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The Bad Rash

By: Risa Caldoza-De Leon MD, FPAPSHPIThe Bad Rash

If you are like most consumerist modern moms, you’d surely see diapers as some sort of a life-saving product that never fails to come in handy when it comes to raising your little bundle of joy.  Truly, the war on body functions has been won by this disposable commodity. But the question is: does using a diaper come with a hefty price that our precious kids have to pay?

An average child will go through several thousand disposable diapers in their young life before potty-training, between 6,500 to 10,000 diapers at 30 months old to be exact. A study by Procter & Gamble Co. found that Filipino babies get their diapers changed thrice a day, while in the U.S, it’s six times a day. However, frequent diaper changes can lead to diaper rash, or diaper dermatitis in medical jargon. Although it is a common skin condition for infants, a bout of diaper rash is never a pleasant time for both mom and baby.

Infants are most likely to experience this skin disorder once in a while.  In fact, two of 10 childhood visits to the dermatologist are due to diaper rash. Half of all infants will have some form of this skin disorder in their first year, generally between 3-12 weeks of life and peaking at 9-12 months. But diaper rash can also affect persons of any age who wear diapers, like the paralyzed patient and elderly.

An infant’s skin is very delicate: much softer, immature, and more permeable compared to older children and adults. This makes a recipe for diaper rash, especially when the skin gets damaged and irritated due to contact with pee (urine) and poop. The baby’s skin becomes sore, puffy red, scale, and tender. It can cover the lower tummy, buttocks, genitals, thigh folds, and other areas directly in contact with the soiled diaper. As a result, babies then get cranky and cry whenever their butt is washed or touched. But remember that diaper rash is not a sign of parental neglect.

Contact with urine (pee) changes the skin's environment (called pH levels), which enable bacteria and fungi, like the yeast called Candida albicans, to grow more easily, thus causing a rash. In Candida diaper dermatitis, the rashes are deep red, scaly, and shiny with satellite lesions (additional irritation near the main skin rash). It usually starts in the creases or folds of the thighs and in the diaper area, and will eventually spread to cover large portions of the baby’s skin. This type of rash may be linked with thrush, a yeast infection in the baby's mouth.  Yeast passes through his tummy when he eats, ends up in his poo, and finally makes a landing on his diaper, right next to his warm, damp skin.

Some babies also get a rash as reaction to baby wipes, detergent, soap or the elastic in plastic pants. Diarrhea (loose stools) can make an existing case of diaper rash worse.

It’s another reason to breastfeed; babies who are breastfed have a lower chance of diaper rash since their poo have a lower pH than in formula-fed babies. However, when babies start to eat solid foods, they poo more and the pH starts to rise, resulting in a diaper rash.

Know your ABCs

It pays for moms to know their alphabet when dealing with diaper rash.

A  -  Air out the skin by allowing the children to go diaper-free for several hours each day, or for as long as possible without mommy getting nervous. Keep in mind that in many hot countries, even today, babies simply wander about naked below the waist. In China, for instance, babies wear pants with a hole cut out of the bottom.

Let the baby’s bottom get some air by allowing him to play diaper-less on a waterproof sheet or a plastic tablecloth with a towel on top of it. Bare-butt child is a lot better than rash-butt.

B  - Barrier creams/ointments protect the skin. The use of barrier products has been proven in numerous trials to minimize the contact of pee and poo with the skin. Barrier preparations work either by providing a film over the surface of the skin or providing lipids that can penetrate into the skin.

These skin protectants are approved by the US Food and Drug Administration (FDA) and defined as products that temporarily protects injured or exposed skin and mucous membrane surfaces from harmful or annoying stimuli. They may also provide relief to such surfaces. Ideally, zinc oxide ointment or products containing zinc oxide are used for diaper rash. It is inexpensive and has antiseptic and astringent properties. It also has low risk for allergies. It can be bought over-the-counter without a doctor’s prescription. That’s how safe it is.

Zinc ointment may be all that is needed in mild diaper rash that is not infected. Some even contain menthol than can cause better circulation to an area and aid in healing. Layer it thick! An ointment is a thicker barrier and, thus, gives more protection. This should be applied at every diaper change and could be covered with a thin layer of petroleum jelly to prevent sticking to the diaper. Do not share creams and ointments with other kids. Also, do not touch the affected skin and then put your fingers back into the jar afterward. Use a different finger if you need more ointment.

Most studies say that using talcum powder or cornstarch gives no benefit. There is also the risk of your baby inhaling the powder and getting it into his lungs. Some experts say cornstarch might make diaper rash worse as it can spread yeast and bacteria.

C - Clean; keep the skin dry and clean. This involves changing diapers as often as you can, ideally every two hours, and after every poop. A study in 2008 which compared the use of infant wipes and the golden cleansing practice of water and washcloth showed that the former can clean the diaper area more effectively. It is also safer to use in infants with rashes. Choose a brand that is alcohol and fragrance-free.

Many kids show a good response to simply sitting in a warm water bath twice a day for 15 to 20 minutes.

D - Disposable diapers rather than cloth diapers should be considered when your baby has diaper rash because they are highly absorbent and specifically designed to minimize skin exposure to wetness. Put the diaper loosely to prevent chafing. Change the diaper often, and please do not wait until it threatens to outweigh your child and swallow him whole.

E - Educate yourself on how to prevent a recurrence of diaper rash. Good job mommy if you’re reading this!

If the rash doesn’t go away or gets worse, it’s time to consult your doctor. Raise the red flag when your baby develops a fever and hard to console, or when you see sores and pus coming from the rash. Your doctor may prescribe antibiotics or mild steroid cream depending on the cause. For yeast diaper rash, a topical antifungal cream such as nystatin, clotrimazole, or miconazole may be given. The good news? That dang diaper rash usually responds well to treatment. 

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