Dr. Hands explains what diaper rash exactly is, also known as dermatitis. He also shares information with other types of diaper rash and how to treat it.
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Treating Different Types of Diaper Rash Diaper rash is one of the most common of all pediatric problems. I venture to say it is a rare mother who can ever say their child never had a diaper rash. The most common is really an irritant contact dermatitis. This is one that affects the buttocks, the lower abdomen, the medial thigh, the labia, the scrotum. It spares skin folds. It is what we call the generic diaper rash. It’s usually red. It’s edematous meaning swell a little bit. It may have a lot of bumps. There may be scaling. Sometimes the dermatitis leads to little ulcers which are quite unpleasant and even can have a little bleeding associated with them. There is also a phenomenon called intertriginous dermatitis which actually fits just the pampers at the level of the diaper. Intertrigonitis is associated with this. This is a rash where two skin surfaces meet. Now you think of that in the diaper area but you also will see intertrigonitis behind the ears and under the neck. Now of the years ammonia has been blamed for the cause of this. This is undoubtedly not the case. The theory is that urine and feces interact on the skin. The urine hydrates the skin, makes it edematous, breaks down the barriers. The urease which is this enzyme produced by the microbes in the stool breaks down the urine and produces an elevated pH, an alkaline pH. This in turn activates enzymes in the fecal matter which have an adverse effect on the skin and this is probably the origin of the diaper rash. Ammonia is not the cause. Now there is a differential diagnosis in addition to an irritant diaper rash. There is something called atopic dermatitis which is what you know is eczema. There is Candidiasis which is a fungal infection in the area. Yet it can be bacterial skin infections that can imitate. There is a skin disorder called seborrhea, you know this cradle cap when it involves the hair and the scalp but it can also cause problems here. And then rarely again in this disease is like psoriasis. It’s just a cytosis that can cause a similar rash. This is why if you have a persistent diaper rash you really do need to see the physician and let him work at the rash and make sure that it’s what is the common variety what do you do for diaper rashes. One, change frequently is of course the cornerstone. Super absorbent, disposable diapers are helpful. Never use plastic over them. Resist excessive cleaning or washing of the area. Barrier creams are very helpful. These are common variety diaper creams that everyone knows of, Desitin, A&D etcetera. And lastly, if there is a lot of swelling, edema, the rash is very problematic, the doctor can prescribe steroids. Our caution with steroids is there are multiple classes of steroids. Steroids in babies can be absorbed through the skin. Do not use the strong steroids. The prescription steroids the doctor should guide you on which steroids to use. We recommend the hydrocortisone type of steroid, 1% which is the mildest of all steroids. It has the least chance of being absorbed, the least chance of causing any problems but this should all be done under a doctor’s recommendation.

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