What is a diaper rash? How does it develop? What are the symptoms and causes of diaper rash? How can it be diagnosed and treated effectively? Get answers to these and more questions about pediatric diaper rash.

Understanding Diaper Rash: Causes and Risk Factors

Diaper rash, also known as diaper dermatitis, is a common skin condition that develops in the area covered by an infant’s diaper. It is particularly prevalent in babies between 4 to 15 months old, and may become more noticeable when they begin to eat solid foods.

The primary causes of diaper rash include:

• Candida infection: The yeast fungus Candida can thrive in the warm, moist environment under a diaper, leading to a bright red, irritated rash.
• Irritants: Chemical irritants such as ammonia from urine breakdown, acids in stool, and harsh soaps used to clean cloth diapers can all contribute to diaper rash.
• Moisture and friction: Diapers that are too tight or rub against the skin can cause irritation and inflammation.
• Antibiotics: Babies whose mothers are taking antibiotics while breastfeeding or who are taking antibiotics themselves are more prone to developing Candida-related diaper rash.

Symptoms of Diaper Rash: Identifying the Condition

Parents may notice the following symptoms in their child’s diaper area:

• Bright red rash that expands in size
• Very red and scaly areas on the scrotum and penis in boys, or the labia and vagina in girls
• Pimples, blisters, ulcers, large bumps, or sores filled with pus
• Smaller red patches, called “satellite lesions,” that grow and blend with other patches
• Older infants may scratch the affected area when the diaper is removed

It’s important to note that diaper rashes are usually confined to the area covered by the diaper and do not typically spread beyond the diaper’s edge.

Diagnosing Diaper Rash: Clinical Examination and Testing

Healthcare providers can often diagnose a yeast (Candida) diaper rash simply by examining the child’s skin. In some cases, a KOH (potassium hydroxide) test may be performed to confirm the presence of Candida.

What is a KOH test, and how does it work? A KOH test involves taking a small sample of the affected skin and mixing it with a potassium hydroxide solution. This solution helps dissolve the skin cells, allowing the healthcare provider to examine the sample under a microscope for the presence of Candida fungi.

Treating Diaper Rash: Effective Strategies

The primary goal in treating diaper rash is to keep the affected skin clean and dry. Here are some effective strategies:

1. Lay the baby on a towel without a diaper whenever possible, to allow the skin to air-dry.
2. Change diapers frequently, as soon as the baby urinates or has a bowel movement.
3. Gently clean the diaper area with water and a soft cloth or cotton ball, avoiding rubbing or scrubbing.
4. Pat the area dry or allow it to air-dry completely.
5. Use absorbent diapers to keep the skin dry and reduce the risk of infection.
6. Consult with a healthcare provider about the best creams, ointments, or powders to use for the specific type of diaper rash.

Preventing Diaper Rash: Proactive Measures

Taking proactive steps can help prevent the development of diaper rash. These include:

• Regularly changing diapers to keep the skin clean and dry
• Using gentle, fragrance-free products to clean the diaper area
• Avoiding tight-fitting diapers that may cause friction and irritation
• Ensuring proper hygiene, such as washing hands before and after diaper changes
• Monitoring for signs of Candida infection or other underlying issues

Complications and Considerations

While diaper rash is generally a benign condition, it’s important to be aware of potential complications, such as:

• Secondary bacterial or fungal infections, which may require additional treatment
• Persistent or worsening rash that does not respond to standard treatment
• Rashes that extend beyond the diaper area, which may indicate a more serious underlying condition

If a diaper rash does not improve with home treatment or if the baby shows signs of discomfort or distress, it’s crucial to seek medical attention from a healthcare provider.

Conclusion

Diaper rash is a common and treatable condition in infants and young children. By understanding the causes, symptoms, and effective management strategies, parents and caregivers can help keep their little ones comfortable and prevent the development of more serious skin problems. Timely diagnosis and appropriate treatment are key to managing diaper rash effectively.

Diaper rash Information | Mount Sinai

Dermatitis – diaper and Candida; Candida-associated diaper dermatitis; Diaper dermatitis; Dermatitis – irritant contact

A diaper rash is a skin problem that develops in the area under an infant’s diaper.

This microscopic film shows a fluorescent stain of Candida. Candida is a yeast (fungus) that causes mild disease, but in immunocompromised individuals it may cause life-threatening illness. (Image courtesy of the Centers for Disease Control and Prevention.)

Candida, a yeast organism, may cause a skin infection beneath an infant’s diaper which appears as bright red patches.

Diaper rash may be caused by chemical irritants rather than bacterial or candidal infection. Common irritants include ammonia from the breakdown of urine, acids in the stool, and soaps used in laundering cloth diapers.

Causes

Diaper rashes are common in babies between 4 to 15 months old. They may be noticed more when babies begin to eat solid foods.

