Why does it occur
A baby's skin is thinner and more vulnerable than an adult's. Under the diaper, it is in a warm and humid environment, gets wet and becomes permeable. Fecal enzymes, especially with frequent loose stools, and ammonia produced from urine irritate it. Rubbing against the edges of the diaper increases the damage. Candida fungi, which live in the intestines, and bacteria multiply on the damaged surface, which turns simple irritation into infectious dermatitis.
- Prolonged contact with urine and feces
- Rare diaper changes
- Diarrhea, teething, change of diet
- Taking antibiotics by a child or nursing mother
- Tight diaper and friction
- Irritating wet wipes and scented products
Types and symptoms
Simple contact dermatitis appears as redness in raised areas of skin that come into contact with the diaper, while the folds remain clear. Candidal dermatitis also affects folds, has a bright red color, clear boundaries and small red dots or pustules along the edges - the so-called screenings. Bacterial infection manifests itself as blisters, crusts and pustules. The child may become restless and cry when changing a diaper or urinating.
- Redness of the buttocks and perineum
- Peeling, soaking of the skin
- Damage to folds and dropouts due to candidiasis
- Blisters and crusts due to bacterial infection
- Fussiness and crying when changing a diaper
What can be confused with
Not every redness under the diaper is diaper dermatitis. Infants in this area have seborrheic dermatitis with yellow greasy scales, atopic dermatitis, psoriasis, streptoderma and scabies. A rare but important cause is zinc deficiency, which is accompanied by rashes around the mouth and hands, diarrhea and hair loss. If the rash is atypical or does not respond to proper care, the pediatrician will refer the child to a pediatric dermatologist.
- Seborrheic dermatitis
- Atopic dermatitis
- Streptoderma
- Psoriasis
- Scabies
- Enteropathic acrodermatitis due to zinc deficiency
Diagnostics
The pediatrician makes a diagnosis during examination. He evaluates the location of the rash, the involvement of folds, the presence of screenings, blisters and crusts, and also finds out how often the diaper is changed, what type of stool the child has, whether he has received antibiotics and what products are used for care. Tests are required infrequently: if a bacterial infection is suspected, a culture of the discharge is taken, and if there is doubt about the fungal nature, a scraping is taken for microscopy.
- Pediatrician examination
- Assessment of nursing, nutrition and stool
- Skin culture for pustules
- Microscopy of scrapings for fungi
- Consultation with a pediatric dermatologist for persistent symptoms
Treatment and prevention
The basis of treatment is dryness and protection of the skin. The diaper is changed immediately after soiling, the skin is carefully cleaned with warm water, dried with blotting movements and the child is left without a diaper for several minutes. Then a protective cream with zinc oxide or petroleum jelly is applied in a thick layer. For candidiasis, the pediatrician prescribes an antifungal cream, and for a bacterial infection, local antibacterial agents. Hormonal ointments are used only as prescribed by a doctor for a short course.
- Change diaper every 2-3 hours and immediately after bowel movement
- Use well-absorbent diapers of the appropriate size
- Do not use talc - the child may inhale its particles
- Choose wipes without alcohol or fragrance or wash with water
- Regularly arrange air baths
- Don't pull the diaper too tight