Diaper Dermatitis (Diaper Rash)

Diaper dermatitis, or diaper rash, is an irritation of the skin that occurs on the area covered by a diaper, including the bottom, thighs, abdomen, or genital area. This is also known as incontinence associated dermatitis, or skin irritation caused by urine or feces.

Diaper dermatitis is common in babies and toddlers, especially in infants between 9 and 12 months old. However, diaper dermatitis can occur at any age. Diaper rash can cause pain and discomfort. If left untreated, infection can develop.

Signs of diaper dermatitis include small pink or red dots, redness, inflamed skin, or blisters. Skin may be itchy or painful.

Causes of diaper dermatitis

Diaper rash occurs as skin is exposed to moisture, friction, urine and feces, and other skin irritants. Factors that contribute to diaper dermatitis include:

• Moisture
• Urine or stool
• Diarrhea
• New foods that cause changes to the digestive system
• Friction, chafing, or rubbing
• Skin irritants or allergic reactions (often from soap, laundry detergent, wipes or lotions)
• Bacteria
• Antibiotics that cause yeast infections (fungus that grow in warm and moist areas) or diarrhea
• Cancer treatments including chemotherapy and radiation therapy
• Medications that are excreted in urine and stool

During cancer, children have additional risk factors for diaper dermatitis. Cancer treatments such as chemotherapy may contribute to diaper dermatitis due to excretion in urine or stool. Radiation therapy may also may also make skin more sensitive and susceptible to irritation. The use of steroid medications or having a compromised immune system can also increase risk.

Older children may have a loss of bladder or bowel control (incontinence) due to illness, medications, or disease. These patients may need to wear diapers or “pull-ups,” increasing risk for incontinence associated dermatitis.

Treating diaper dermatitis

Treatment for diaper dermatitis depends on symptoms, age of the child, health, and severity of the rash. Be sure to let the care team know about any signs of skin irritation. Check with a care team member before using any product on the skin.

A doctor may recommend diaper rash treatments including:

• Not wearing diapers for a period of time
• More frequent diaper changes
• Ointment or paste that protects the skin
• Antifungal cream for a yeast infection

Preventing diaper dermatitis

During cancer, it is important to be take steps to prevent diaper dermatitis.

• Check diapers regularly, and change when soiled. Children at high risk for diaper rash should have diapers checked at least every 2 hours and more often in the case of diarrhea or IV fluids.
• Clean the skin gently. Clean the skin right away with mild soap and water or a mild pre-moistened wipe. Avoid products with alcohol or fragrance. Do not scrub the skin. Always wipe downwards gently. Pat skin dry.
• Use an ointment or paste recommended by the care team. Apply a moisture barrier to the skin. Always check with your provider, but topical barriers containing zinc oxide and/or petrolatum are generally recommended. Apply several thin layers. The ointment should completely cover the affected area. Do not rub in.
• Avoid baby powders. Powders can be breathed in, causing breathing and lung problems.
• Keep diapers loose. Give diaper-free time to increase airflow, reduce moisture, and minimize chafing.
• Check skin regularly. Examine the child’s skin on a daily basis, including the diaper area. Patients at high risk for skin irritation should be checked more often. Older children may avoid being checked. However, regular monitoring is important to catch early signs of irritation.
• Inform a care team member about any sign of irritation or inflammation.
• Make sure all caregivers know how to care for the skin.

Rashes in the diaper area can result from a variety of causes. It can be hard to tell one type of rash from another, but they may require different treatment.

• Contact or irritant diaper dermatitis is the most common type of diaper rash. It is caused by any irritation, usually urine and feces. Signs vary from mild redness to red, shiny, and/or peeling skin. Areas affected often include the buttocks, thighs, abdomen, and waist.
• Candida (yeast) diaper dermatitis is caused by a yeast infection which may develop if diaper rash is not treated. Skin may show deep red patches of inflammation. There may be raised fluid-filled pustules. Skin affected often includes folds of the skin around the thighs and genitals. Sometimes the child may also have a yeast infection in the mouth (thrush).

Other rashes may include allergic reactions, seborrhea, and bacterial infection.

Contact a provider if the child:

• Develops large sores, blisters, pimples, boils, or crusts
• Has not improved in 24 hours
• Has a rash that bleeds, turns bright red or becomes solid, or if the rash spreads beyond the diaper area
• Has trouble sleeping due to the rash
• Develops a fever
• Acts sick

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