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  • Diaper Rash

      

    time:2009-09-27 13:24from:healther123.com writer:healther123.com hit:times

    • Diaper rash (diaper dermatitis) is a skin problem caused by the skin staying wet, rubbing from the diaper, and contact with chemicals in the urine and stool. The skin may look red, raw, scalded, or burned. While a diaper rash is uncomfortable, generally it is not a serious problem.

    Diaper rash is the most common skin problem in babies and young children, but it can occur at any age if diapers or incontinence briefs are worn. Diaper rash occurs most often in babies between the ages of 9 and 12 months. It often occurs in babies who sleep for many hours without waking so the wet diaper is on them longer.

    An adult may develop a rash in the genital area if he or she cannot wash the genital area well, such as while on a long backpacking trip. If an adult does not have complete bowel or bladder control (incontinence), he or she may use incontinence briefs. These briefs can cause skin irritation or a person may be allergic to the perfumes in the material. This type of rash is very similar to a baby's diaper rash. Home treatment measures may help the rash go away.

    The skin may blister or peel in severe cases of diaper rash, leaving raw areas that may bleed or ooze fluid. A diaper rash that becomes raw, oozes fluid, or bleeds is harder to treat. Fungal or bacterial infections may be the cause of a severe diaper rash.

    The most common causes of diaper rash include:

    • Not changing a wet or dirty diaper often enough. The skin becomes irritated from contact with urine and stool, particularly when diarrhea is present.
    • Babies starting to eat solid foods. This may change their stools and make diaper rash worse.
    • Rubbing of the skin by a diaper or incontinence brief. The irritated area may include the thighs, genitals, buttocks, or belly area.
    • A skin reaction to perfumes in disposable diapers or incontinence briefs, to chemicals in skin-cleaning "diaper wipes," or to the detergents or fabric softeners used to clean cloth diapers.

    A diaper rash may also be a sign of abuse or neglect.

    • Neglect occurs when a caregiver does not treat a diaper rash at the time treatment is needed.
    • Abuse occurs when a caregiver purposely does not treat a diaper rash because of anger directed at the child or vulnerable adult.

    Sometimes a diaper rash may occur with other skin problems, such as psoriasis, atopic dermatitis, or seborrhea. The rash may be red and oozing. A crust may form, and there will often be similar patches of rash on other parts of the body.

    Most diaper rashes last about 24 hours and can be treated at home. The rash clears up when the diapers are changed more often, careful washing and cleaning of the skin is done, or nonprescription ointments are put on the area. Treatment for diaper rash is the same for both children and adults.

    Review the Check Your Symptoms section of this topic to determine if and when to see a doctor.

    Check Your Symptoms

    If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

    Review health risks that may increase the seriousness of the symptoms.

    If you have any of the following symptoms, evaluate those symptoms first.

    Yes

    Do you think the diaper rash may have been caused by abuse or neglect?

    See significance of abuse or neglect if you need information to help you answer the question below.

    Review health risks that may increase the seriousness of the symptoms.

    Call your health professional immediately if you answer "Yes" to the following question.

    Yes

    Do you think the diaper rash may have been caused by abuse or neglect?

    If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

    close
    Yes

    Does the skin look red and raw, as though it has been scalded or burned?

    See significance of a red, raw rash if you need information to help you answer the questions below.

    Review health risks that may increase the seriousness of the symptoms.

    Call your health professional immediately if you answer "Yes" to any of the following questions.

    Yes

    Is diaper rash causing severe pain with urination?

    Yes

    Is diaper rash causing severe pain so your child does not want to urinate?

    Call your health professional today if you answer "Yes" to the following question.

    Yes

    Are there areas of raw skin larger than 1 in. (2.5 cm) across?

    You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

    Yes

    Is the diaper rash getting worse after 24 hours of home treatment?

    Yes

    Is the diaper rash not getting better after 48 hours of home treatment?

    If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

    close
    Yes

    Are there signs of a fungal infection in the diaper rash area?

    See significance of a fungal infection if you need information to help you answer the questions below.

