rash. We assure you the best possible care tailored to your specific needs.

Pantai Hospitals has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.