Changing diapers frequently helps reduce chance of diaper rash

By his two-week office visit, the newborn was already showing off. He was alert and vigorous and successfully breast-feeding, with a nice weight gain of over one ounce per day. His exam was perfect too, except for a case of diaper rash.

The little guy had a flat red rash covering the front part of the diaper area and continuing back around his rectum, but not affecting any of his skin folds and creases.

I assured the parents that this finding was not unusual in newborns because they tend to poop and pee after nearly every one of their many feedings. No matter how attentive the caretaker or how swift the diaper change, this constant exposure to urine and wet, seedy yellow newborn stools can be a bit irritating to sensitive baby skin.

In her article in the journal Pediatric Health, Dr. Marty O. Visscher finds that most diaper rashes are actually forms of irritant contact dermatitis.

The specialist states that a number of factors can make diapered skin more prone to damage, including "overhydration," contact with skin irritants such as urine and stool, friction of skin-to-diaper and skin-to-skin, increased skin pH compared to non-diapered skin, prematurity - since immature skin has fewer protective outer layers, use of antibiotics, episodes of diarrhea, and underlying medical conditions.

The key to preventing and treating diaper rash, according to Visscher, lies in reducing diaper area humidity and thus skin hydration. She notes that advances in diaper design, such as the development of disposable diapers with absorbent gelling material and "breathable" outer layers, have led to a decrease in severity of rashes, but have not completely eliminated the skin problem.

The skin science researcher urges caretakers to change diapers frequently and to start treatment at the first sign of any pinkness, rash, or skin breakdown. Diaper cream application should be thick enough to provide a physical barrier between the skin and irritants but still thin enough to remain semipermeable, so that damaged skin can be allowed to heal.

There is no need to completely scrub off all diaper cream with each diaper change. The goal is to remove only soiled areas of cream and to avoid excess rubbing and irritation of skin. Gentle skin cleaning is advised, using products that do not contain alcohol, fragrance, or other irritants.

Babies' bottoms can be washed with water, but diaper wipes are convenient for those frequent diaper changes. Dr. Visscher cites studies showing that cleaning with a diaper wipe actually resulted in less redness and roughness than use of water and a cotton washcloth or cotton balls.

Diaper powders are best avoided, according to Drs. Linda Nield and Deepak Kamat in an article in Consultant for Pediatricians, due to risk of inhalation and aspiration pneumonia. In addition, high potency topical steroids found in certain prescription antifungal-corticosteroid combinations should not be used in the diaper area due to risk of systemic absorption and thinning of skin.

If steroid creams are used to treat the inflammation of moderate to severe diaper rashes, low potency steroids such as one percent hydrocortisone should be selected and used sparingly once or twice a day for a three-day trial and for no more than two weeks.

When diaper rashes don't improve after the first three days of treatment with barrier creams, consider the presence of secondary yeast infections. These fungal rashes have a red patchy appearance and tend to affect the skin folds and produce neighboring small red raised "satellite" lesions. In these cases, Nield and Kamat recommend the addition of a topical antifungal medication to be continued for three days after the rash resolves.

• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.

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