Diaper rash is a bright red breakout that is caused by irritation to a baby’s buttocks, thighs and genitals. It is usually caused by prolonged contact with urine or feces in the diaper area.

Diaper rash often appears after solid foods are added to a baby's diet or after a baby begins taking antibiotics. Consistently wet or infrequently changed diapers, diarrhea and the use of plastic pants to cover a diaper can also contribute to diaper rash. It is most common in babies during the first 12 months of life. However, some adults, including those who use adult diaper products for urinary or fecal incontinence (inability to control urination or defecation, respectively) may also develop diaper rash.

A visual examination is usually sufficient to identify diaper rash. In most cases, it can be treated with over-the-counter remedies, although prescription medications may be necessary to treat more severe cases.

The best way to treat diaper rash – and to keep it from occurring in the first place – is to ensure that skin remains as clean and dry as possible. It is especially important to change diapers promptly when they are dirty.

Diaper rash is a common form of skin inflammation (dermatitis) that appears as a patchwork of bright red skin on a baby’s buttocks, thighs and genitals. Most babies will develop diaper rash at some point.

Diaper rash usually causes mild redness and scaling on the skin that is covered by the diaper. In more severe cases, it may lead to pimples and the skin may break and ooze. Diaper rash can occur with both cloth and disposable diapers.

Children under the age of 2 are most likely to develop diaper rash, with the highest level of incidence occurring between the ages of 9 months and 12 months, when the child is able to sit up more often but may not yet be walking. A family history of allergic rhinitis (hay fever), asthma, eczema or allergies may predispose a baby to developing diaper rash. 

Adults with urinary or fecal incontinence (inability to control urination or defecation, respectively) who use adult diaper products may also develop diaper rash. It can also occur in adults who are unable to routinely wash the genital area, such as during a long hiking trip. Treatment of diaper rash is the same for children and adults.

Diaper rash is a general term to describe several different kinds of skin conditions that occur in the diaper covered area. The different types of diaper rash include:

• Irritant contact dermatitis. The most common form of diaper rash, which can make the genital area, thighs and buttocks appear red and puffy. The rash commonly follows bouts of diarrhea. An associated type of rash due to the edges or bindings of the diaper rubbing against the skin is called tidemark dermatitis. Irritant contact dermatitis comes and goes, generally causing mild discomfort.
  
  
• Atopic dermatitis. The most common form of eczema, this type of rash shows up as red and scaly patches on the legs and in the groin area. This rash may start in other areas of the body first and then spread to the diaper area when the infant is between six and 12 months old. Atopic dermatitis may be caused by genetic predisposition to allergic rhinitis (hay fever), asthma and allergies.
  
  
• Candidal dermatitis. This is a rash caused by a yeast infection and is very tender and painful. The rash appears in the fold of the genitals, legs and creases of abdomen and thighs. The rash begins as small red spots that become more numerous and then form together as a raised bright red rash with distinct edges. The most common cause is a baby that has been or is taking antibiotics.
  
  
• Perianal dermatitis. This rash appears as a bright to dark redness around the anus. The feces of bottle fed babies are more alkaline and the alkalinity may be the cause of this rash. This rash does not normally appear in breast-fed babies until they begin eating solids.
  
  
• Seborrheic dermatitis. This rash appears as a deep red, rough, raised rash that often has yellowish scales. This type of rash usually starts on the scalp and is known as cradle cap, although it may start in the diaper area and then spread up the body. The rash is caused by overactive oil glands in the skin. The rash usually occurs in infants under three months old.
  
  
• Impetigo. Either a rash that is yellow–brown and crusty or pus filled pimples or blisters surrounded by a red area. This rash can appear anywhere on the body from the face to the thighs, including the diaper area. Impetigo is caused by a bacterial infection and may require treatment with a prescribed topical or oral antibiotic.
  
  
• Staphylococcal scalded skin syndrome. This is an infection that starts as a rash, usually around the diaper area or bellybutton in babies. The area around the rash gets red and painful and may spread all over the body. Large blisters then form in affected areas. These blisters break easily and the skin peels off when touched. It is caused by the Staphylococcus aureus bacteria and requires treatment with a prescribed antibiotic.
  
  
• Intertrigo. A red rash which occurs as a result of skin rubbing on skin. It is usually found in the folds between the thighs and abdomen. The rash commonly follows bouts of diarrhea.
  
