| Subject | Contents |
| Definition | Diaper rash: An irritation of the skin caused by dampness, the interaction of urine (and ammonia from the urine), and feces. A rash is any skin swelling (bumps) or blotches on a baby (can be red, skin-colored, or slightly lighter or darker than skin color). |
| Alternative Names | Baby rash; Diaper rash; Miliaria/Milia; Prickly heat; Candidal (yeast) diaper rash
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| Considerations | Diaper rash is very common. Most babies who wear diapers will experience it to some degree. Factors that lead to diaper rash include continuously wet or infrequently changed diapers, and the use of plastic pants to cover the diaper. Most bumps and blotches on a newborn baby are harmless and clear up by themselves. By far the most common skin problem of infants is diaper rash, but there are some other skin disorders that are usually not serious unless accompanied by other symptoms. |
| Common Causes | Diaper rash ( rash in the diaper area) is a skin irritation caused by prolonged dampness and the interaction of urine and feces with the skin. Yeast diaper rash is caused by a yeast (candida) that also causes thrush in the mouth. The rash looks different from a regular diaper rash. It is very red, and there are usually small red bumps on the outer edges of the rash. This rash requires treatment with a medication. Heat rash (caused by the blockage of the pores that lead to the sweat glands) is most common in very young children, but can occur at any age. When it is hot or humid, the infant sweats, but because of the blockage of the sweat glands, this sweat is held within the skin and forms little red bumps, or occasionally small blisters in young infants. Erythema toxicum can cause flat red splotches (usually with a white, pimple-like bump in the middle) that appear in up to half of all babies. These blotches rarely appear after 5 days of age, are usually gone in 7 to 14 days, and are nothing to worry about. Baby acne is caused by exposure to the mother's adult hormones. The little white dots often seen on a newborn's nose represent an abnormal amount of normal skin oil that is a result of these hormones. Acne usually occurs between 2 and 4 weeks of age, but may appear up to 4 months after birth and can last for 12 to 18 months. Cradle cap causes greasy, scaling , crusty patches on the scalp that appear in a baby's first 3 months. It usually goes away by itself, but some cases may require treatment with medication. Prickly heat causes rash or blotches during hot weather or in a hot environment (it is the same as heat rash). Milia/miliaria are tiny white, clear or red bumps on the skin (usually on the face and chest). Usually the white or clear ones are seen in newborns. The red ones are also called "heat rash" or "prickly heat." Hives are red welts that move around on the body. For example, if you drew a circle around one of the welts, then a few hours later that circle would not have a welt in it, and there would be welts on other parts of the body. They differ in size and shape and are usually very itchy. The most common cause of hives is a viral infection. There is no treatment for the virus, and the hives may last for a few weeks. You can use antihistamine medication for the itching. Sometimes bacterial infections cause hives. These will be treated with antibiotics. Sometimes hives are a sign of an allergy. This will be determined by your doctor after asking you several questions. Eczema is a condition of the skin in which areas are dry, red (or darker than normal skin color) and itchy. When it goes on for a long time the areas become thickened. It is often associated with asthma and allergies, although it can often occur without either of these. It often runs in families. |
| Home Care | DIAPER RASHES Keep the skin dry. Change wet diapers as quickly as possible. Allow the baby's skin to air dry as long as is practical. Launder cloth diapers in mild soap and rinse well. Avoid using plastic pants. Avoid irritating wipes (especially those containing alcohol) when cleaning the infant. Ointments such as Desitin, Vitamin A&D, Vaseline ConstantCare, or other ointments or creams may help reduce friction and protect the baby's skin from irritation. Powders such as cornstarch or talc should be used cautiously, as they can be inhaled by the infant and cause lung injury. If your baby has a yeast diaper rash, then you will need a prescription cream from your doctor to treat it. BABY RASHES Heat rash (same as prickly heat, red milia/miliaria) and is best treated by providing a cooler and less humid environment for the child. While powders do not harm the child, they are unlikely to help the condition. Powders should be stored out of reach of the infant to prevent accidental inhalation. Avoid ointments and creams because they tend to keep the skin warmer and block the pores. Erythema toxicum is normal in newborn babies and will go away on its own in a few days. You do not need to do anything for it. White or clear milia/miliaria will go away on their own. You do not need to do anything for it. BABY ACNE Normal washing is usually all that is necessary. Use plain water or mild baby soap and only bathe your baby every 2-3 days. Avoid acne medicines used by adolescents and adults. OTHER SKIN PROBLEMS For skin problems caused by eczema , the keys to reducing rash are to avoid scratching, and keep the skin moisturized. Keep the fingernails short and consider putting soft gloves on small children at night to minimize scratching. Drying soaps and anything that has caused irritation in the past (including foods) should be avoided. Apply a moisturizing cream (Eucerin, Lubriderm, Aqua-phor are good choices), vaseline, or even Crisco immediately after baths to avoid drying. Hot or long baths, or bubble baths, may be more drying and should be avoided. Loose, cotton clothing will help absorb perspiration . Consult a doctor if these measures do not control the eczema, (your child may need prescription medicines) or if the skin begins to appear infected. While the majority of children with eczema will outgrow it, many will have sensitive skin as adults. For cradle cap , wash the hair/scalp with water or a mild baby shampoo. Use a brush to remove the flakes of dry skin. If this cannot be removed easily, you can apply an oil to the scalp to soften it. Cradle cap usually disappears by 18 months. If it does not disappear or becomes infected, or if it is resistant to the above treatments, consult your doctor. For hives, talk with your doctor to try to find the cause. Some specific causes require prescription medication, although most are caused by a virus and do not need anything other than antihistamine medications to help stop the itching. |
