09/12/2019 | Catarina Vilela
Diaper dermatitis, also called diaper rash and diaper rash, is the most common rash in infants and young children. It typically occurs on convex skin surfaces that are in direct contact with the diaper, including the buttocks, lower abdomen, genitals, and upper thighs. The diaper increases the local temperature and humidity and consequently the skin is susceptible to friction with the diaper. There are several triggering factors. Prevention is best, for example with zinc oxide lotions.
What are the symptoms of diaper dermatitis?
Diaper dermatitis has the following symptoms:
- Red skin (redness).
- Irritated skin, which can get hot.
- Red spots or pus may appear and ooze (moisture).
- Changes in baby's disposition: It becomes more uncomfortable than usual and cries when the diaper area is washed.
Why do babies have diaper rash or diaper rash?
Certainly many parents have already wondered about this.
Diaper dermatitis may occur:
- if the baby has very sensitive skin.
- when the wet diaper of urine and droppings remains in contact with the skin for a long time, especially if the baby is sitting for long periods. The main irritants that cause diaper dermatitis are fecal lipases and proteases.
- due to a diarrhea situation, by digestive agents in the ejection. Your baby may have redness that does not go away and small red bumps, peeling the skin and even bleeding.
- allergic contact dermatitis to the diaper plastic material (very rare).
- by allergic reaction to the synthetic products that make up the diaper.
- when the baby is on antibiotics (susceptible to microorganisms that can infect the skin).
- when the baby begins to eat solid foods, which causes changes in the poop's characteristics and acidity.
- allergy to baby laundry or diaper washing products when using non-disposable diapers, ie cloth diapers. A mild, mild detergent should be used for proper rinsing.
- if the baby (or nursing mother) is taking antibiotics.
- more exacerbated by the use of diapers, in the case of psoriasis, atopic dermatitis, seborrheic dermatitis, miliary, candidiasis, allergic contact dermatitis. And those that are present in the region but are not related to diaper use such as enteropathic acrodermatitis, Langerhans cell histiocytosis, pediatric gluteus granuloma, perianal streptococcal dermatitis, bullous impetigo, scabies, congenital syphilis, AIDS.
- and being complicated by fungal infections, usually candidiasis.
- when there is infection caused by “bad” bacteria from other skin or mucous membranes carried by poorly washed hands during diaper change.
- Urine (ammonia) alone is not a triggering factor.
Thus, the diagnosis of diaper area dermatitis may not be specific, but rather a localization diagnosis, which encompasses a group of dermatoses and results from the interaction of several factors.
How can you prevent and treat diaper rash?
Since atopic dermatitis is characterized by an inflammation of the skin, its treatment is entirely focused on reducing itching, repairing the skin and reducing inflammation whenever necessary. The treatment is simple and depends on the type and severity of dermatitis. Basically the area should be kept clean and dry, minimizing contact with aggressive and irritating factors and not exposing to unnecessary irritants.
So some measures we should take to prevent diaper erythema are:
- Dry Skin: Keep baby's skin clean and dry.
- Changing the diaper: Change the diaper frequently, especially if you have had a dump, to avoid skin irritation in contact with feces and urine. Generally the diaper should be changed six to eight times a day.
- Cleaning: It should be mild with warm water or water dispersible oil or liquid petroleum jelly. Use soap as much as possible at most 2x / day. It should be smooth without perfume, neutral or slightly acidic pH.
- Redness: If redness occurs, apply an ointment such as zinc oxide or Vaseline, which can serve as a barrier to preventing the diaper from sticking to the skin. And it is not necessary to clean this protective layer with each diaper change. This in case there is already redness.
- Super absorbent diapers: to retain moisture, keeping it out of contact with baby's skin. Note that a good absorbent diaper is not necessarily a diaper of an expensive or known brand!
- Avoid friction: using, for example, the appropriate size of diaper. Don't be afraid of diaper allergies, as explained earlier, erythema is rarely caused by actual diaper allergies.
- Do not over tighten the diaper. Besides being uncomfortable, it does not favor air circulation inside the diaper.
