Common Diaper Rash Types: How to Recognize and Treat Them
Medically reviewed by Susan Bard, MDMedically reviewed by Susan Bard, MDDiaper rash, medically known as diaper dermatitis, is typically caused by urine or feces touching diapered skin for prolonged periods. It can also be triggered by yeast overgrowth (candidiasis), eczema, psoriasis, and many other things like chemical irritants or bacterial infections. There are at least eight common diaper rash types. All types of diaper rash make the skin irritated and inflamed, causing discomfort or pain. While it occurs mostly in babies, adults who wear diapers or incontinence pads can also get diaper dermatitis.On lighter skin tones, diaper rash usually looks red. On darker skin tones, the redness may be harder to see, or the rash might show signs of post-inflammatory hypopigmentation, making it less pigmented and lighter in color than surrounding skin.
Reproduced with permission from ©DermNet NZ www.dermnetnz.org 2022.
Irritant Contact DermatitisDiaper rash caused by contact dermatitis presents as erythema (redness or discoloration) and inflammation in areas after prolonged contact with an irritant, typically urine or feces. Sometimes, this type of diaper rash has scaling lesions (plaques), small raised bumps (papules), or lots of little fluid-filled blisters (pustules).TreatmentIrritant contact dermatitis is self-healing and should clear up in two or three days once contact with the irritant ceases. Washing off the irritant with mild, unscented soap and warm water, followed by diaper-free periods that allow skin to air dry and breathe, is a vital part of treatment.PreventionTaking what's known as the "ABCD" approach to diaper rash prevention is the best way to prevent irritant contact dermatitis in the diaper area:"A" is for "air it out": Go diaper-free whenever possible and expose diaperless skin to fresh air."B" is for "barrier creams": Use a protective barrier cream with zinc oxide or petrolatum (petroleum jelly) like Vaseline or Aquaphor Advanced Therapy ointment."C" is for keeping it "clean": Change diapers frequently and wash with gentle, fragrance-free soap."D" is for "disposable diapers": Breathable and super-absorbent disposable diapers can prevent diaper rash better than traditional cloth ones.Candidiasis or Yeast InfectionsYeast diaper rashes, medically known as candidiasis, are caused by an overgrowth of yeast (Candida albicans). It is a type of fungal rash. This diaper rash usually presents as a red, shiny, and moist-looking rash with small, reddish bumps or white patches. It usually has clearly defined, raised borders that can be itchy and painful.TreatmentBecause a fungus causes yeast diaper rash, topical antifungal medications like Lotrimin (clotrimazole) are the gold standard treatment. PreventionCandida albicans, the fungus that causes yeast diaper rash, thrives in a warm, moist environment. Keeping the diaper area clean, dry, and airing it out between diaper changes can help prevent candidiasis. Be sure to change diapers regularly.EczemaDiaper rash caused by eczema, also called atopic dermatitis, usually looks red and dry with scaly patches. It often has a rough, bumpy texture and may include small, fluid-filled blisters (pustules). The rash can be itchy and tends to make babies fussy. It causes discomfort regardless of age.TreatmentFor babies, products containing colloidal oatmeal can help with eczema-induced diaper rash. Over-the-counter (OTC) topical corticosteroids, such as 0.5% or 1% hydrocortisone cream, which can be used to treat adult diaper rash caused by atopic dermatitis (eczema). However, in general, topical steroids are not recommended for children under 2 years old.If your child's eczema-related diaper rash doesn't respond to unmedicated treatments, speak to a pediatrician (medical doctor who treats babies, children, and adolescents) or other healthcare provider about the pros and cons of using an OTC topical corticosteroid or prescription-strength topical steroids on your infant or toddler based on symptom severity.PreventionTo prevent an eczema diaper rash, keep the skin under a diaper clean and dry with fragrance-free soaps. Avoid scented wipes and wipes with alcohol. Keeping the skin barrier healthy and hydrated by applying moisturizer regularly.Bacterial Skin InfectionsDiaper rashes caused by bacteria such as strep or staph are also referred to as perianal bacterial infections. This rash usually appears as a bright red circular pattern near the anus. This type of diaper rash can cause severe itching or burning, especially after defecation.TreatmentBacterial skin infections are often accompanied by a fever and can be life-threatening for babies and infants. If a diaper rash is caused by a bacterial infection, seek medical attention immediately. Antibiotics are the gold standard treatment for bacterial infections but must be prescribed by a healthcare provider.PreventionGood hygiene practices and avoiding contact with contagious bacteria are the best ways to prevent bacterial skin infections that affect the diaper area.IntertrigoIntertrigo diaper rash is caused by skin rubbing against itself. The friction often causes a red, bumpy rash. It may emit a foul-smelling odor. This type of diaper rash can lead to secondary infection if rubbing causes the skin to break and the open wound is exposed to fungiTreatmentSkin barrier creams and