Diaper rash products were a hot gift at a baby shower I attended recently—and it’s no wonder, when you consider that up to 50% of infants will suffer from at least one diaper rash at some point. 
Remember, the skin of infants is physiologically different when compared to that of older children and adults in terms of structure and composition. This makes infant skin inherently more vulnerable to breakdown and irritation than ours. Given the obvious discomfort diaper rash causes little ones, it’s worth it to have a few tricks up our sleeves to help clear up the symptoms.
Did you know there are different types of diaper rash? It’s true! And throwing diaper rash cream on anything red down there may not be the effective course of treatment for some forms. In fact, diaper rash (aka diaper dermatitis) can be quite challenging to treat if not identified accurately. It can sometimes feel like you’re on an episode of MacGyver, trying to figure out just the right strategy to help your baby’s painful, red skin around their most sensitive parts! With three sons under seven, my husband and I have seen our share of diaper rashes, and I’ve pulled together tips for the four most common ones. Always consult your child’s physician with any rash that is new or persistent, and, of course, your mileage may vary with these tips. Every kiddo is different!
- Cause: Diapers themselves. This most common type of diaper rash is caused by wet skin (from urine and stool mainly) being in contact with the diaper.
- Looks like: Typically, there is redness and swelling of the skin along the top of the diaper, over baby’s bum, and around the legs.
- Try: Allowing baby to go without a diaper as much as possible keeping the skin clean and dry. My kids ran around naked A LOT, and I swear it helped us escape (and sometimes quickly heal) many a diaper rashes. In addition, my kids have done better when we used wipes without alcohol or perfumes because they can excessively dry out and irritate the skin. Applying thick ointment, like zinc oxide, on completely dry skin can protect from excess moisture while wearing a diaper.
- Cause: Yeast overgrowth. This is also called a yeast infection. Yeast grows rapidly in a warm, moist environment, making diapers the perfect place for yeast to thrive. Although yeast is a normal part of the microbes living on our skin, the overgrowth happens when there is an imbalance in these microbes. Diarrhea, acid in stools, ammonia from urine, tight diapers, and reactions to soaps and products used to clean cloth diapers can contribute to candida dermatitis. Also, yeast overgrowth on the skin can be indicative of an internal, gastrointestinal microbial imbalance.
- Looks like: Candida diaper rash is usually seen as redness and swelling in and around the creases of the legs, bottom, testicles and vulva rather than around the diaper lines like irritant diaper rash. Pimples, blisters, ulcers, large bumps, or sores filled with pus can be present. Candida dermatitis classically has “satellite lesions” where there are small round spots of rash located near the main, large rash.
- Try: Check with your physician to see if candida may be the cause of your baby’s diaper rash. She may prescribe an antifungal medication as a treatment. Probiotics and a healthy, whole foods diet are good places to start in creating and maintaining a balanced gastrointestinal microflora.
- Cause: Allergy or irritant. This type of diaper rash is due to an allergic response caused by contact with something. It could be an allergy to the chemicals and materials in the diaper, wipes, diaper cream, lotion, soaps, shampoos, or laundry detergents. Fragrances and preservatives are the most frequent allergens in baby products; however, every baby is unique so you may have to do some serious investigating to locate the perpetrator on an ingredient list.
- Looks like: This type of rash is harder to identify but is red and can have areas where the skin is worn away. It most commonly appears as a red, irritated bottom on young infants if the allergen is coming from the diaper. Make sure to check the entire body of your infant for additional areas of potential dermatitis to ensure that other non-diaper allergens aren't causing this irritation. It can occur anywhere the allergen touches the skin.
- Try: You’ll need to do some detective work and figure out what your baby is allergic to—antifungal creams or zinc oxide may not be as effective for this rash. I always turn to ingredient lists when trying to find the potential cause of an allergy, even though we try to use gentle soaps, lotions and detergents at our house to begin with. In general, I like to limit skin products with added fragrances as a way to limit allergen exposure from fragrances.
- Cause: Bacteria. The most common culprit of bacterial dermatitis is Staphylococcusaureus (Staph) and Group A Streptococcus (Strep). Bacterial rashes often occur when the skin is already irritated or has small cuts and abrasions either from vigorous wiping or a previous non-bacterial rash.
- Looks like: Staph: small or large pus-filled blisters that rupture easily and will form a “honey-colored” crust or scab. Strep: bright red, well-defined rash around the anus (often seen as a ring) and possibly extending into the perineum (the place between the anus and genitals). You may notice small cuts, or abrasions, in the anus leading to small amounts of blood in the stool. Strep infections can occur in older children as well. It usually itches and will cause pain with stool elimination (often leading to constipation from holding stool).
- Try: Consulting your child’s physician. Bacterial infections can escalate quickly and getting appropriate treatment can be essential.
It took me a long time to learn that there were so many types of diaper rash and that I couldn’t just slather any red area with diaper cream and expect it to disappear. Diaper rash may seem like no big deal because it is so common, but you now know that it can get a little complicated. Tapping into the knowledge and expertise of your medical team is always helpful in formulating a treatment plan for your child’s skin health, especially if your baby has a rash that does not go away with treatment, continues to come back, or is accompanied by a fever. Cheers! To all of our efforts keeping those little bottoms smooth and healthy.
1. Aherton D, Mills K. What can be done to keep babies’ skin healthy? RCM Midwives 2004;7: 288-290
Sarah Kolman is the mom of three boys, a Registered Nurse, an Integrative Nutrition Health Coach, and has a master's degree in Contemplative Psychotherapy. Her private practice as a health coach blends her experience and career as a nurse with her passion for nutrition and holistic wellness. She is the author of Full Plate: Nourishing Your Family's Whole Health in a Busy World.