What Causes Mild to Severe Diaper Rash?
Medically reviewed by Susan Bard, MDMedically reviewed by Susan Bard, MDSome main causes of diaper rash are irritation, infection, and allergies. Infants' immature skin and the changing skin of older adults make these groups more vulnerable to skin irritation.Other contributing factors include infrequent changes, diarrhea, and friction from tight diapers.
Photo composite by Joules Garcia for Verywell Health; Getty Images
Diaper Rash CausesDiaper rash (diaper dermatitis) affects at least half of all babies at some point. It's an inflammatory condition involving general redness, inflamed, scaly red or purple bumps (papules), or white or yellow pus-filled bumps (pustules). It can be lighter or darker depending on skin tone. Several things can cause diaper rash. Sometimes, it's a combination of factors.Irritation (Irritant Dermatitis)Irritant dermatitis happens when the skin in the diaper area spends too much time in contact with urine and stool. Teething can increase the chances of developing diaper rash due to swallowing extra saliva that passes through the gut.When stool and urine stay in the diaper too long, they combine to make ammonia, causing a mild chemical burn. Diarrhea stools contain enzymes that can irritate the skin. Skin can also become irritated when diapers fit too tightly and rub against the skin.InfectionDiapers can interfere with air circulation, creating a warm and moist environment. Urine alters pH levels in the skin, which helps bacteria and fungi (yeast) thrive. Taking antibiotics can increase the risk of a yeast infection called candidiasis. Rarely, diaper rash is caused by bacteria such as Staphylococcal (staph) and Streptococcus (strep) (impetigo) infections.Allergies (Contact Dermatitis)Skin in the diaper area can have an allergic reaction to any number of things, including:Baby wipesDisposable diapersFabric softenerLaundry detergentLotion and creamsSoapNew FoodsWhen a baby starts on a new food, it can affect the content or frequency of bowel movements.Rare CausesRare conditions that can cause a rash in the diaper area include:Seborrheic dermatitisPediatric psoriasisGenetic conditions such as acrodermatitis enteropathica, an inherited form of zinc deficiency
Risk FactorsReasons babies and older adults are more vulnerable to diaper rash include:Newborn skin is susceptible to disruption in the skin barrier and absorption of irritants.With age, skin becomes drier and more acidic.Skin under a diaper has prolonged contact with urine and feces, leading to changes in skin pH.Diapers can cause friction on the skin.Malnutrition or micronutrient deficiencies are common in the older population and may impair the skin's response to harmful stimuli.
Severe SymptomsIn cases of severe diaper rash, the skin might appear cracked. You might also see large blisters, oozing pus, painful open sores, and bleeding. Your baby may also develop a fever. Severe diaper rash may be due to factors such as:An infection caused by bacteria or yeastUsing wipes on diaper rash can increase irritationWiping too often and too vigorously with soap, which strips the skin of its protective barrier
Effects in Breastfed BabiesBreastfed babies tend to have diaper rash more often than bottle-fed babies. This is due to many factors, such as:Having more frequent, loose bowel movementsA reaction to something the breastfeeding parent has eatenCommon antibiotics that can be transferred from parent to infant via breast milkWhen a breastfeeding parent is taking antibiotics, which can kill off good bacteria that help prevent yeast infection in the baby
Why Symptoms May ReturnAntibiotics can sometimes cause diarrhea, which increases the risk of diaper rash. Antibiotics also destroy beneficial bacteria that keep Candida yeast in check. Even after you see improvement, symptoms may return if your child is on antibiotics or if you're taking antibiotics and nursing.Other reasons diaper rash symptoms may return are:Your baby is starting to eat new foods.You're using soaps, detergents, diapers, or wipes that irritate.Diapers are too tight, and you may need a larger size.Role of Diaper Material TypeDisposable diapers are super absorbent and wick moisture away from the skin. Because they're so absorbent, you may not change them as often, which keeps skin in contact with urine and feces. Also, different brands may have ingredients that affect sensitive skin.Cloth diapers may be softer and less irritating to the skin. They also allow for better air circulation. However, they need to be changed more frequently. Not changing diapers enough or using harsh detergents when washing them may raise the risk of diaper rash.Steps to Minimize Diaper RashIf you use cloth diapers, avoid harsh detergents, fabric softeners, and dryer sheets. These can irritate the skin. Run an extra rinse cycle to make sure all the detergent rinses out.If you use disposable diapers, look for breathable ones without fragrances or dyes. Plain water and a washcloth or cotton ball are good alternatives for those who are sensitive to baby wipes.Some other steps you can take to minimize diaper rash are:Be careful not to put the diaper on too tightly.Change diapers as soon as you can after they get wet or soiled.Gently clean the entire diaper area, including within skinfolds.Pat dry with a soft cloth and avoid rubbing.Let the skin dry completely before putting on another diaper.Use diaper cream or ointment with each diaper change.Avoid using powders, especially cornstarch.Soak your baby's bottom with warm water between changes (when possible).Protect the baby's skin using a barrier ointment containing petroleum jelly or zinc oxide at diaper changes. Your healthcare provider may recommend medicated cream or ointment for a rash caused by yeast or bacterial infections.Signs that you should consult with a healthcare professional include:Pimples, ulcers, bleeding, oozing fluidFeverRash that spreads beyond the diaper areaRash that's worse even with home treatmentRash in a baby that is less than 6 weeks oldSummarySeveral factors may cause a diaper rash. The most common causes are irritation, infection, and allergic reactions. A diaper creates a warm, moist area for bacteria and yeast to grow. Prolonged contact with urine and feces can also affect pH levels in the skin.Most of the time, a diaper rash clears up on its own. Changing diapers frequently, avoiding harsh substances, and using barrier ointments can help protect the skin. See a healthcare provider for severe symptoms such as open sores, pus, and fever or if symptoms don't improve with home treatment. Read the original article on Verywell Health.
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