Diaper rash

Date Updated: 04/07/2020

Overview

Diaper rash is a common form of inflamed skin (dermatitis) that appears as a patchwork of bright red skin on your baby's bottom.

Diaper rash is often related to wet or infrequently changed diapers, skin sensitivity, and chafing. It usually affects babies, though anyone who wears a diaper regularly can develop the condition.

Diaper rash can alarm parents and annoy babies. But it usually clears up with simple at-home treatments, such as air drying, more frequent diaper changes and ointment.

Symptoms

Diaper rash is characterized by the following:

Skin signs. Diaper rash is marked by red, tender-looking skin in the diaper region — buttocks, thighs and genitals.
Changes in your baby's disposition. You may notice your baby seems more uncomfortable than usual, especially during diaper changes. A baby with a diaper rash often fusses or cries when the diaper area is washed or touched.

When to see a doctor

If your baby's skin doesn't improve after a few days of home treatment, talk with your doctor. Sometimes, you'll need a prescription medication to treat diaper rash.

Have your child examined if the rash:

Is severe or unusual
Gets worse despite home treatment
Bleeds, itches or oozes
Causes burning or pain with urination or a bowel movement
Is accompanied by a fever

Causes

Diaper rash can be traced to a number of sources, including:

Irritation from stool and urine. Prolonged exposure to urine or stool can irritate a baby's sensitive skin. Your baby may be more prone to diaper rash if he or she is experiencing frequent bowel movements or diarrhea because feces are more irritating than urine.
Chafing or rubbing. Tightfitting diapers or clothing that rubs against the skin can lead to a rash.
Irritation from a new product. Your baby's skin may react to baby wipes, a new brand of disposable diapers, or a detergent, bleach or fabric softener used to launder cloth diapers. Other substances that can add to the problem include ingredients found in some baby lotions, powders and oils.
Bacterial or yeast (fungal) infection. What begins as a simple skin infection may spread to the surrounding region. The area covered by a diaper — buttocks, thighs and genitals — is especially vulnerable because it's warm and moist, making a perfect breeding ground for bacteria and yeast. These rashes can be found within the creases of the skin, and there may be red dots scattered around the creases.
Introduction of new foods. As babies start to eat solid foods, the content of their stool changes. This increases the likelihood of diaper rash. Changes in your baby's diet can also increase the frequency of stools, which can lead to diaper rash. If your baby is breast-fed, he or she may develop diaper rash in response to something the mother has eaten.
Sensitive skin. Babies with skin conditions, such as atopic dermatitis or seborrheic dermatitis (eczema), may be more likely to develop diaper rash. However, the irritated skin of atopic dermatitis and eczema primarily affects areas other than the diaper area.
Use of antibiotics. Antibiotics kill bacteria — the good kinds as well as the bad. When a baby takes antibiotics, bacteria that keep yeast growth in check may be depleted, resulting in diaper rash due to yeast infection. Antibiotic use also increases the risk of diarrhea. Breast-fed babies whose mothers take antibiotics are also at increased risk of diaper rash.

Prevention

The best way to prevent diaper rash is to keep the diaper area clean and dry. A few simple strategies can help decrease the likelihood of diaper rash developing on your baby's skin.

Change diapers often. Remove wet or dirty diapers promptly. If your child is in child care, ask staff members to do the same.
Rinse your baby's bottom with warm water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths, cotton balls and baby wipes can aid in cleaning the skin, but be gentle. Don't use wipes with alcohol or fragrance. If you wish to use soap, select a mild, fragrance-free type.
Gently pat the skin dry with a clean towel or let it air dry. Don't scrub your baby's bottom. Scrubbing can further irritate the skin.
Don't overtighten diapers. Tight diapers prevent airflow into the diaper region, which sets up a moist environment favorable to diaper rashes. Tight diapers can also cause chafing at the waist or thighs.
Give your baby's bottom more time without a diaper. When possible, let your baby go without a diaper. Exposing skin to air is a natural and gentle way to let it dry. To avoid messy accidents, try laying your baby on a large towel and engage in some playtime while he or she is bare-bottomed.
Consider using ointment regularly. If your baby gets rashes often, apply a barrier ointment during each diaper change to prevent skin irritation. Petroleum jelly and zinc oxide are the time-proven ingredients in many diaper ointments.
After changing diapers, wash your hands well. Hand-washing can prevent the spread of bacteria or yeast to other parts of your baby's body, to you or to other children.