  
• Miliaria. A rash that is the result of exposure to high heat and humidity. The diapered area may become very sweaty when it is hot. The lack of airflow and holding sweat tightly against the skin can create the ideal situation for a miliaria rash. The rash also commonly follows bouts of diarrhea.
  
  
• Psoriasis. A chronic and common skin condition that is often associated with family history. It often involves the scalp and nails but may occur in the diaper area. Psoriasis is often responsive to steroid medications. The condition is not responsive to barrier creams or antifungal medications.

There are many potential causes of diaper rash. These include:

• Exposure to stool and urine. Prolonged exposure to urine or feces can irritate a baby's sensitive skin. Feces can be especially irritating. As a result, babies may be more prone to diaper rash during periods of frequent bowel movements. The longer a child sits in a soiled diaper, the more likely they are to develop a diaper rash. The same holds true for individuals who use adult diaper products for urinary or fecal incontinence (inability to control urination or defecation, respectively) and those who are unable to wash their genital area frequently.
  
  
• Chafing or rubbing. Diapers that are too tight or clothing that rubs against the skin can cause diaper rash.
  
  
• Reaction to various foods. Babies usually start eating solid foods during the ages of 4 months to 12 months, which may cause changes in their stool. Changes in a baby's diet that increase the frequency of stools may lead to diaper rashes. An intolerance or allergy to a food (e.g., milk, wheat, soy) may cause diaper rash or result in bouts of diarrhea that create diaper rash. In addition, babies who are breastfed may develop diaper rash as a result of ingredients in their mother's diet.
  
  
• Reaction to contact with a new product. Irritation that leads to diaper rash can result from contact with disposable wipes, disposable diapers, baby lotions, powders or oils. Detergents, bleaches and fabric softeners used to launder cloth diapers can also irritate a baby's bottom.
  
  
• Bacterial or yeast infections. Skin infections may spread to the buttocks, thighs and genitals because those areas are warm and moist. Such rashes generally originate within the creases of the skin. Vaginal yeast infections may pass from a mother to a child during childbirth. Other infections may pass from any person who touches a baby without washing their hands first.
  
  
• Sensitive skin. Babies who suffer from skin conditions such as eczema may be more likely to develop diaper rashes.
  
  
• Use of antibiotics. Antibiotics can kill harmful bacteria, but can also rid the body of good bacteria that help prevent yeast infections. This can lead to diaper rash. Mothers who are taking antibiotics while breastfeeding can also cause this effect in their infants.

Occasionally diaper rash can be associated with serious diseases. This is not common. However, babies with congenital syphilis, HIV/AIDS and other diseases may develop diaper rash as a symptom or result of the physical response to disease.

Symptoms associated with diaper rash include reddish, puffy and slightly warmer skin in the buttocks, thighs and genital region that come into contact with the diaper. The rash may appear as patches of rough, red, scaly skin with areas of small, red pimples. In some cases, the rash may be open and ooze.

A baby with diaper rash may appear uncomfortable, especially during diaper changes, and may fuss or cry when the diaper area is washed or touched. Infants with diaper rash may also develop associated oral thrush, in which the mouth becomes infected with the fungus Candida.

Diaper rash should clear within a few days of starting home-based treatments. However, some cases of diaper rash may lead to secondary infections that require prescription medications. Individuals should consult a physician if a rash does not respond to home-based treatments, or if the following signs and symptoms are evident:

• Rash is severe, worsens or extends beyond the diaper area
• Fever
• Blisters or boils
• Pus or weeping discharge
• Lethargy, unusual irritability or fussiness
• Weight loss or reduction in appetite

Most cases of diaper rash can be identified without a visit to a physician. However, in some cases, patients may seek the care of a physician. This is especially true of many parents who encounter the condition in their child for the first time. During a visit to a physician, a complete physical examination will be performed and a thorough medical history compiled. In most cases, diaper rash can be diagnosed simply by making a visual examination of the skin. Microscopic examination of skin scrapings can help determine if the rash is caused by fungi or bacteria.

After diaper rash is identified, the best plan is to ensure that the skin remains as clean and dry as possible. Diaper rash may be treated with various over-the-counter medications, most of which contain zinc oxide.

In the past, experts recommended the use of talcum powder or cornstarch to protect a baby’s skin and absorb excess moisture. However, this is no longer advised because inhaled talcum powder can irritate a baby's lungs and cornstarch may promote the growth of yeast and bacteria.

