Diaper Rash (Diaper Dermatitis)

What is diaper rash?

Diaper rash or diaper dermatitis is an irritation of the skin in the diaper area. The diaper area includes the buttocks (bottom), thighs, and genital area. Diaper rash is also known as incontinence-associated dermatitis. It is caused by urine (pee) or feces (poop).

Diaper rash is common in infants and toddlers, especially babies between 4 and 15 months old. It peaks between the ages of 9 and 12 months. However, diaper rash can occur at any age. Diaper rash can cause pain and discomfort. If left untreated, an infection can happen.

Children with serious illnesses may be at a higher risk of developing diaper rash. Chemotherapy may irritate the skin in the diaper area if it comes out through pee or poop. Steroid medicines or having a weak immune system can also increase the risk. Radiation therapy may make skin more sensitive to irritation.

Be sure to tell your care team about any signs of skin irritation. 

Symptoms of diaper rash

Signs and symptoms of diaper rash depend on the cause. Each child’s symptoms may be different. 

Common signs and symptoms of diaper rash include: 

• A bright, red rash in the diaper area
• Red, rough skin on the scrotum and penis in boys
• Red, rough skin in the vagina area in girls
• Pimples, blisters, sores, big bumps, or spots filled with pus
• Small red spots that can grow and join the main rash
• Fussing, crying, or acting uncomfortable, especially during diaper changes 

On darker skin, diaper rash may appear as a lightening or darkening of the skin.

Causes of diaper rash

Factors that cause or increase the risk of diaper rash include:

• Moisture
• Pee or poop
• Frequent poops
• Diarrhea
• New foods that cause changes to the digestive system
• Friction, chafing, or rubbing
• Reactions to irritants such as certain soaps, laundry detergents, wipes, or lotions
• Antibiotics that cause yeast infections (fungus that grows in warm and moist areas) or diarrhea
• Chemotherapy or other medicines that come out in pee and poop
• Bacterial or fungal (yeast) infection on the skin  
• Radiation to the diaper area

Some patients may have a loss of bladder or bowel control (incontinence) due to their medical condition and may need to wear diapers, training pants, or other incontinence products. This increases the risk of skin irritation and incontinence-associated dermatitis.

Types of diaper rash

Diaper rash can have different causes and symptoms. Types of diaper rash include:

• Contact diaper rash: This is the most common type of diaper rash. It happens when skin comes in contact with an irritant such as urine (pee) or feces (poop). A red, shiny rash starts on the bottom and can spread to the thighs, stomach, and waist area. It does not generally involve folds in the skin. 
• Candida diaper rash: This rash is caused by Candida yeast. It typically starts in the folds of the diaper area and then spreads. It may also show up on the face, scalp, or neck. The rash is usually a deep red, shiny rash with swollen, red or purple bumps outside the main rash. This type of rash may be linked with thrush, a yeast infection in the mouth.
• Seborrheic diaper rash: This rash is red with oily, yellow patches. It affects the skin folds. The rash may also be on the face, scalp, or neck. Its cause is unknown.

Sometimes, a rash that looks like diaper rash can be something else. These conditions include:

• Impetigo is caused by a bacterial infection.
• Perianal streptococcal disease is caused by group A streptococcus.
• Allergic dermatitis is caused by soaps, detergents, the diaper, or other irritants.

A diaper rash can also be a sign of an underlying condition. For example, a rash in the diaper area can sometimes be an early sign of acute graft-versus-host disease (GVHD) after a stem cell (bone marrow) transplant. It is important to watch closely for skin changes in infants and toddlers who have had a transplant. 

Treatment of diaper rash

Treatment of diaper rash depends on symptoms, your child’s age, health, and severity of the rash. The goal is to treat the cause and allow the skin to heal.

Steps to help prevent and treat diaper rash:

• Check diapers regularly and change them when wet or soiled: Children at high risk for diaper rash should have their diapers checked at least every 2 hours. Diaper changes are needed more often if your child has diarrhea or when they get IV fluids.
• Clean the skin gently: Clean the skin with mild soap and water or a water-based wipe. Avoid products with alcohol or fragrance. Do not scrub the skin. Always wipe downward gently. Pat the skin dry.
• Use an ointment or paste recommended by the care team: Apply a moisture barrier ointment or paste (diaper cream) generously to the skin. Not all creams are moisture barriers. Ointments with zinc oxide are generally recommended. 

How to use a moisture barrier cream

• Use a soft cloth to clean the diaper area with warm water and mild soap, and pat dry.
• You do not need to remove all the existing moisture barrier cream.
• Apply a thick layer of approved cream to the entire affected area. You have applied enough cream when you can no longer see any skin through the cream.
• Use the cream after each diaper change. Reapply as needed to keep the affected area covered.
• If your child gets chemotherapy medicines, wear gloves and other personal protective equipment (PPE) for diaper changes as instructed. Always follow instructions for the safe handling of body fluids after chemotherapy.

Mild diaper rash will usually heal within 2–4 days with proper care. A rash caused by a yeast infection may take longer to get better. 

Contact a health care provider if your child:

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

Tips for families

• Check your child's skin regularly: Examine your child’s skin daily, including the diaper area. Patients at high risk for skin irritation need to be checked more often. Older children may avoid being checked. But regular monitoring is important to catch early signs of irritation. 
• Only use the diaper creams recommended by your health care provider: Many creams and ointments can irritate the skin and make diaper rash worse. 
• Avoid baby powders: Powders can be breathed in, causing breathing and lung problems.
• Keep diapers loose or take diapers off: Give diaper-free time to increase airflow, reduce moisture, and cut down on chafing. Keep the moisture barrier cream in place, whether the diaper is on or off. 
• Make sure all caregivers know how to care for the skin.
• Practice hand hygiene: Always wash your hands with soap and water or use hand sanitizer before and after changing a diaper. 

Let your care team know about any skin irritation or inflammation.

Questions to ask the care team

• What causes diaper rash?
• How do I know if my child has diaper rash?
• What is the best way to treat diaper rash?
• How often should I change my child’s diaper?
• When should I be worried about infection or worsening symptoms?
• What can we do to prevent diaper rash?
• What soaps, wipes, or diaper creams should we avoid?
• Could this rash be a sign of something more serious?

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