In the past, it was common to use powders, such as cornstarch or talcum powder, to protect a baby's skin and absorb excess moisture. Doctors no longer recommend this. Inhaled powder can irritate a baby's lungs.

Cloth or disposable diapers?

Many parents wonder about what kind of diapers to use. When it comes to preventing diaper rash, there's no compelling evidence that cloth diapers are better than disposable diapers or vice versa.

Because there's no one best diaper, use whatever works for you and your baby. If one brand of disposable diaper irritates your baby's skin, try another. If the laundry soap you use on cloth diapers seems to cause a diaper rash, switch products.

Whether you use cloth diapers, disposables or both kinds, always change your baby as soon as possible after he or she wets or soils the diaper to keep the bottom as clean and dry as possible.

Washing cloth diapers

If you use cloth diapers, careful washing can help prevent diaper rash. Washing methods vary and many routines work well. They key is to clean, disinfect and remove soap residue. Here's one effective method:

Pre-soak heavily soiled cloth diapers in cold water.
Wash diapers in hot water with a mild detergent and bleach. Bleach kills germs. You could also add vinegar to the wash cycle to eliminate odors and rinse out soap residue.
Double rinse the diapers in cold water to remove traces of chemicals and soap.
Skip fabric softener and dryer sheets because they can contain fragrances that may irritate your baby's skin.

Treatment

The best treatment for diaper rash is to keep your baby's skin as clean and dry as possible. If your baby's diaper rash persists despite home treatment, your doctor may prescribe:

A mild hydrocortisone (steroid) cream
An antifungal cream, if your baby has a fungal infection
Topical or oral antibiotics, if your baby has a bacterial infection

Use creams or ointments with steroids only if your baby's pediatrician or dermatologist recommends them — strong steroids or frequent use can lead to additional problems.

Diaper rashes usually require several days to improve, and the rash may come back repeatedly. If the rash persists despite prescription treatment, your doctor may recommend that your baby see a specialist in skin conditions (dermatologist).

Lifestyle and home remedies

Generally, a diaper rash can be treated successfully at home with these practices:

Keeping diaper area clean and dry. The best way to keep your baby's diaper area clean and dry is by changing diapers immediately after they are wet or soiled. Until the rash is better, this may mean getting up during the night to change the diaper.

After you've gently cleaned and dried the skin, apply a cream, paste or ointment. Certain products, such as zinc oxide and petroleum jelly, work well to protect the skin from moisture. Don't try to scrub off this protective layer completely at the next diaper change, as that could hurt the skin more. If you do want to remove it, try using mineral oil on a cotton ball.
Increasing airflow. To aid the healing of diaper rash, do what you can to increase air exposure to the diaper region. These tips may help:

Air out your baby's skin by letting him or her go without a diaper and ointment for short periods of time, perhaps three times a day for 10 minutes each time, such as during naps.
Avoid airtight plastic pants and diaper covers.
Use diapers that are larger than usual until the rash goes away.

Applying ointment, paste, cream or lotion. Various diaper rash medications are available without a prescription. Talk to your doctor or pharmacist for specific recommendations. Some popular over-the-counter products include A + D, Balmex, Desitin, Triple Paste and Lotrimin (for yeast infections).

Zinc oxide is the active ingredient in many diaper rash products. They are usually applied to the rash throughout the day to soothe and protect your baby's skin. It doesn't take much – a thin covering will do. The product can be applied over medicated creams, such as an antifungal or a steroid, when necessary. You could also apply petroleum jelly on top, which helps keep the diaper from sticking to the cream.

Ointments, pastes or creams may be less irritating than lotions. But ointments and pastes create a barrier over the skin and don't allow it to receive air. Creams dry on the skin and allow air through. Talk with your doctor about what type of product would be better for your child's rash.