| Call your health care provider if | there are any blisters '>blisters or small red patches beyond the diaper area. the rash is worse in the skin creases. the rash extends beyond the diaper area. there is no improvement after 3 days of home treatment. there is a fever , or other unexplained symptoms associated with the rash. there is a rash, spots, blister , or discoloration in an infant 3 months or younger. your child is scratching a lot any of the areas look infected |
| What to expect at your health care provider's office | The medical history will be obtained and a physical examination performed. Medical history questions documenting your symptom in detail may include: type of rash Does it look like pinpoint red spots ( petechiae )? Does it look like small red areas ( purpura )? Does it look like bruises ( ecchymoses )? Has it occurred more than once without known cause (recurrent)? Does it look like hives (red welts that come and go on different parts of the body and are very itchy)? Does it look like blisters ? Are they filled with yellow or honey-colored fluid? Does it look like ulcerations (craters in the skin)? Does it look like dry, tough skin growth (keratosis)? Is it associated with overexposure to sunlight ( actinic keratosis )? Is the rash scaling or crusting? Does it look like small, solid, red, elevated bumps ( papule )? Does it look like both a macule (flat area) and papule (small bump)? Is it a slightly elevated flat lesion (plaque)? location Is it in the diaper area only? Is it on the rectum? Is it on the scalp or face? Is it on the trunk? Is it on the lower extremities (legs or feet)? Is it over the muscles that straighten the leg (extensor surfaces)? Is it on the upper extremities (arms or hands)? Is it over the muscles used to straighten the arm (extensor surfaces) Is it on the genitals? distribution Is the rash spreading to other areas? Does the amount of skin area affected increase over time (enlarging)? Is the number of skin lesions increasing over time? Do the spots come and go, or do they always stay in the same place? Is it at the site of a skin injury (cut, scrape, etc.)? Is it at a site of chronically damaged skin (e.g., burn )? Do lesions affect one side of the body (unilateral) or both sides (bilateral)? Did the rash begin on hands or feet ( distal extremities)? Have the sores gradually increased in size over months to years? Are the lesions on exposed skin? On sun exposed areas only? Did the lesions begin at the site of an exposure? quality or color Is the skin darkening ( hyperpigmentation ) or thickening? Is the skin red (erythematous) or is it flesh colored? shapes and borders Do the lesions have sharp, distinct borders? Do the lesions have a bulls eye shape (irisated)? time pattern Did the rash begin suddenly (within hours) or slowly and gradually? How long did the rash last? Are there short-lasting episodes of rashes (transient)? Does the same type of rash occur repeatedly (recurrent)? How often does the rash occur? Did symptoms begin at birth or in infancy? What age? Has the rash been long standing ( chronic )? Did symptoms begin after a fever occurred and was relieved? During which months does the rash usually occur? Did you have a vesicle (blister) that appeared after a number of weeks? How many? aggravating factors Is it worse after taking a bath (or other exposure to water)? Is it worse when you are stressed? Does it occur after cold exposure ? Is it worse after you use skin softening or smoothing agents (emollients)? Is it worse after an exposure to the sun? relieving factors Does the rash get better after you use skin softening or smoothing agents? changes over time Did you have red cheeks followed within 2 days by a red spotty rash? Was the rash of a brief duration and then went away (evanescent)? Did the lesion change from a vesicle to an ulcer ? Did the lesion change from an hard bump (nodule) to a "beefy" red ulcer? other What other symptoms are also present? Is there fever? Is there itching ? Is there pain? Is there drainage? What kind? What laundry detergent do you use? How long have you used it? What kind of soap do you use? How long have you used it? Do you put anything on the skin (creams, lotions, oils, perfumes, etc)? Is your child taking any medications? How long has he/she taken them? Has your child eaten any new foods recently? Has your child been in contact with grasses/weeds/trees recently? Has your child had a recent illness? Does your child have any allergies? Do allergies run in your family? Do any skin problems run in your family? Does asthma run in your family (many times asthma and eczema are associated)? The baby's skin will be thoroughly examined to determine the extent and type of the rash. Diagnostic tests that may be performed include: allergy skin tests blood studies (e.g., CBC , blood differential ) microscopic examination of a sample of the affected skin However, most of the time the history and physical exam are enough to make a diagnosis. Intervention: Nystatin cream may be prescribed for diaper rash caused by yeast. If the rash is severe, a corticosteroid cream may be recommended. Oral antibiotics may be prescribed if a bacterial infection is diagnosed. For eczema , the doctor may prescribe ointments cortisone drugs to decrease inflammation. Antihistamines may be recommended to decrease itching. For hives, an antihistamine may be recommended to decrease itching. After seeing your health care provider: If a diagnosis was made by your health care provider related to your baby's rash, you may want to note that diagnosis in the personal medical record. |
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