ointments that prevent friction (such as Vaseline petroleum jelly) when skin folds rub together are first-line treatments for intertrigo. Some adults may choose to use talcum powder, but because inhaling talcum powder particles can irritate a baby's lungs and cause breathing problems, don't use talc-based powders to treat baby diaper rash caused by intertrigo.PreventionIntertrigo diaper rash is often triggered by a warm, moist environment inside a diaper that makes the skin sticky and clammy. Creating better ventilation and keeping diaper-area skin dry by exposing it to fresh, circulating air in front of a fan can help prevent friction in the skin folds that causes intertrigo.Psoriatic Diaper RashPsoriatic diaper rash is caused by psoriasis. Although psoriasis usually develops later in life, in rare cases, babies can get it. Plaque psoriasis, the most common type, is an autoimmune condition that causes a patchy reddish rash with silvery-white or gray scales that peel off the skin.TreatmentTreatment for psoriatic diaper rash typically involves a combination of over-the-counter and prescription-only medications. Because psoriasis treatment is complex and varies from person to person, it's important to consult with a dermatologist (medical specialist of conditions of the skin, hair, and nails) or other healthcare provider about the best treatment plan.PreventionBecause psoriatic diaper rash is a heritable disease caused by a combination of genetics and environmental triggers, there's no way to completely prevent it. The most effective prevention technique is identifying what triggers psoriatic flare-ups and minimizing exposure to the allergen (trigger of the allergy).Allergic DermatitisAllergic dermatitis is a type of contact dermatitis caused by allergens. Diaper rash caused by an allergen is typically red and itchy. It's a less common cause of diaper rash, but it may occur when your baby is allergic to a dye in disposable diapers or a soap. Although it's uncomfortable, allergic dermatitis is usually harmless and clears up quickly once the allergen is identified and removed.TreatmentThe first step in treating allergic dermatitis is to wash the affected area with gentle soap and warm water to remove the allergen from the skin. Next, try to pinpoint what caused the allergic reaction and avoid having that allergen come in contact with the skin in the future.PreventionUsing hypoallergenic and fragrance-free products that don't contain perfumes or dyes can reduce the risk of allergic dermatitis.Other Rashes That Can Occur in the Diaper AreaA variety of skin rashes not typically considered diaper dermatitis can flare up in the diaper area. A differential diagnosis is a systematic process that eliminates possible reasons for the rash as it pinpoints the underlying cause.Seborrheic DermatitisSeborrheic dermatitis is a skin condition that causes red patches and yellowish, greasy-looking scales. It's most likely to appear on areas of the body with a lot of oil-producing sebaceous glands.ImpetigoImpetigo is an extremely contagious bacterial skin infection. It causes skin sores and creates a honey-colored crust with fluid-filled blistery bumps. It's caused by the same bacteria that causes staph infections, Staphylococcus aureus or Group A Streptococcus.Heat RashHeat rash, known medically as miliaria, is a heat-related illness caused by hot weather. It's sometimes called "prickly heat" and is characterized by little red bumps that can itch and burn.Should You Use Cloth or Disposable Diapers?Although disposable diapers are not good for the environment, individuals prone to diaper rash or who experience a flare-up should use breathable and highly absorbent disposable diapers, not cloth diapers. Disposable diapers have also been found to prevent diaper rash compared to cloth diapers. However, using cloth or disposable diapers is a personal choice based on your priorities.When to Contact a Healthcare ProviderIf a diaper rash doesn't respond to home remedies or OTC products and takes longer than three days to heal, contact a healthcare provider. Depending on the type of diaper rash and its underlying cause, prescription-strength topical corticosteroids, antifungals, or antibiotics may be prescribed.Contact a healthcare provider immediately if a diaper rash shows signs of infection or is accompanied by a fever.SummaryMany things can cause diaper rash. Recognizing and treating the underlying cause of each specific diaper rash type is key. Most diaper rashes are caused by wet or soiled diapers that aren't changed frequently. Using disposable (not cloth) diapers and changing them regularly helps prevent diaper dermatitis.Barrier creams containing zinc oxide or petroleum jelly can protect skin in the diaper area from being exposed to rash-causing irritants like urine or feces. Going diaperless and airing out the diaper area whenever possible is always good.If a diaper rash is caused by yeast fungus, use antifungal creams to treat it. If it's caused by eczema, topical steroids can help adults, but babies should use a fragrance-free cream with colloidal oatmeal. Bacterial diaper rashes are treated with germ-killing antibiotic ointments. If an allergy causes a diaper rash, the best remedy is to identify the allergen and prevent future skin contact. Read the original article on Verywell Health.
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