- No diaper: Try not to use a diaper as much as possible to facilitate aeration.
- Wipes: The use of wipes is not contraindicated, however they may be irritating and contain preservatives capable of causing contact sensitization. When using wipes, they should be fragrance free and alcohol free. Waterwipes wipes are 99.9% water and one drop of fruit extract ( grapefruit). It has no aggressive chemicals, no alcohol, no perfumes. They are pure, soft and safe wipes for the most delicate skin of the baby.
- Compresses: If a rash does not disappear, another option is to use TNT (nonwoven) compresses or a damp cloth with warm water.
- Dry well! Good drying without rubbing on any of the options.
- Before you go to bed: For older children, always change the diaper before going to bed.
- Clean and Dry: Before you put a new diaper on, your baby's tail must be completely clean and dry.
- Clean the creams well: Each time you apply a new cream, be sure to remove any traces of the cream you have previously placed with oil or mineral water.
- Clean finger: If you need to apply more cream use a clean finger to unpack it.
- Barrier Cream: Use a barrier cream for minor skin irritation in this area. The layer should be thin with each diaper change.
- Washing Hands: Wash your hands after changing the diaper, and if necessary, clean your baby's as well.
- Talcum powder, never! Avoid using talcum powder (even though our grandmothers tell us it is the best way to prevent diaper rash) because of the risk of aspiration and lung problems
- Healthcare Professional: If there is no improvement, consult a healthcare professional. Other types of creams such as cortisone ointments may be necessary if there is an extensive inflammatory reaction or antifungal ointments if the lesions suggest candidiasis.
- Candidiasis: If diaper dermatitis persists for more than three days, the skin is very red and with rounded spots may be Candidiasis. This is caused by a fungus that exists in the intestine without causing disease, but in the presence of diaper dermatitis can cause infection.
- Steroid creams: Steroid creams (eg hydrocortisone) should not be used without a prescription. Very potent corticosteroids are contraindicated because of the risk of atrophy and stretch marks, the risk of systemic absorption and because occlusion increases their potency.
When should I contact a doctor in case of diaper dermatitis?
- If, despite all precautions, after about a week, the inflammation does not pass and / or worsens;
- If there are blisters, wounds, pus, bloody lesions;
- If there are lesions in other areas of the skin that are not in contact with the diaper;
- If the child has a fever, diarrhea, prostration, or crying intensely when urinating or defecating;
- If your child has a chronic illness, particularly digestive or immune system disorders.
Is it my fault if my baby has a diaper rash?
"Don't feel bad if your baby has a diaper rash," says Ellen Schumann, MD, a pediatrician in Weston, WI. Most babies do, and some will often. "It's not a reflection of your parenting skills. In most cases, it's not your fault."
At what age is the child most likely to develop dermatitis?
The critical period is between the first and the sex of the month, and at this stage that extra care is required.
What is the advantage of breastfeeding in diaper dermatitis?
Breastfeeding is advantageous in preventing diaper dermatitis because the urine and feces of breastfed babies are less irritating.
Is there any relationship between tooth eruption and diaper area dermatitis?
These two events happen at about the same time but are not proven to be related.
Is dermatitis related to diaper design and quality?
In recent years the design of diapers has made a major technological advance, however, skin dermatitis leads to approximately 20% of all consultations in the area of childhood dermatology. In recent years, there has been a decrease in the frequency and severity of diaper dermatitis, especially due to the better quality of the material used to make diapers, which has significantly contributed to the advancement of hygiene care. Bambo Nature diapers are dermatologically tested.
What is the impact of diapers on diaper rash?
Modern disposable diapers have three layers:
- an interior that has filter function,
- an intermediate with liquid absorption capacity,
- a waterproof exterior.
The last layer is extremely important in waterproofing the diaper but prevents perspiration, which increases the temperature and humidity. These factors are favorable to dermatitis. Modern diapers are more occlusive and are therefore responsible for the rare cases of allergic contact dermatitis.
The ideal diaper should have good water-holding capacity, allow good (less occlusive) aeration, and change color immediately after the child has urinated. This diaper doesn't exist yet.
Catarina Vilela (nurse)