Rash: This irritating and inflammatory process that occurs on the skin that comes into contact with the diaper is one of the most common skin problems during the baby’s first year of life, especially between six and twelve months.
Diaper rash is one of the most common skin problems during the first year of life, affecting up to 35% of infants, especially between six and twelve months.
It is usually called by that name any disease that irritates mainly in the area covered by the diaper. However, the correct definition would be an irritating and inflammatory process that occurs in the skin that comes into contact with the diaper, favored by the special conditions of that area.
It does not cause significant harm to the infant, but it does cause frequent concerns to its parents.
1. Why Does This Irritation Appear?
There does not appear to be a single specific cause for the irritation, but rather a combination of several factors, which alters skin conditions and decreases resistance to irritation and penetration of external agents.
The factors that favor the development of diaper rash are:
a. Excessive Humidity
It is often considered the main trigger for irritation. Healthy skin has a greasy layer that acts as a mechanical barrier and helps prevent water loss through the skin.
Excess moisture creates a microclimate in the area covered by the diaper, causing maceration of the skin, which is excessively hydrated and is more sensitive to damage due to friction.
Excess moisture causes maceration of the skin that makes it more sensitive to damage by friction.
The barrier capacity is also reduced, favoring irritants to penetrate the skin and microorganisms to develop more quickly.
b. By Friction
When rubbing or friction occurs between the skin and the skin itself or between the skin and the diaper, physical injuries are caused, which are more intense in the parts of the most friction (inner thighs, genitals, buttocks, pubis).
Excessive moisture increases the skin’s fragility, making it more sensitive to friction, leading to more severe injuries if both factors are combined.
c. Baby Stool
The feces of children usually contain a large number of enzymes produced by the intestinal bacterial flora. These substances are one of the major irritants to the skin, especially if the barrier function is impaired, and the skin pH has increased.
The feces contain many enzymes produced by the intestinal bacterial flora that are very irritating to the skin.
The enzymes called ureases to transform the area in the urine into ammonia, thus producing an increase in pH, which further promotes irritation from other substances present in the stool.
Some studies show that children who are exclusively breastfed have fewer – producing bacteria in their intestines. The pH of the stool is lower, leading to a lower frequency of diaper rash.
d. By the Accumulation of Urine
The newborn child can urinate physiologically more than 20 times a day, and in the infant stage, it can be reduced up to 7 times a day.
Ammonia produced in the urine does not act as an initial irritant. Still, if it accumulates on inflamed and diaper-covered skin, it worsens injuries and helps perpetuate the clinical picture.
2. Other Factors That Cause Irritation
Other less significant factors can contribute to aggravating the clinical picture of existing dermatitis. For example:
Inadequate skin hygiene, due to the use of highly irritating soaps, not suitable for your delicate skin.
Bacteria: can penetrate the altered skin barrier and cause infections that complicate the process.
Fungi: Candida albicans, present in children’s feces, can quickly invade macerated or inflamed skin and increase the severity of dermatitis.
It is essential to know that previous treatment with oral antibiotics can cause an imbalance in the intestinal bacterial flora, promoting excessive growth of this fungus in the stool.
Diarrhea: increases the amount of fluid in the stool and the internal rhythm, eliminating more enzymes and microorganisms in the seat, worsening the lesions.
Urinary tract disorders that cause persistent urine output.
3. Types of Dermatitis
Diaper rash can affect the diaper area in different ways and degrees. The clinical pictures are not always typical, but many times children have a combination of them.
a. Irritative Dermatitis of the Convex Areas
it is the most frequent and typical. The lesions appear mainly in the skin areas that most come into contact with the diaper, that is, the external genitalia, buttocks, pubic area, and inner thighs. Depending on its degree of intensity, the following can be observed:
Erythema in W: there is redness (erythema) in the gluteal regions, genitals, and convex surfaces of the thighs, without affecting the bottom of the skin folds.
