Diaper rash

Other Names:-Nappy rash,Diaper dermatitis
Definition:
Diaper rash  is a generic term applied to skin rashes in the diaper area that are caused by various skin disorders and/or irritants.

Generic rash or irritant diaper dermatitis (IDD) is characterized by joined patches of erythema and scaling mainly seen on the convex surfaces, with the skin folds spared.

{Diaper dermatitis with secondary bacterial or fungal involvement tends to spread to concave surfaces (i.e. skin folds), as well as convex surfaces, and often exhibits a central red, beefy erythema with satellite pustules around the border (Hockenberry, 2003).}

Diaper rash  is a red, patchy irritation found on baby’s skin in the genital area, the folds of the thighs and the buttocks.Almost every baby will get diaper rash at least once during the first 3 years of life, with the majority of these babies 9-12 months old. .

Diaper rash appears on the skin under a diaper. Diaper rash typically occurs in infants and children younger than 2 years, but the rash can also be seen in people who are incontinent or paralyzed. Read more about the causes, symptoms, and treatments for diaper rash.

There are many misconceptions about a baby’s  Diaper Rash:

*Baby‘s bottom is always  be perfectly smooth and rash-free
*Diaper rash is abnormal
*Diaper rash is a sign of food or formula allergies
*Diaper rash means the baby has bad diarrhea or a yeast infection

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Having a diaper rash is a normal part of being a baby. There are many ways you can limit the amount of rash, but from time to time it will flare up again.  But sometimes Diaper rash may alarm parents and annoy babies, but most diaper rash cases can be resolved with simple at-home treatments.

Symptoms:
Diaper rash is characterized by the following:

*Skin signs. Diaper rash is marked by red, puffy and 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.

Diaper rashes can occur intermittently, anytime your child wears diapers, but they’re more common in babies during their first 15 months, especially between 8 and 10 months of age.

When to visit  a doctor:-
Diaper rash is usually easily treated and improves within a few days after starting home treatment. If your baby’s skin doesn’t improve after a few days of home treatment with over-the-counter ointment and more frequent diaper changes, talk to your doctor. Sometimes, diaper rash leads to secondary infections that may require prescription medications.

Have your child examined if:

*The rash is severe
*The rash worsens despite home treatment
Also see your child’s doctor if the rash occurs along with any of the following:

*Fever
*Blisters or boils
*A rash that extends beyond the diaper area
*Pus or weeping discharge


Causes:

Babies are so susceptible to diaper rash that wet and soiled diapers can irritate baby’s delicate skin. Naturally, if  baby is in a wet diaper for too long, she or he will be more prone to getting a rash.

Some of the most common causes of diaper rash to be aware of are:

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*Irritation due to bowel movements
*Irritation due to moisture from sweat and urine
(even the most absorbent diapers leave some wetness behind)
*Not drying the skin thoroughly after a diaper change
*Diaper chafing/friction
*Diarrhea, which may be caused by antibiotics
*Change in food or introducing new foods

Irritant diaper dermatitis develops when skin is exposed to prolonged wetness, decreased skin pH caused by urine and feces, and resulting breakdown of the stratum corneum, or outermost layer of the skin. In adults, the stratum corneum is composed of 25 to 30 layers of flattened dead keratinocytes, which are continuously shed and replaced from below. These dead cells are interlaid with lipids secreted by the stratum granulosum just underneath, which help to make this layer of the skin a waterproof barrier. The stratum corneum’s function is to reduce water loss, repel water, protect deeper layers of the skin from injury and to repel microbial invasion of the skin (Tortora and Grabowski, 2003). In infants, this layer of the skin is much thinner and more easily disrupted.

Effects of urine:-

Although wetness alone macerates the skin, softening the stratum corneum and greatly increasing susceptibility to friction injury, urine has an additional impact on skin integrity because of its effect on skin pH. While studies show that ammonia alone is only a mild skin irritant, when urea breaks down in the presence of fecal urease it increases skin acidity (lower pH), which in turn promotes the activity of fecal enzymes such as protease and lipase (Atherton, 2004; Wolf, Wolf, Tuzun and Tuzun, 2001). These fecal enzymes increase the skin’s permeability to bile salts and act as irritants in and of themselves.

There is no detectable difference in rates of diaper rash in conventional disposable diaper wearers and reusable cloth diaper wearers. “Babies wearing superabsorbent disposable diapers with a central gelling material have fewer episodes of diaper dermatitis compared with their counterparts wearing cloth diapers. However, keep in mind that superabsorbent diapers contain dyes that were suspected to cause allergic contact dermatitis (ACD).” [1] (Kazzi, 2006) Whether wearing cloth or disposable diapers they should be changed frequently to prevent diaper rash, even if they don’t feel wet.

