nappy rash

Diaper dermatitis: description

The sore butt in babies, toddlers or incontinent patients is called diaper dermatitis. This term generally refers to a rash in the genital and buttocks area. Sometimes fungi or bacteria additionally affect the skin. In the moist and warm nappy region, these germs can multiply particularly well. In this case, yeast fungi of the genus Candida colonize the skin at about 75 percent much more frequently than bacteria. A fungal infection located in the diaper area is referred to by physicians as the genito-gluteal candidosis.

In some cases, diaper dermatitis may spread to adjacent areas of skin (eg, thighs, back, lower abdomen). Doctors here speak of stray herds. A reddened, sore butt in the baby occurs relatively frequently. About two out of three children experience diaper rash (type I) at least once in their lives, usually in the first few months of infancy. Elderly people who can no longer control their urine or stool (urinary or fecal incontinence) often wear diaper pants for protection. Therefore, diaper rash (type II) can also occur in them.

Diaper dermatitis: symptoms

In diaper dermatitis, the affected skin appears blurred red. This so-called flat erythema, in most cases, wets what many call “soreness.” At the edge of the diaper rash small pustules (pustules, whimles) or skin nodules (papules) may appear. Sometimes the blisters spread to the inner thighs and lower back or abdominal area and are called satellite pustules.

If fungi or other pathogens such as babies sore buttocks, symptoms intensify. The affected skin itches sometimes very strong and may also hurt. In contrast to a simple diaper dermatitis, the skin affected by a fungus is much more red. In addition, the edges are sharply defined and fine scaly. In severe cases (especially with bacterial infections caused by staphylococci or streptococci), larger blisters may form, the skin may detach and tissue damage may form (erosions, ulcers).

Rarely, these additional infections are accompanied by fever. An infection can sometimes cause skin changes on the upper body, on the face and on the head. For example, the association of bacterial diaper dermatitis and bark lichen (Impetigo contagiosa) has been observed in studies. Because the buttocks bother babies, they cry more often and sleep worse.

Diaper rash: causes and risk factors

The development of diaper dermatitis can have various causes. Basically, the genital skin is irritated mainly by repeated and prolonged stool and urine contact. Under the water- and air-tight diaper, the resulting moisture and heat accumulates (occlusion). It forms a so-called wet chamber. As a result, the upper skin layer swells and loses its protective function.

Irritant factor ammonia

This effect is reinforced by ammonia. This chemical compound of water and nitrogen is formed by the cleavage (by the enzyme urease) of the urea in the urine. Ammonia irritates the skin of the diaper region. It also slightly raises the pH of the skin. In this way, the skin loses its acid mantle. This normally prevents the growth of some pathogenic germs.

Infection with fungi or bacteria

In damp and warm diaper environment and by a disturbed protective function of the skin pathogens (especially the yeast fungus Candida albicans) can now multiply easily and penetrate into the skin. There they trigger inflammatory reactions and the skin appears very red. Newborns are especially affected by diaper dermatitis in the first three months because their immune system is not yet mature.

Risk factor for wrapping and care products

In addition, there are numerous other risk factors that can lead to or increase diaper dermatitis. Tight diapers can rub on the skin, irritating and damaging it. In a few cases sufferers do not tolerate certain materials of the diaper. Such allergic reactions are called contact dermatitis. Also, fragrances or preservatives of some skincare products or detergents can cause allergic reactions to children and adults, developing diaper rash.

Poor hygiene

Bad hygiene contributes significantly to baby’s sore bottom. Infants, as well as those wearing protective pants, who are rarely wrapped or not thoroughly washed or dried, are at an increased risk of diaper rash.

Risk factor underlying diseases

Has a baby sore buttocks skin is always to think of intestinal or diarrheal diseases. Frequent and fluid bowel movements increase skin irritation. In addition, a bowel fungus disease (intestinal candidosis) increases the risk of diaper rash through fungi. The skin does not have to be damaged. But the wet chamber in the diaper is sufficient for the propagation and colonization of the genital and anal skin.

An additional infection of the skin with disease-causing pathogens is also favored by various underlying diseases. These include skin diseases such as atopic dermatitis (eczema), psoriasis, seborrhoeic dermatitis of the baby or generally a dry skin. But even a weakened defense system increases the risk of diaper dermatitis.

Studies have also found that a lack of biotin (vitamin B7, especially in eggs, milk, soy products, nuts) promotes diaper dermatitis. The same applies to the vital trace element zinc. Ingestion disorders, such as congenital enteropathy acrodermatitis, but also unilateral diets typically cause zinc deficiency, thereby increasing the risk of diaper dermatitis.

Diaper dermatitis: diagnosis and examination

The diagnosis of a diaper dermatitis is made by the pediatrician or a specialist in skin diseases, the dermatologist. It is almost exclusively sufficient to examine the skin of the person concerned thoroughly. Classic signs (redness, pustules, oozing, dandruff) and appearance in the typical skin area (genital, buttocks, back, lower abdomen, thighs) are usually sufficient to detect diaper dermatitis.

Exact skin examination is also important to differentiate diaper rash from other diseases. Atopic eczema (atopic dermatitis, cradle cap), for example, is rarely seen in the diaper region. Rather, the weeping, crusty skin lesions appear especially on the head and body trunk. Childlike psoriasis also affects several areas of the skin and can be recognized by reddish, flaky skin hardening (plaques).