Confluent erythema: the redness becomes more vivid and intense in the folds, and there may be exudation (fluid) in the affected area.
b. Erosive Dermatitis
There are already erosions and small superficial ulcerations, with a low rim (punched out), which dot the affected area in small numbers.
c. Lateral Irritant Dermatitis Affects
The lateral area of the buttocks, which corresponds to the regions of the diaper without absorbent material. There is prolonged and direct contact with plastic parts of the diaper. It is common in fat children.
d. Irritative Dermatitis Due to Chemical Substance
the skin is directly irritated by the use of antiseptic materials, detergents, or perfumes in the diaper area.
e. Perianal Irritant Dermatitis
Perianal irritant dermatitis produces irritation of the anal tract and its surroundings due to repeated or continuous contact with feces or excessive friction when using wipes, soaps, etc.
4. What if It Gets Complicated?
The most common complications of irritant diaper rash are due to infections or the use of inappropriate medications for its treatment.
Candida albicans superinfection: the erythema turns an intense red-purplish color, with papules (small pimples) or pustules (blisters with pus), especially on the outer margin of the affected area.
Bacterial superinfection: pustules appear in the area.
Infantile gluteal granuloma: this complication is associated with the use of high-potency topical corticosteroids, and it involves violaceous or purplish-red nodules up to 2-3 cm in diameter.
Hypopigmentation: sometimes when dermatitis heals, there may be a discoloration of the skin, and even a scar in the area.
5. Should I Take You to the Doctor?
The diagnosis of diaper dermatitis is clinical, through the signs we have described, and no complimentary test is necessary to confirm it.
However, suppose the doctor suspects an infectious complication (Candida, bacteria ). In that case, he or she may take a sample of the lesion to carry out a culture that indicates the specific treatment of the infection.
The diaper area is affected by other diseases in addition to diaper rash, such as psoriasis, atopic dermatitis, among others. Talking with you and the physical exam will help the doctor know how to differentiate them.
6. How to Prevent?
The primary prevention is to carry out and maintain proper hygiene in the area, which must always remain dry and clean, the appropriate use of absorbent diapers and frequent changes. It also combines, whenever possible, times with a diaper with the bottom in the air in the sun.
Soap and Water Should Only Be Used When Bathing
The water must be lukewarm, and the solvent must be acidic or neutral. They have to prevent perfumes. Dry the area thoroughly with gentle strokes, avoiding rubbing the towel on the skin and causing irritation.
The diaper should be checked frequently and changed as soon as it is wet, as often as necessary. This is the only way to avoid the irritant action of feces and urine.
The number of diaper changes per day is a crucial factor in the prevention of dermatitis. Put on a new diaper only when the skin is well dry and clean.
Ultra-absorbent, breathable, and non-occlusive disposable diapers contain an absorbent gel material inside the cellulose core, which can absorb the weight of urine several times, in addition to having the ability to reduce the high pH of the area diaper.
This type of diaper helps to reduce the risk of irritative dermatitis, although this does not mean that the baby can be left for many hours without checking.
If cloth diapers are used, they should be rinsed several times after each wash to remove any traces of soap or detergent that could irritate the skin.
To reduce friction, the diaper should be as comfortable as possible, and you should avoid adjusting it too much.
If the skin is irritated or if the baby suffers from repeated episodes of dermatitis, it is advisable to let the baby rest without diapers for several hours a day to dry and “air” the area.
The use of drugs such as corticosteroids, antibiotics, and topical antifungals should be avoided for prevention due to the risk of allergies.
7. How is It Cured?
As in many other diseases, the best treatment is prevention. When the skin is already damaged, if the prevention measures already explained are followed, dermatitis usually subsides in a matter of days.
However, some treatments improve dermatitis in case general measures are not enough:
In cases of severe dermatitis, the use of topical corticosteroids reduces or eliminates inflammation. In the diaper area, the occlusion improves the absorption of corticosteroids, the use of low or medium-strength corticosteroids being sufficient.
If there is a superinfection by Candida albicans, the use of a topical antifungal can improve dermatitis. Sometimes the association of a mild corticosteroid with a topical antifungal can be used.
The topical antibiotics, such as mupirocin, should be reserved for cases of proven bacterial infection and not routinely, for application to irritated skin may worsen the process.
Some powdered preparations can act as astringent as well as antibacterial and are useful in perianal dermatitis.