The word "diaper rash" refers to a condition of irritant diaper dermatitis, which is reflected by a skin rash in the diaper area caused by irritants, contact and other factors.
It is characterized by united patches of erythema and scaling and is mainly seen on the convex surfaces of the skin. When there is bacterial or fungal superinfection, the folds are also affected and the lesions appear bright red, erythema and satellite pustules around the lesion.
It can be considered an irritating form of contact dermatitis, because in most cases it is due to skin contact with urine and feces. It is very important to identify when there is only dermatitis, without fungal involvement, since the treatment is completely different.
Dermatitis occurs when the skin is exposed to prolonged moisture and increased skin pH caused by urine and feces and the resulting breakdown of the stratum corneum. This may be due to diarrhea, frequent bowel movements, tight diapers, and overexposure to ammonia or allergic reactions. The key is excessive humidity, so any change that keeps skin surfaces dry will end the problem.
It is always thought that using cloth diapers would eliminate the problem; However, there has been no detectable difference in the rates of diaper rash in conventional disposable diaper and cloth diaper users. The important thing whether using cloth or disposable diapers is that they should be changed frequently to prevent diaper rash, even if they don't feel wet.
It has been seen that infant diet and diaper rash are also linked because fecal enzymes are in turn affected by diet. Breastfed babies have a lower incidence of diaper rash, because their stools have a higher pH and enzyme activity is lower. Diaper rash is also more likely to be diagnosed in infants 8-12 months of age, perhaps in response to an increase in solid food consumption and dietary changes around that age that affect fecal composition.
The link between feces and diaper rash is also evident in the observation that children are more susceptible to developing diaper rash after receiving antibiotics, as these affect the intestinal microflora.
It is important to check for secondary infections, since the skin is more vulnerable to secondary infections due to bacteria and fungi. Colonization by Candida albicans, a common fungus in the area, is significantly more common in children with symptomatic diaper rash. Staphylococcus aureus, a skin bacteria, also occurs more frequently in children with symptoms than in healthy children. Candida appears to be the most common opportunistic invader in diaper areas, therefore it is important to recognize it and treat it.
The most effective treatment is to discontinue the use of diapers, allowing the affected skin to air out. Thoroughly drying the skin before putting on the diaper is a good prevention measure, since excess moisture is the real problem. Various powders, such as talcum powder or starch, can reduce humidity, but can introduce other complications. Airborne dusts of any type can irritate lung tissue, and starchy plant-based dusts provide food for fungi and are not recommended by the American Academy of Dermatology.
Creams based on zinc oxide are very effective, especially in prevention, because they have both a drying effect and an astringent effect on the skin, being slightly antiseptic without causing irritation. In persistent skin rashes, an antifungal cream should be considered and when there is significant contact irritation, a low-potency topical corticosteroid can be used under medical supervision.
Finally, we just want to reiterate that keeping the skin as dry as possible, avoiding continuous contact of urine and feces with the diaper and continuous skin care with creams designed for each case.
Published in SaludPanama by Dr. Katia Rueda
Specialist in Pediatrics - Neonatology