    Review health risks that may increase the seriousness of the symptoms.

    Call your health professional immediately if you answer "Yes" to the following question.

    Yes

    Does your baby have white patches in the mouth and it is hard for him or her to swallow or eat?

    Call your health professional today if you answer "Yes" to any of the following questions.

    Yes

    Do you have white patches on the roof of your mouth?

    Yes

    Do you think a medicine may be causing a rash in the diaper area?

    Note:
    • Stop giving the medicine to your child.
    • Call the doctor who prescribed or recommended the medicine before giving the next dose to determine whether another medicine needs to be prescribed.
    • If you think your child may be having a reaction to a nonprescription medicine or an herbal remedy, stop giving that medicine and call your doctor to talk about the problem.

    You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

    Yes

    Is there a fiery red rash, mainly in the skin creases, with well-defined borders and tiny red or pus-filled pimples outside the border for longer than 24 hours after using home treatment?

    Yes

    Is there rash in skin folds, such as the neck, underarms, or belly button, for longer than 24 hours?

    If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

    close
    Yes

    Are signs of infection present in the diaper rash area?

    See significance of signs of infection if you need information to help you answer the questions below.

    Review health risks that may increase the seriousness of the symptoms.

    Call your health professional immediately if you answer "Yes" to the following question.

    Yes

    Are there red streaks spreading from the rash?

    Call your health professional today if you answer "Yes" to any of the following questions.

    Yes

    Is there increased pain, swelling, redness, heat, or tenderness around the rash?

    Yes

    Is the area around the rash tender to the touch?

    Yes

    Are there clear, fluid-filled blisters that, when broken open, leave large red, raw areas?

    Yes

    Is there pus in or drainage from the diaper rash area?

    Yes

    Do you know or think your child has a fever?

    Yes

    Has your child developed a rash and is fussy, agitated, or combative?

    You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions.

    Yes

    Is the rash getting worse after 24 hours of home treatment?

    Yes

    Is the rash not getting better after 48 hours of home treatment?

    If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

    close
    Yes

    Are there signs of a rash on other parts of the body?

    See the significance of signs of a rash if you need information to help you answer the question below.

    Review health risks that may increase the seriousness of the symptoms.

    You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.

    Yes

    Is there a red, patchy rash in the diaper area with greasy, silvery, or yellow crusts, and is the rash also present on other parts of the body?

    If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

    close

    Other Symptoms to Watch For

    Are any of the following symptoms present?

    If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

    Home Treatment

    Home treatment is generally all that is needed for most cases of diaper rash. At the first sign of a diaper rash, try the following steps.

    • Keep the skin dry and make sure the skin is not in contact with urine and stool.
      • Change the diaper or incontinence brief every time it is wet or soiled. During the daytime, check the diaper or brief every 3 hours. You may need to change the diaper or brief during the night to prevent or clear up a rash. It is not unusual to change a diaper or brief 8 times in a 24-hour period.
      • Use a superabsorbent disposable diaper.
    • Gently wash the diaper area with warm water and a soft cloth. Rinse well and dry completely.
      • Do not use any soap unless the area is very soiled. Use only a mild soap if soap is needed.
      • Do not use "baby wipes" that have alcohol or propylene glycol to clean the skin while a diaper rash is present. These may burn the skin and spread bacteria on the skin.
      • You may use a blow-dryer set on warm setting to get the diaper area fully dry on adults. Do not use a blow dryer on babies or small children.
    • Leave diapers and incontinence briefs off as much as possible.
    • Protect the healthy skin near the rash with a cream such as Desitin, Diaparene, A&D Ointment, or zinc oxide. Do not apply the cream to broken skin, because it can slow the healing process.
    • If you use a disposable product, fold the plastic area away from the body, and do not put the diaper on too tightly. Do not use bulky or many-layered diapers or incontinence briefs.
    • Do not use plastic pants until the rash is gone.
    • Give more fluids to make the urine less concentrated. Cranberry juice may be used by adults and children over 12 months of age. Do not use other juices, which may make the urine more irritating to the skin.

