Diaper dermatitis: description
A sore bottom in a baby, toddler or incontinent patient is called diaper dermatitis. This term generally stands for a skin inflammation in the intimate and buttock area.
In some cases, diaper dermatitis can spread to neighboring skin areas (e.g., thighs, back, lower abdomen). Doctors refer to this as scattered lesions.
Diaper dermatitis: symptoms
Typical symptoms of diaper dermatitis are:
- extensive reddening of the skin (erythema), usually beginning around the anus and extending to the inner thighs and abdomen
- formation of small skin nodules and scales
- open, weeping, sore areas (often described as “soreness”)
- pain and itching in the pelvic area
- burning sensation when urinating
- Diapers smell like ammonia
Infestation with fungi or other germs
Yeast fungi can spread on baby’s sore bottom: Candida albicans, a fungus that typically lives in the intestines, can easily colonize the damaged skin, leading to diaper thrush. In this case, the skin lesions are no longer sharply defined, but individual nodules as well as pustules and pimples spread into the surrounding area (e.g. on the thighs). At the edge of the rash, the skin often scales.
As a result of infection, skin lesions can sometimes develop on the upper body, face and head. For example, the association of bacterial diaper dermatitis and impetigo contagiosa has been observed in studies.
Diaper dermatitis: causes and risk factors
Irritant factor ammonia
This effect is intensified by ammonia. This chemical compound of water and nitrogen is formed during the cleavage (by the enzyme urease) of the urea found in urine. Ammonia irritates the skin of the diaper area. It also slightly raises the pH of the skin. In this way, the skin loses its protective acid mantle. This normally prevents the growth of some germs.
Infection with fungi or bacteria
Risk factor wrapping and care products
Poor hygiene
Poor hygiene is a major contributor to babies’ sore bottoms. Infants, as well as adults wearing protective pants, who are infrequently diapered or not thoroughly washed or dried, have an increased risk of diaper rash.
Risk factor underlying diseases
An additional infection of the skin with disease-causing pathogens is also favored by various underlying diseases. These include skin diseases such as atopic eczema, psoriasis, seborrheic eczema or dry skin in general. But a weakened immune system also increases the risk of diaper dermatitis.
Diaper dermatitis: diagnosis and examination
The diagnosis of diaper dermatitis is made by the pediatrician or a specialist in skin diseases, the dermatologist. It is usually sufficient for the physician to thoroughly examine the affected skin areas. Classic signs (redness, pustules, oozing, scales) and the appearance in the typical skin area (genitals, buttocks, back, lower abdomen, thighs) are usually sufficient to diagnose diaper dermatitis.
Further examinations
During the physical examination, the doctor also looks for other signs of illness outside the diaper area. The yeast Candida albicans, for example, often also affects the mouth and intestines. To determine the exact pathogen, the doctor takes a swab of the affected skin area. This is particularly necessary in severe cases (additional bacterial infection) or if the prescribed diaper dermatitis therapy has failed.
Diaper dermatitis: treatment
If underlying diseases have been ruled out as the cause, one relies on the following measures to heal baby’s sore bottom. They are also suitable for the prevention of diaper rash!
Let air to baby’s sore bottom!
Change diapers regularly!
It is recommended not only to check the diapers several times a day, but also to change them every three to four hours (in the case of urine and feces, change immediately). To prevent the diaper from rubbing too much, it should be put on loosely. Then less heat can accumulate underneath.
Wash all used textiles after use at least 60 degrees Celsius (boil wash).
Clean and dry the diaper area properly!
Wash all used textiles after use at least 60 degrees Celsius (boil wash).
Clean and dry the diaper area properly!
See your doctor!
If you notice a rash on your child or relative, you should consult your pediatrician or dermatologist. He or she can rule out possible underlying diseases and provide useful tips on diaper rash treatment. Do not hesitate to ask him directly about special treatment options as well. In case of an additional infection of the skin, the doctor will also prescribe medication.
Use only ointments or pastes specified by the doctor!
In case of diaper dermatitis, soft, zinc-containing water-based pastes are particularly suitable. Drying and disinfecting soft pastes can be applied to severely oozing rashes beforehand. In the case of severe skin damage, cortisone ointments may also be helpful. However, these should only be used by the doctor and only for a short time.
Summarized: ABCDE recommendations
A group of experts from California summarized diaper rash treatment recommendations using the letters ABCDE in a professional article:
- A = air (air) – diaper-free times
- B = barrier – the natural skin barrier should be protected or maintained with appropriate pastes.
- C = clean – careful and gentle cleansing is an important part of diaper dermatitis therapy.
- E = education – this should involve a doctor or expert (e.g. midwife) who can educate about diaper dermatitis and provide useful treatment tips.
Diaper dermatitis: course of the disease and prognosis
Diaper dermatitis usually heals within a short time without consequences. It is important to take preventive measures, to avoid causative risk factors and to treat possible infections carefully.