As a general rule, stick with products designed for babies. Avoid items containing baking soda, boric acid, camphor, phenol, benzocaine, diphenhydramine, or salicylates. These ingredients can be toxic for babies.
Bathing daily. Until the rash clears up, give your baby a bath each day. Use warm water with mild, fragrance-free soap.

Alternative medicine

The following alternative treatments have worked for some people:

Witch hazel (winter bloom), a flowering plant. A study showed that applying an ointment made with witch hazel to diaper rash helped. The study included 309 children.
Human breast milk. Results are mixed on whether human breast milk applied to diaper rash is better than other treatments. One study showed that applying breast milk to diaper rash is an effective and safe treatment. Infants with diaper rash were treated with either 1 percent hydrocortisone ointment or breast milk. The study included 141 infants. Treatment with breast milk was as effective as the ointment alone.

Another study compared human breast milk with a cream made from zinc oxide and cod liver oil. Newborns with diaper rash were treated with the cream or the breast milk. The study included 63 newborns. Treatment with the cream was more effective.
Calendula and aloe vera. A study comparing aloe vera and calendula in the treatment of diaper rash in children found each to be an effective treatment of diaper rash.
Shampoo clay (bentonite). A study showed that shampoo clay was effective in healing diaper rash and that it worked faster than calendula. The study included 60 infants.
Other substances. Other natural remedies have been tried, including evening primrose and a mixture of honey, olive oil, and beeswax. Further study is needed to prove their effectiveness for treating diaper rash. Some of these substances may promote bacterial growth.

Preparing for an appointment

Generally, a diaper rash can be treated successfully at home. Make an appointment with your baby's doctor if the rash gets worse despite several days of home treatment, is severe or occurs along with a fever.

Here's some information to help you get ready for your appointment.

What you can do

List your baby's signs and symptoms, and for how long your baby has had them.
List key information about your baby's medical conditions and food intake. For example, has your baby been treated for any illness or given any medications recently? Has the baby's diet changed? If your baby is breast-fed also note any medications he or she may have been exposed to through breast milk, as well as changes in the mother's diet, such as an increase in tomato-based foods.
List all products that come into contact with your baby's skin. Your baby's doctor will want to know what brand of diapers, laundry detergent, soaps, lotions, powders and oils you use for your baby. If you suspect one or more products may be causing your baby's diaper rash, you may wish to bring them to the appointment so your doctor can read the label.
List questions to ask your doctor. Creating your list of questions in advance can help you make the most of your time with your doctor.

Below are some basic questions to ask your doctor about diaper rash.

What is the most likely cause of my baby's rash?
What are other possible causes?
What can I do to help my baby's skin heal?
What diaper ointments, pastes, creams or lotions would you recommend for my baby?
When should I use an ointment or paste instead of a cream or lotion?
Do you suggest any other treatments?
What products or ingredients should I avoid using with my baby?
Should I avoid exposing my baby to certain foods, either through breast milk or through my baby's diet?
How soon do you expect my baby's symptoms to improve?
What can I do to prevent this condition from recurring?
Is the rash a sign of some other internal problem?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

When did you first notice your baby's signs and symptoms?
What type of diaper does your baby typically wear?
How often do you or your baby's child care provider change your baby's diaper?
What types of soap and wipes do you use to clean your baby?
Do you apply any skin care products to your baby, such as lotions, powders, creams and oils?
Is the baby breast-fed? If so, is the mother taking antibiotics? Are there any changes to the mother's own diet?
Have you introduced your baby to solid foods?
What treatments have you tried so far for your baby's rash? Has anything helped?
Has your baby recently had any other medical conditions, including any illness that caused diarrhea?
Has your baby recently taken any new medications?

What you can do in the meantime

In the time leading up to your appointment, avoid products that seem to trigger your baby's rash. Wash your baby's bottom with water after each diaper change. Avoid soaps and wipes that contain alcohol or fragrance.

Give your baby as much diaper-free time as possible, so that his or her skin can have a chance to stay dry and start healing. When you do use diapers, change them frequently and apply a diaper rash cream, lotion, paste or ointment to act as a barrier between your baby's skin and a dirty diaper.