    If the diaper rash does not get better after several days, try the following steps.

    • Soak in a warm bath for 10 minutes, 3 times a day, if the skin is very raw.
      • For babies and young children, add 2 Tbsp (30 mL) of baking soda to a baby tub, basin of warm water, or bathtub. Remember, do not bathe a baby until the umbilical cord has fallen off, and never leave a child alone while he or she is in the bath.
      • Have older children and adults sit in a bathtub with a few inches of warm water or use a sitz bath.
    • If you use a disposable product, change brands or switch to a cloth product. Try a superabsorbent disposable diaper or brief with absorbent gelling material (AGM), which pulls moisture away from the skin. Some people are less likely to develop a rash with one diapering product than another.
    • If you use a cloth product, switch to a disposable product. The cloth or the products used to clean the cloth diaper may be causing the rash.
    • If you use cloth and do not want to switch to a disposable product, change detergents.
      • Rinse diapers or briefs twice when washing.
      • Use vinegar in the final rinse at a strength of 1 fl oz (30 mL) vinegar to 1 gal (4 L) of water.

    When treating a diaper rash:

    • Do not use a nonprescription adult vaginal yeast medicine on a baby or child. Check with your doctor before using any product made for an adult on a baby or child.
    • Adults can use a nonprescription adult yeast medicine to treat diaper rash. Follow the instructions on the package.
    • Do not use baby powder while a rash is present. The powder can build up in the skin creases and hold moisture. This may help bacteria grow and cause an infection.
    • Do not use cornstarch on a rash in the diaper area. Cornstarch also allows bacteria to grow.

    Symptoms to Watch For During Home Treatment

    Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

    • A rash in the diaper area gets worse after 24 hours or does not get better after 48 to 72 hours of home treatment.
    • A rash in the diaper area looks like a rash on other parts of the body.
    • White patches appear in the mouth.
    • Pimples, blisters, open weeping sores, boils, or crusts develop in the diaper area.
    • Signs of infection develop.
    • Symptoms become more severe or frequent.

    Prevention

    The following simple steps can help prevent diaper rash.

    • Always wash your hands and your child's hands well before and after each diaper change.
    • Change diapers or incontinence briefs as soon as possible after they become soiled or wet. Check the diaper at least every 2 hours. Diapers or incontinence briefs need to be changed at least 8 times every 24 hours.
    • Leave the diaper or incontinence brief off and allow the area to air-dry for 5 to 10 minutes after each diaper change. Make sure a baby is in a safe place during this time.
    • Wash cloth diapers with mild detergent and rinse them twice. Do not use bleach or fabric softeners.
    • If you use cloth diapers, do not use plastic pants which hold moisture on the skin.
    • If diarrhea is present, protect the diaper area with a cream such as Desitin, Diaparene, A&D Ointment, or zinc oxide. This will protect the skin from bacteria that might cause infection. For more information, see the topic Diarrhea, Age 11 and Younger or Diarrhea, Age 12 and Older.

    Preparing For Your Appointment

    To prepare for your appointment, see the topic Making the Most of Your Appointment.

    You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

    • How long has the rash been present?
    • Has the rash changed since you first saw it?
    • What home treatment have you tried? Did it help?
    • Have you had problems with a rash in the diaper area before? If yes, when and how was it treated?
    • Has there been any recent diarrhea?
    • Are any prescription and nonprescription medicines being taken? Have antibiotics been taken recently?
    • Has there been a change in diet?
    • Are you using a new type of diaper or incontinence brief?
    • Have you recently changed bathing or laundry products?
    • Is there a history of family skin disorders or allergies?
    • Does a caregiver have any yeast infection, particularly a vaginal yeast infection?
    • Are any health risks present?

    Related Information

    Credits

    Author Jan Nissl, RN, BS
    Editor Susan Van Houten, RN, BSN, MBA
    Associate Editor Tracy Landauer
    Primary Medical Reviewer Michael J. Sexton, MD - Pediatrics
    Specialist Medical Reviewer Alexander H. Murray, MD, FRCPC - Dermatology
    Last Updated August 1, 2008