Baby Eczema In Diapers

Nappy rash is a term dreaded by most parents.  It is very common and often difficult to control.  Nappy rash can be the result of a contact dermatitis (eczema) or a fungal infection.  Both are very different and require different treatments so knowing which your baby has is important.

Fungal Infections In The Diaper Region

Typically fungal infections in the diaper region present with a rash that is bright red and shiny and has sharply outlined patches.  Small white pustules or spots are often present around the edge of the diaper area and the affected skin will feel coarse.  The rash may cover the whole diaper area extending into the groin and thigh folds.

Contact Dermatitis In The Diaper Region

Nappy rash resulting from contact dermatitis is due to an irritation to the skin coming into constant contact with urine and faeces.  This form of eczema is different to the usual atopic eczema that is most common in children. In this nappy rash the diaper area is covered with a red, burn-like rash and the skin is slightly rough, red and scaly.  The skin folds in the groin and thigh are not usually affected.

Nappy rash caused by contact dermatitis is not as common as atopic eczema which commonly affects the rest of the body.  This is because the body has a natural protection:  The diaper area is very humid. This coupled with the fact that urine is a natural moisturizer is believed to be why a large proportion of babies do not develop dermatitis or eczema in their diaper region.

Manufacturers in the production of moisturizers and cosmetics use urea, which is present in urine in large quantities.  This is because it penetrates the skin quickly trapping in water therefore helping to prevent the skin from becoming dry.  Eczema and dry skin go hand in hand.  Urine coming into contact with the diaper area will keep the skin moisturized and therefore help to reduce the risk of eczema.

This of course does not mean that all children will be unaffected by urine.  Some children will find urine being in contact with the skin irritating.

Help Minimize The Irritation:

  • Wash the skin thoroughly using a gentle soap or soap substitute at every diaper change.
  • Change diapers regularly
  • Allow the skin to breath by leaving the diaper off when possible (ie at diapeer change time and after baths)
  • Use a protective barrier cream at each diaper change.
  • If using cloth diapers choose soft fluffy diapers rather than old scratchy diapers that may aggravate the skin further.
  • Finding a disposable diaper that suits the skin type may be a matter of trial and error.  Disposable diapers may help to keep the skin dry as they draw the moisture away from the skin.
  • Nappy rash caused by a fungal infection will need to be treated with an antifungal cream.
  • Nappy rash caused by contact dermatitis will need to be treated with a cream designed to treat eczema.

When To Call The Doctor

  • If the rash has pus or starts to weep
  • If the rash develops small fluid filled pustules
  • If the rash becomes severe or spreads beyond the nappy area
  • If the rash does not respond to treatments
  • If the rash is fungal and is in other locations like the baby’s mouth or mother’s nipples
  • If you are unsure if the rash is fungal or dermatitis

Mel Sinclair, RN