ANSWERS: 1
  • <div class="section1"> Definition

    Dermatitis of the buttocks, genitals, lower abdomen, or thigh folds of an infant or toddler is commonly referred to as diaper rash.

    Description

    The outside layer of skin normally forms a protective barrier that prevents infection. One of the primary causes of dermatitis in the diaper area is prolonged skin contact with wetness. Under these circumstances, natural oils are stripped away, the outer layer of skin is damaged, and there is increased susceptibility to infection by bacteria or yeast.

    Diaper rash is a term that covers a broad variety of skin conditions that occur on the same area of the body. Some babies are more prone to diaper rash than others.

    Causes and symptoms

    Frequently a flat, red rash is caused by simple chafing of the diaper against tender skin, initiating a friction rash. This type of rash is not seen in the skin folds. It may be more pronounced around the edges of the diaper, at the waist and leg bands. The baby generally doesn't appear to experience much discomfort. Sometimes the chemicals or detergents in the diaper are contributing factors and may result in contact dermatitis. These rashes should clear up easily with proper attention. Ignoring the condition may lead to a secondary infection that is more difficult to resolve.

    Friction of skin against itself can cause a rash in the baby's skin folds, called intertrigo. This rash appears as reddened areas that may ooze and is often uncomfortable when the diaper is wet. Intertrigo can also be found on other areas of the body where there are deep skin folds that tend to trap moisture.

    Seborrheic dermatitis is the diaper area equivalent of cradle cap. It is scaly and greasy in appearance and may be worse in the folds of the skin.

    Yeast, or candidal dermatitis, is the most common infectious cause of diaper rash. The affected areas are raised and quite red with distinct borders, and satellite lesions may occur around the edges. Yeast is part of the normal skin flora, and is often an opportunistic invader when simple diaper rash is untreated. It is particularly common after treatment with antibiotics, which kill the good bacteria that normally keep the yeast population in check. Usual treatments for diaper rash will not clear it up. Repeated or difficult to resolve episodes of yeast infection may warrant further medical attention, since this is sometimes associated with diabetes or immune problems.

    Another infectious cause of diaper rash is impetigo. This bacterial infection is characterized by blisters that ooze and crust.

    Diagnosis

    The presence of skin lesions in the diaper area means that the baby has diaper rash. However, there are several types of rash that may require specific treatment in order to heal. It is useful to be able to distinguish them by appearance as described above.

    A baby with a rash that does not clear up within two to three days or a rash with blisters or bleeding should be seen by a healthcare professional for further evaluation.

    Treatment

    Antibiotics are generally prescribed for rashes caused by bacteria, particularly impetigo. This may be a topical or oral formulation, depending on the size of the area involved and the severity of the infection.

    Over-the-counter antifungal creams, such as Lotrimin, are often recommended to treat a rash resulting from yeast. If topical treatment is not effective, an oral antifungal may be prescribed.

    Mild steroid creams, such as 0.5&ndash;1% hydrocortisone, can be used for seborrheic dermatitis and sometimes intertrigo. Prescription strength creams may be needed for short-term treatment of more stubborn cases.

    Alternative treatment

    Good diaper hygiene will prevent or clear up many simple cases of diaper rash. Diapers should be checked very frequently and changed as soon as they are wet or soiled. Good air circulation is also important for healthy skin. Babies should have some time without wearing a diaper, and a waterproof pad can be used to protect the bed or other surface. Rubber pants, or other occlusive fabrics, should not be used over the diaper area. Some cloth-like disposable diapers promote better air circulation than plastic-type diapers. It may be necessary for mothers to experiment with diaper types to see if the baby's skin reacts better to cloth or disposable ones. If disposable diapers are used, the baby's skin may react differently to various brands. If the baby is wearing cloth diapers, they should be washed in a mild detergent and double rinsed.

    The diaper area should be cleaned with something mild, even plain water. Some wipes contain alcohol or chemicals that can be irritating for some babies. Plain water may be the best cleansing substance when there is a rash. Using warm water in a spray bottle (or giving a quick bath) and then lightly patting the skin dry can produce less skin trauma than using wipes. In the event of suspected yeast, a tablespoon of cider vinegar can be added to a cup of warm water and used as a cleansing solution. This is dilute enough that it should not burn, but acidifies the skin pH enough to hamper the yeast growth.

    Barrier ointments can be valuable to treat rashes. Those that contain zinc oxide are especially effective. These creams and ointments protect already irritated skin from the additional insult of urine and stool, particularly if the baby has diarrhea. Cornstarch powder may be used on rashes that are moist, such as impetigo.

    Nutrition

    What the baby eats can make a difference in stool frequency and acidity. Typically, breast-fed babies will have fewer problems with rashes. When adding a new food to the diet, the baby should be observed closely to see whether rashes are produced around the baby's mouth or anus. If this occurs, the new food should be discontinued.

    Babies who are taking antibiotics are more likely to get rashes due to yeast. To help bring the good bacterial counts back to normal, Lactobacillus bifidus can be added to the diet. It is available in powder form from most health food stores.

    Herbal treatment

    Some herbal preparations can be useful for diaper rash. Calendula reduces inflammation, tightens tissues, and disinfects. It has been recommended for seborrheic dermatitis as well as for general inflammation of the skin. The ointment should be applied at each diaper change. Chickweed ointment can also be soothing for irritated skin and may be applied once or twice daily.

    Prognosis

    Treated appropriately, diaper rash will resolve fairly quickly if there is no underlying health problem or skin disease.

    Prevention

    Frequent diaper changes are important to keep the skin dry and healthy. Application of powders and ointments is not necessary when there is no rash. Finding the best combination of cleansing and diapering products for the individual baby will also help to prevent diaper rash.

    Source: The Gale Group. Gale Encyclopedia of Medicine, 3rd ed.

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