Diaper rashes caused by infection with a yeast (fungus) called candida are very common in children. Candida grows best in warm, moist places, such as under a diaper. Candida diaper rash is more likely to occur in babies who:

• Are not kept clean and dry
• Are taking antibiotics or whose mothers are taking antibiotics while breastfeeding
• Have more frequent stools

Other causes of diaper rash include:

• Acids in the stool (seen more often when the child has diarrhea)
• Ammonia (a chemical produced when bacteria break down urine)
• Diapers that are too tight or rub the skin
• Reactions to soaps and other products used to clean cloth diapers

Symptoms

You may notice the following in your child’s diaper area:

• Bright red rash that gets bigger
• Very red and scaly areas on the scrotum and penis in boys
• Red or scaly areas on the labia and vagina in girls
• Pimples, blisters, ulcers, large bumps, or sores filled with pus
• Smaller red patches (called satellite lesions) that grow and blend in with the other patches

Older infants may scratch when the diaper is removed.

Diaper rashes usually do not spread beyond the edge of the diaper.

Exams and Tests

The health care provider can often diagnose a yeast diaper rash by looking at your baby’s skin. A KOH test can confirm if it is candida.

Treatment

The best treatment for a diaper rash is to keep the skin clean and dry. This also helps prevent new diaper rashes. Lay your baby on a towel without a diaper whenever possible. The more time the baby can be kept out of a diaper, the better.

Other tips include:

• Always wash your hands before and after changing a diaper.
• Change your baby’s diaper often and as soon as possible after the baby urinates or passes stool.
• Use water and a soft cloth or cotton ball to gently clean the diaper area with every diaper change. Do not rub or scrub the area. A squirt bottle of water may be used for sensitive areas.
• Pat the area dry or allow to air-dry.
• Put diapers on loosely. Diapers that are too tight do not allow enough air flow and may rub and irritate the baby’s waist or thighs.
• Using absorbent diapers helps keep the skin dry and reduces the chance of getting an infection.
• Ask your provider or nurse which creams, ointments, or powders are best to use in the diaper area.
• Ask if a diaper rash cream would be helpful. Zinc oxide or petroleum jelly-based products help keep moisture away from baby’s skin when applied to completely clean, dry skin.
• Do not use wipes that have alcohol or perfume. They may dry out or irritate the skin more.
• Do not use talc (talcum powder). It can get into your baby’s lungs.

Certain skin creams and ointments will clear up infections caused by yeast. Nystatin, miconazole, clotrimazole, and ketoconazole are commonly used medicines for yeast diaper rashes. For severe rashes, a steroid ointment, such as 1% hydrocortisone, may be applied. You can buy these without a prescription. But first ask your provider if these medicines will help.

If you use cloth diapers:

• Do not put plastic or rubber pants over the diaper. They do not allow enough air to pass through. Use breathable diaper covers instead.
• Do not use fabric softeners or dryer sheets. They may make the rash worse.
• When washing cloth diapers, rinse 2 or 3 times to remove all soap if your child already has a rash or has had one before.

Outlook (Prognosis)

The rash usually responds well to treatment.

When to Contact a Medical Professional

Contact your child’s provider if:

• The rash gets worse or does not go away in 2 to 3 days
• The rash spreads to the abdomen, back, arms, or face
• You notice pimples, blisters, ulcers, large bumps, or sores filled with pus
• Your baby also has a fever
• Your baby develops a rash during the first 6 weeks after birth

Bender NR, Chiu YE. Eczematous disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 674.

Moon M, Guerrero AM, Li X, Koch E, Gehris RP. Dermatology. In: Zitelli BJ, McIntire SC, Nowalk AJ, Garrison J, eds. Zitelli and Davis’ Atlas of Pediatric Physical Diagnosis. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 8.

Last reviewed on: 8/10/2021

Reviewed by: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Diaper dermatitis. How to treat and prevent

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. 1995 Dec;98(6):79-84, 86.

U I Sires 
¹
, S B Mallory

Affiliations

Affiliation

• ¹ Division of Dermatology, Washington University School of Medicine, St Louis, MO 63110, USA.

• PMID:

  7501582

U I Sires et al.

Postgrad Med.

1995 Dec.

. 1995 Dec;98(6):79-84, 86.

Authors

U I Sires 
¹
, S B Mallory

Affiliation

• ¹ Division of Dermatology, Washington University School of Medicine, St Louis, MO 63110, USA.

• PMID:

  7501582

Abstract

Dampness, maceration, fecal enzymes, chemicals, and other irritants lead to diaper dermatitis in infants. Most cases can be cleared with frequent diaper changes, use of superabsorbent disposable diapers (which contain gelling material in their core), and a low-potency topical corticosteroid. If the eruption lasts for more than 3 days or classic erythematous satellite lesions are present, addition of an antifungal agent should help resolve the condition. Recalcitrant or clinically atypical eruptions may signify rarer disorders, such as psoriasis, Langerhans’ cell histiocytosis, Leiner’s disease, or acrodermatitis enteropathica. Patients with these conditions should be referred to a dermatologist, if possible, for further evaluation and treatment.

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