During physical examination, the doctor therefore also pays attention to other signs of illness outside the diaper area. The yeast fungus Candida albicans, for example, often affects the mouth and intestine. To determine the exact pathogen, the doctor makes a smear of the affected skin area. This measure is necessary especially for severe cases (due to bacteria) or when prescribed diaper dermatitis therapy has failed.

If there is a suspicion of allergy, the doctor carries out further tests. This includes above all the patch test. Possible triggering substances of the diaper rash are glued to a healthy skin area with certain test patches. Within 48 hours, the typical rash develops in case of intolerance. The doctor may take blood (for example, to determine the level of inflammation or the level of zinc). With severe diarrhea, stool samples usually help to discover the cause.

Diaper dermatitis: treatment

After possible underlying diseases have been ruled out, there are various measures to cure baby sore buttocks. There are a number of measures that both prevent diaper rash and treat the rash.

Let air hurt baby’s bottom!

The constant contact with a wet diaper favors the development of diaper dermatitis. Therefore, let your child kick on the changing table for a while without a diaper or walk around naked in the apartment. Existing diaper rashes also heal quickly under fresh air. The same applies to the diaper dermatitis of older persons. It is common, for example, in intensive care units to leave the patient continuously without protective pants.

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 (immediate change when the urine and the stool are empty). So that the diaper does not rub too much, it should be put on loose. As a result, less heat can accumulate. In addition to a regular diaper change, the choice of diaper is crucial. The diapers should be permeable to air and highly absorbent (possibly with a gel pad). With diaper dermatitis disposable diapers are preferable to cloth diapers as they can better wick away the moisture. Wash all used textiles after use at a minimum of 60 degrees Celsius (cooking linen).

Clean and dry the diaper area thoroughly, but not over the top!

Use only warm, clear water for cleaning. You should refrain from using soaps or special care products, as these irritate the skin unnecessarily and may trigger allergies. Dried dirt or ointment residues can be removed well with an oil-wetted cloth (eg olive or almond oil) or so-called syndets (synthetic detergents). Finally dab the diaper area thoroughly dry. In order not to damage the irritated skin of diaper dermatitis with rough tissues, many experts recommend that the skin be dry-blown on a low-heat level. You should pay particular attention to skin folds, where the moist-warm environment can easily form.

Question recently changed care measures!

Often, diaper rash occurs when the diaper brand is changed or new care products are used. Always ask yourself if you have changed anything recently. If you have already tested certain diaper rash ointments without success, stop using them and consult a doctor. Also pay attention to possible new eating habits. Diets, spicy foods or certain intestinal diseases can trigger or increase diaper dermatitis.

See your doctor!

If you notice a rash in your child or relative, you should consult your pediatrician or dermatologist. This can rule out possible underlying diseases and gives useful tips for diaper rash treatment. Do not hesitate to ask him directly for special treatment options. According to some midwives, for example, healing wool is supposed to heal wounds in toddlers and babies. This sheep-derived wool is inserted into the diaper and is intended to inhibit inflammation via the contained natural wool wax and to provide ventilation and fluid absorption. In addition to advice on special pastes and wound protection creams, your doctor will prescribe additional medication in case of an additional infection.

Use only ointments or pastes prescribed or recommended by your doctor!

In a diaper dermatitis particularly soft, zinc-containing water-based pastes are suitable. On strongly weeping rashes previously drying and disinfecting soft pastes can be applied. Cortisone ointments may also help with severe skin damage. These should only be used by the doctor and only for a short time.

If the doctor detects a colonization of diaper rash with yeasts or bacteria, he prescribes medicines that work specifically against these germs. Fungal infections are so-called antifungals (e.g., miconazole, nystatin). It is sufficient to apply the prescribed pastes several times a day thinly on the affected skin region. However, if the fungus is also present elsewhere, for example in the mouth or intestine, the antifungal treatment must be extended (mouthwashes, tablets). In a bacterial infection, antibiotics are the drugs of choice.

A US expert group from California has summarized the recommendations for diaper rash treatment with the letters ABCDE in a scientific article:

• A = air (air) à diaper-free times
• B = barrier The natural skin barrier should be protected or maintained by suitable pastes.
• C = clean à Careful and careful cleaning is an important part of diaper rash therapy.
• D = diapers (diapers) à the right diaper choice helps against diaper dermatitis.
• e = education à A doctor or expert (eg midwife) should be consulted to educate about diaper dermatitis and to give useful treatment tips.

Diaper rash: disease course and prognosis

Diaper rash usually heals without consequences within a short time. It is important to follow preventive measures, to avoid causing risk factors and to treat possible infections carefully. One possible consequence is the so-called granuloma gluteal infantum. It can be caused by excessive treatment with cortisone-containing diaper rash-ointments and shows through coarse, bluish-red and painful nodules along a skin line in the genital area. They often develop with diaper dermatitis, but can also leave visible scars.

Sometimes there are several diaper rash relapses. Especially then it is advisable to consult a pediatrician or dermatologist and have the child examined for possible underlying diseases (immune deficiency, allergies, etc.). Under certain circumstances, diaper dermatitis spreads to other parts of the body. In some cases this may indicate an infection of the entire body. Again, a doctor should be consulted as soon as possible. Thus, if treated promptly serious complications of an infected nappy rash be avoided.