When treated with home care, diaper rash usually subsides within two to three days. Diaper rash that persists may require prescription medications, such as antifungal creams (if the rash is caused by Candida infection), antibiotics (if the virus is caused by bacterial infection) or mild hydrocortisone creams. Rashes that persist for a period of weeks may necessitate a visit to a dermatologist.

A physician should be consulted before using over-the-counter treatments on a case of diaper rash. Prescription medications should only be used under the close supervision of a physician.

Parents can take several steps to substantially reduce the risk that their baby will develop diaper rash. Many of these rules also apply to adults who hope to prevent their own diaper rash. They include:

• Wash hands. Any person changing a diaper should wash their hands thoroughly both before and after the diaper change. This can help prevent the spread of bacteria or yeast.
  
  
• Change diapers often. Diapers should be checked often and wet or soiled diapers should be changed promptly.
  
  
• Rinse the bottom with water during each diaper change. Sinks, tubs or water bottles can all be used for this purpose. Moist washcloths and cotton balls may be used, but wipes that contain alcohol or fragrance should be avoided. Parents should also occasionally soak their child's bottom in warm water between changes.
  
  
• Pat the bottom dry with a clean towel. Scrubbing may further irritate the skin. It is also important to ensure that the skin is completely dry before a new diaper is placed on the child.
  
  
• Try a different type of diaper. Recurrent rashes may be caused by a reaction to the diaper. If cloth diapers are used, try disposable, while if disposable diapers are used then try using cloth. Changing to a different brand of disposable diaper may also help. Some of the dyes and perfumes in disposable diapers may be irritants. Some of the detergents used to clean cloth diapers can also be irritants, so changing detergents may also help.
  
  
• Avoid diapers with plastic edges and do not over-tighten diapers. Individuals should be sure that airflow to the diaper region is not restricted. Proper airflow prevents a buildup of moisture that can lead to diaper rashes. Diapers that are too tight may lead to chafing at the waist or thighs.
  
  
• Avoid using plastic pants. These pants can trap moisture and increase temperature in the diaper region.
  
  
• Occasionally leave the baby's bottom uncovered. Exposing skin to air is a natural and gentle way to let it dry. Parents may want to lay a baby on a large towel and engage in some playtime during these periods.
  
  
• Wash cloth diapers carefully. Heavily soiled cloth diapers should be presoaked and washed in hot water with a mild detergent. Fabric softeners and dryer sheets that may contain fragrances should not be used because these may cause irritation. It is also recommended that cloth diapers be double rinsed. Those who use a diaper service should make sure the service also follows these steps.
  
  
• Use diaper liners and breathable diaper covers. Diaper liners in cloth diapers can keep skin drier. Breathable diaper covers allow air to circulate.
  
  
• Use ointment regularly. Applying a barrier ointment during each diaper change can prevent skin irritation in babies prone to diaper rash. Petroleum jelly and zinc oxide are often found in these ointments.
  
  
• Increase the baby’s fluid intake. This may help to make urine less concentrated and thus reduce the amount of ammonia the baby’s skin is exposed to. Children over 12 months of age may be helped by drinking cranberry juice to make the urine less concentrated. However, check with a pediatrician before adjusting the baby’s diet.

New mothers may also wish to consider breastfeeding their infant. Babies who are breastfed tend to have fewer diaper rashes because their stools contain fewer enzymes and other substances that irritate the skin.

There is no evidence that either cloth diapers or disposable diapers are more likely to help prevent diaper rash. Parents may experiment with each to determine which is better for their baby.

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their doctor the following questions related to diaper rash:

1. When is my baby most likely to get diaper rash?
   
   
2. Do my child’s symptoms suggest diaper rash?
   
   
3. What may have caused my child’s diaper rash? Does my child’s diaper rash mean I did something wrong?
   
   
4. Is diaper rash dangerous to my child?
   
   
5. Is my child’s rash contagious? Is it likely to spread to other parts of my child’s body?
   
   
6. How can I best treat my child’s diaper rash?
   
   
7. Is my child likely to develop diaper rash again?
   
   
8. Are there steps I can take to prevent diaper rash?
   
   
9. When should I seek a doctor’s attention for diaper rash?
   
   
10. Does my choice of diaper affect my child’s risk for diaper rash?