Effects of diet:-

The interaction between fecal enzyme activity and IDD explains the observation that infant diet and diaper rash are linked, since fecal enzymes are in turn affected by diet. Breast-fed babies, for example, have a lower incidence of diaper rash, possibly because their stools have lower pH and lower enzymatic activity (Hockenberry, 2003). Diaper rash is also most likely to be diagnosed in infants 8–12 months old, perhaps in response to an increase in eating solid foods and dietary changes around that age that affect fecal composition. Any time an infant’s diet undergoes a significant change (i.e. from breast milk to formula or from milk to solids) there appears to be an increased likelihood of diaper rash (Atherton and Mills, 2004).

The link between feces and IDD is also apparent in the observation that infants are more susceptible to developing diaper rash after treatment with antibiotics, which affect the intestinal microflora (Borkowski, 2004; Gupta & Skinner, 2004). Also, there is an increased incidence of diaper rash in infants who have suffered from diarrhea in the previous 48 hours, which may be because fecal enzymes such as lipase and protease are more active in feces which have passed rapidly through the gastrointestinal tract (Atherton, 2004).

The incidence of diaper rash is lower among breastfed infants—perhaps due to the less acidic nature of their urine and stool. (Kazzi, 2006)

Treatments:-

The most effective treatment, although not the most practical one, is to discontinue use of diapers, allowing the affected skin to air out. Thorough drying of the skin before diapering is a good preventive measure, since it’s the excess moisture, either from urine and feces or from sweating, that sets the conditions for a diaper rash to occur. Various moisture-absorbing powders, such as talcum or starch, also help prevention.

Another approach is to block moisture from reaching the skin, and commonly recommended remedies using this approach include oil-based protectants or barrier cream, various over-the-counter “diaper creams”, petroleum jelly and other oils. Such sealants sometimes accomplish the opposite if the skin is not thoroughly dry, in which case they serve to seal the moisture inside the skin rather than outside.

Over-the-counter products:-

Various diaper rash medications are available without a prescription. Talk to your doctor or pharmacist for specific recommendations. Some popular over-the-counter ointments are:

*A + D
*Balmex
*Desitin
*Hydrocortisone
*Zinc oxide paste

Zinc oxide is the active ingredient in many diaper rash creams. These products are usually applied in a thin layer to the irritated region throughout the day to soothe and protect your baby’s skin. Zinc oxide can also be used to prevent diaper rash on normal, healthy skin.

Zinc oxide-based ointments are quite effective, especially in prevention, because they have both a drying and an astringent effect on the skin, being mildly antiseptic without causing irritation.

In persistent or especially bad rashes, an antifungal cream often has to be used. In cases that the rash is more of an irritation, a mild topical corticosteroid preparation, e.g. hydrocortisone cream, is used. As it is often difficult to tell a fungal infection apart from a mere skin irritation, many physicians prefer an antifungal-and-corticosteroid combination cream.

Some sources claim that diaper rash is more common with cloth diapers, yet others claim that the type of diaper makes no difference, but that cloth diapers can speed the healing process. In truth the material of the diaper is relevant inasmuch as it can wick and keep moisture away from the baby’s skin.

Prevention:

A few simple strategies can help decrease the likelihood of diaper rash developing on your baby’s skin:

*Change diapers often. Remove dirty diapers promptly. If your child is in child care, ask staff members to do the same.
*Rinse your baby’s bottom with water as part of each diaper change. You can use a sink, tub or water bottle for this purpose. Moist washcloths and cotton balls also can aid in cleaning the skin. Don’t use wipes that contain alcohol or fragrance.
*Pat your baby dry with a clean towel. Don’t scrub your baby’s bottom. Scrubbing can further irritate the skin.
*Don’t overtighten diapers. Diapers that are too tight prevent airflow into the diaper region, setting up a moist environment favorable to diaper rashes. Tightfitting 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.
*Wash cloth diapers carefully. Pre-soak heavily soiled cloth diapers and use hot water to wash them. Use a mild detergent and skip the fabric softeners and dryer sheets because they can contain fragrances that may irritate your baby’s skin. Double rinse your baby’s diapers if your child already has a diaper rash or is prone to developing diaper rash. If you use a diaper service to clean your baby’s diapers, make sure the diaper service takes these steps as well.
*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 included in many prepared diaper ointments. Using these products on clear skin helps keep it in good condition.
*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.

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, though disposables may keep baby’s skin slightly drier. Because there’s no one best diaper — use whatever works best for you and your baby. If one brand of disposable diaper irritates your baby’s skin, try another.

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

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Diaper_rash
http://www.dailyglow.com/skin-problems/baby-skin-rash.html?xid=g_&gclid=CJbdvPji26ACFcvV5wodbzUVCA
http://www.mayoclinic.com/health/diaper-rash/DS00069
http://www.askdrsears.com/html/11/T081400.asp
http://www.myadbaby.com/diaper_rash.html?utm_source=google&utm_medium=cpc&utm_term=diaper%2Brash%2Bpictures&utm_campaign=diaper%2Brash&buf=999999

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3 thoughts on “Diaper rash”

  1. In 1944, Hugo Drangel of the Swedish paper company Pauliström suggested an idea of placing sheets of paper tissue (cellulose wadding) inside the cloth diaper/ nappy and rubber pants. However cellulose wadding was rough against the skin and when wet, crumbled into balls.

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